Escoliosis idiopática del adolescente: una revisión de las teorías etiológicas de una enfermedad multifactorial

Int J Mol Sci. 2017 Apr 3;18(4). pii: E759. doi: 10.3390/ijms18040759.

Abstract

In this study, the aim was to test the biochemical effects of melatonin supplementation in Intensive Care Unit (ICU) patients, since their blood levels are decreased. Sixty-four patients were enrolled in the study. From the evening of the 3rd ICU day, patients were randomized to receive oral melatonin (3 mg, group M) or placebo (group P) twice daily, at 20:00 and 24:00, until discharged. Blood was taken (at 00:00 and 14:00), on the 3rd ICU day to assess basal nocturnal melatonin values, and then during the treatment period on the 4th and 8th ICU days. Melatonin, total antioxidant capacity, and oxidative stress were evaluated in serum. Melatonin circadian rhythm before treatment was similar in the two groups, with a partial preservation of the cycle. Four hours from the 1st administration (4th ICU day, 00:00), melatonin levels increased to 2514 (982.3; 7148) pg·mL-1 in group M vs. 20.3 (14.7; 62.3) pg·mL-1 in group P (p < 0.001). After five treatment days (8th ICU day), melatonin absorption showed a repetitive trend in group M, while in group P nocturnal secretion (00:00) was impaired: 20 (11.5; 34.5) pg·mL-1 vs. 33.8 (25.0; 62.2) on the 3rd day (p = 0.029). Immediately from the beginning of treatment, the total antioxidant capacity was significantly higher in melatonin treated subjects at 00:00; a significant correlation was found between total antioxidant capacity and blood melatonin values (ρ = 0.328; p < 0.001). The proposed enteral administration protocol was adequate, even in the early phase, to enhance melatonin blood levels and to protect the patients from oxidative stress. The antioxidant effect of melatonin could play a meaningful role in the care and well-being of these patients.

KEYWORDS: antioxidants; critical illness; dietary supplements; melatonin; oxidative stress

Melatonina profiláctica para el delirio en cuidados intensivos (Pro-MEDIC): protocolo de estudio para un ensayo controlado aleatorizado.

Prophylactic Melatonin for Delirium in Intensive Care (Pro-MEDIC): study protocol for a randomised controlled trial.

Martinez FE1, Anstey M2,3,4, Ford A5, Roberts B6, Hardie M7, Palmer R6, Choo L7, Hillman D8,9, Hensley M10, Kelty E11, Murray K12, Singh B13,14,15, Wibrow B2,16.

Trials. 2017 Jan 6;18(1):4. doi: 10.1186/s13063-016-1751-0.

Abstract

BACKGROUND: Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium. METHODS: This trial will be a multi-centre, randomised, placebo-controlled study conducted in closed ICUs in Australia. Our aim is to enrol 850 adult patients with an expected ICU length of stay (LOS) of 72 h or more. Eligible patients for whom there is consent will be randomised to receive melatonin 4 mg enterally or placebo in a 1:1 ratio according to a computer-generated randomisation list, stratified by site. The study drug will be indistinguishable from placebo. Patients, doctors, nurses, investigators and statisticians will be blinded. Melatonin or placebo will be administered once per day at 21:00 until ICU discharge or 14 days after enrolment, whichever occurs first. Trained staff will assess patients twice daily to determine the presence or absence of delirium using the Confusion Assessment Method for the ICU score. Data will also be collected on demographics, the overall prevalence of delirium, duration and severity of delirium, sleep quality, participation in physiotherapy sessions, ICU and hospital LOS, morbidity and mortality, and healthcare costs. A subgroup of 100 patients will undergo polysomnographic testing to further evaluate the quality of sleep. DISCUSSION: Delirium is a significant issue in ICU because of its frequency and associated poorer outcomes. This trial will be the largest evaluation of melatonin as a prophylactic agent to prevent delirium in the critically ill population. This study will also provide one of the largest series of polysomnographic testing done in ICU.

Agonistas del receptor de la melatonina para la prevención del delirio

Melatonin Receptor Agonists for Delirium Prevention.

Walker CK1,2, Gales MA1,3,4.

Ann Pharmacother. 2017 Jan;51(1):72-78. doi: 10.1177/1060028016665863. Epub 2016 Aug 20.

