Letter to the Editor
Low-neurotoxicity anesthesia
Anestesia baja en neurotoxicidad
Read
6
Timeswas read the article
3
Total PDF
3
Total HTML
Share statistics
array:24 [ "pii" => "S2341192918300453" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.12.012" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "889" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:299-300" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935617302736" "issn" => "00349356" "doi" => "10.1016/j.redar.2017.12.003" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "889" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Esp Anestesiol Reanim. 2018;65:299-300" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 135 "formatos" => array:2 [ "HTML" => 101 "PDF" => 34 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Anestesia baja en neurotoxicidad" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "299" "paginaFinal" => "300" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Low-neurotoxicity anesthesia" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Eizaga Rebollar, M.V. García Palacios, J. Morales Guerrero, L.M. Torres Morera" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Eizaga Rebollar" ] 1 => array:2 [ "nombre" => "M.V." "apellidos" => "García Palacios" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Morales Guerrero" ] 3 => array:2 [ "nombre" => "L.M." "apellidos" => "Torres Morera" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192918300453" "doi" => "10.1016/j.redare.2017.12.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300453?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617302736?idApp=UINPBA00004N" "url" => "/00349356/0000006500000005/v1_201805080427/S0034935617302736/v1_201805080427/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192918300441" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.04.001" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "847" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:301-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Air migration in epidural space after placement of catheter with loss of resistance technique to air" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "301" "paginaFinal" => "302" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Migración de aire en espacio epidural tras colocación de catéter con técnica de pérdida de resistencia con aire" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1262 "Ancho" => 2167 "Tamanyo" => 241115 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Air rising through the epidural space after catheter insertion using the loss of resistance to air technique. (A) Air in the lumbar and thoracic epidural space. (B) Air in the thoracic epidural space.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Núñez-Moreno, J.A. Husillos-Alvarez, J. Caurel-Carrera, D. Arias-Rodriguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Núñez-Moreno" ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Husillos-Alvarez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Caurel-Carrera" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Arias-Rodriguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617301937" "doi" => "10.1016/j.redar.2017.07.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617301937?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300441?idApp=UINPBA00004N" "url" => "/23411929/0000006500000005/v1_201805120427/S2341192918300441/v1_201805120427/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192918300465" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.11.018" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "884" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:298-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reflections on the utility of excess bases as a marker in the prognosis of chest trauma in the geriatric population" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "298" "paginaFinal" => "299" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reflexiones sobre la utilidad del exceso de bases como marcador en el pronóstico del traumatismo torácico en la población geriátrica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Y. Peñasco, A. González-Castro, J.C. Rodríguez-Borregán, J. Llorca" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Y." "apellidos" => "Peñasco" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "González-Castro" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Rodríguez-Borregán" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Llorca" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617302670" "doi" => "10.1016/j.redar.2017.11.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617302670?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300465?idApp=UINPBA00004N" "url" => "/23411929/0000006500000005/v1_201805120427/S2341192918300465/v1_201805120427/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Low-neurotoxicity anesthesia" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "299" "paginaFinal" => "300" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Eizaga Rebollar, M.V. García Palacios, J. Morales Guerrero, L.M. Torres Morera" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Eizaga Rebollar" "email" => array:1 [ 0 => "ramonchueizaga@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.V." "apellidos" => "García Palacios" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Morales Guerrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "L.M." "apellidos" => "Torres Morera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Anestesia baja en neurotoxicidad" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We would like to submit our comments on the article “More than 3<span class="elsevierStyleHsp" style=""></span>hours and less than 3 years old. Safety of anaesthetic procedures in children under 3 years of age, subject to surgeries of more than 3<span class="elsevierStyleHsp" style=""></span>hours”, published in the December 2017 issues of the <span class="elsevierStyleSmallCaps">Revista Española de Anestesiología y Reanimación</span>.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> First of all, we must congratulate the authors for their clarity and concision in interpreting and stating their position regarding the warning issued by the US Food and Drug Administration (FDA) about the use of anaesthetics in young children.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> This stems from a topic that has generated much controversy in the last 20 years, starting with the first experimental studies in animal models, followed by retrospective studies in humans, and finally the latest ambispective studies, some of which are still awaiting the final results.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The warning issued by the FDA a year ago caused a considerable stir in the international anaesthesiology community, and led to several publications in 2017, ranging from consensus documents drawn up by international societies and editorials in high impact journals, to opinion articles written by working clinicians.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3–5</span></a> These articles were prompted by the need to take a position on an issue that can, as the authors mention, have both legal and ethical connotations, particularly in the light of the results of the promising PANDA and GAS studies, and the upcoming MASK study. Despite their limitations (the PANDA study recruited patients exclusively from high-income families, and in the GAS study sevoflurane was the only anaesthetic agent used) these trials found no significant differences between single and short-term anaesthetic procedures.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Our purely clinical opinion is based on the fact that there is currently no clear evidence that general anesthetics can induce neurotoxicity in humans, and that undelayable procedures in young children include not only surgical emergencies (gastroschisis or oesophageal atresia), but also scheduled procedures in which delay increases the risk of poor outcome (cleft palate or hypospadias) or even potential emergency situations (inguinal hernia or cryptorchidism).</p><p id="par0020" class="elsevierStylePara elsevierViewall">We would propose a new term, “<span class="elsevierStyleItalic">low neurotoxicity anaesthesia</span>” (similar to low carbohydrate or low-fat diets), which would mitigate anaesthetic-induced neurotoxicity (drugs), surgical stress-induced neurotoxicity (pain and inflammation), and anaesthesiologist-induced neurotoxicity (anaesthetic management). This mainly involves controlling the following factors: <span class="elsevierStyleItalic">Duration</span>–reduce the duration of surgery as much as possible, weighing up the risk-benefit ration of a single prolonged procedure against the several consecutive surgeries; <span class="elsevierStyleItalic">Stimulus/dose balance</span>–separately monitor pain (perfusion index or “new born parasympathetic evaluation”) and anaesthetic depth (bispectral index or entropy) and on this basis independently and accurately determine the best analgesic and anaesthetic dosage (minimising the latter); <span class="elsevierStyleItalic">Adjuvants</span>–with sedative, analgesic and/or neuroprotective properties (dexmedetomidine, magnesium sulfate or vitamin <span class="elsevierStyleSmallCaps">C</span>); <span class="elsevierStyleItalic">Regional anaesthesia</span>–this should be prioritised, as it avoids or reduces the administration of anaesthetic agents, controls pain, and inhibits the neuroendocrine response; <span class="elsevierStyleItalic">Anaesthetic management</span>–this must of the highest quality and should meet the standards of perioperative care in young children recommended by the “Safe Anaesthesia for Every Tot Initiative” (<a id="intr0010" class="elsevierStyleInterRef" href="http://www.safetots.org/">www.safetots.org</a>).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We take note of the interesting ethical and legal considerations the authors put forward in their article, and await the consensus document. We would also thank the authors for their commitment to such a widely though inconclusively debated topic that is so important to the health of our children.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Eizaga Rebollar R, García Palacios MV, Morales Guerrero J, Torres Morera LM. Anestesia baja en neurotoxicidad. Rev Esp Anestesiol Reanim. 2018;65:299–300.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Más de 3 horas y menos de 3 años. Seguridad de procedimientos anestésicos en niños menores de 3 años, sometidos a cirugías de más de 3 horas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Álvarez Escudero" 1 => "R.M. Paredes Esteban" 2 => "F.J. Cambra Lasaosa" 3 => "M. Vento" 4 => "M. López Gil" 5 => "J.C. de Agustín Asencio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2017.04.002" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2017" "volumen" => "64" "paginaInicial" => "577" "paginaFinal" => "584" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28641810" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "US, Food, Drug administration FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women; 2016. Avaiable from: <a id="intr0015" class="elsevierStyleInterRef" href="http://www.fda.gov/ucm/groups/fdagov-public/@fdagov-drugs-gen/documents/document/ucm533197.pdf">http://www.fda.gov/ucm/groups/fdagov-public/@fdagov-drugs-gen/documents/document/ucm533197.pdf</a> [acccessed 14.12.16]." ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of anaesthetics in young children: consensus statement of the European Society of Anaesthesiology, the European Society for Paediatric Anaesthesiology, the European Association of Cardiothoracic Anaesthesiology and the European Safe Tots Anaesthesia Research Initiative" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T.G. Hansen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/EJA.0000000000000629" "Revista" => array:6 [ "tituloSerie" => "Eur J Anaesthesiol" "fecha" => "2017" "volumen" => "34" "paginaInicial" => "327" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28459783" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anesthesia and developing brains – implications of the FDA warning" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.B. Andropoulos" 1 => "M.F. Greene" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMp1700196" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2017" "volumen" => "376" "paginaInicial" => "905" "paginaFinal" => "907" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28177852" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurotoxicity versus neuroprotection of anesthetics: young children on the ropes?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Eizaga Rebollar" 1 => "M.V. García Palacios" 2 => "J. Morales Guerrero" 3 => "L.M. Torres Morera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40272-017-0230-8" "Revista" => array:6 [ "tituloSerie" => "Paediatr Drugs" "fecha" => "2017" "volumen" => "19" "paginaInicial" => "271" "paginaFinal" => "275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28466422" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safe anesthesia for every tot – the SAFETOTS initiative" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Weiss" 1 => "L. Vutskits" 2 => "T.G. Hansen" 3 => "T. Engelhardt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0000000000000186" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2015" "volumen" => "28" "paginaInicial" => "302" "paginaFinal" => "307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25887194" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006500000005/v1_201805120427/S2341192918300453/v1_201805120427/en/main.assets" "Apartado" => array:4 [ "identificador" => "74420" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter sto the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000005/v1_201805120427/S2341192918300453/v1_201805120427/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300453?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 3 | 3 | 6 |