Abstract

OBJECTIVE: To review the prospective controlled trials available for the use of melatonin receptor agonists for delirium prevention. DATA SOURCES: A MEDLINE literature search (1946 to July 2016) was conducted using the search terms delirium, melatonin, ramelteon, tryptophan, and melatonin-receptor agonist. Prospective controlled clinical trials with delirium prevention as an outcome were included. The references of identified articles were reviewed to identify other relevant articles. STUDY SELECTION AND DATA EXTRACTION: Controlled clinical trials in humans, limited to the English language, were reviewed. Five randomized and 1 nonrandomized prospective controlled clinical trial exploring the use of melatonin receptor agonists for delirium preventionwere evaluated. DATA SYNTHESIS: Melatonin agonist therapy for delirium prevention has produced conflicting results in clinical trials. Delirium incidence ranged from no change to significant reductions of approximately 12% to 30%. Four trials were conducted with melatonin as the investigated agent, 1 with l-tryptophan, and 1 with ramelteon. The study setting also varied, with 4 trials being conducted in surgical patients and 2 trials in medical patients. Melatonin provided conflicting results, with 3 trials showing decreased delirium incidence and the largest randomized controlled trial showing no benefit. No benefit was found using l-tryptophan in delirium prevention. The single, small ramelteon trial showed decreased delirium incidence. Safety evaluations during trials were limited. Three trials found adverse effects similar to placebo, whereas the remaining 3 trials did not evaluate adverse effects. CONCLUSIONS: The routine use of melatonin receptor agonists for delirium prevention cannot be recommended at this time.

KEYWORDS: delirium; melatonin; melatonin-receptor agonist; ramelteon; tryptophan

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Congreso Nacional de Residentes de Anestesiología

7 al 9 de junio, 2018. Lima, Perú

X Foro Internacional de Medicina del Dolor y Paliativa

Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Ciudad de México, 7 al 9 de junio de 2018.

Información/ Information

V Congreso Internacional de Vía Aérea, EVALa, México

Junio 7-9, 2018. Guadalajara. México

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

lunes, 21 de mayo de 2018

Sueño, melatonina, UCI / ICU, sleep, and melatonine

Mayo 21, 2018. No. 3087

Calidad del sueño y alteraciones del ritmo circadiano en UCI. Una revisión

Sleep quality and circadian rhythm disruption in the intensive care unit: a review.

Boyko Y1, Jennum P2, Toft P1.

Nat Sci Sleep. 2017 Nov 10;9:277-284. doi: 10.2147/NSS.S151525. eCollection 2017.

Abstract

Sleep and circadian rhythm are reported to be severely abnormal in critically ill patients. Disturbed sleep can lead to the development of delirium and, as a result, can be associated with prolonged stay in the intensive care unit (ICU) and increased mortality. The standard criterion method of sleep assessment, polysomnography (PSG), is complicated in critically ill patients due to the practical challenges and interpretation difficulties. Several PSG sleep studies in the ICU reported the absence of normal sleep characteristics in many critically ill patients, making the standard method of sleep scoring insufficient in this patient group. Watson et al proposed a modified classification for sleep scoring in critically ill patients. This classification has not yet been validated. Sleep disturbance in the ICU is a multifactorial problem. The ICU environment, mechanical ventilation, medication, as well as the critical illness itself have been reported as important sleep disturbing factors. Secretion of sleep hormone, melatonin, expressing circadian rhythmicity was found abolished or phase delayed in critically ill patients. Various interventions have been tested in several studies aiming to improve sleep quality and circadian rhythm in the ICU. The results of these studies were inconclusive due to using the sleep assessment methods other than PSG or the absence of a reliable sleep scoring tool for the analysis of the PSG findings in this patient population. Development of a valid sleep scoring classification is essential for further sleep research in critically ill patients.

KEYWORDS: critically ill patients; environmental factors; mechanical ventilation; melatonin; polysomnography; sedation; sleep patterns

Patrón de secreción de melatonina en paciente graves. Estudio piloto descriptivo

Melatonin Secretion Pattern in Critically Ill Patients: A Pilot Descriptive Study.

Boyko Y1, Holst R2, Jennum P3, Oerding H4,5, Nikolic M6, Toft P1.

Crit Care Res Pract. 2017;2017:7010854. doi: 10.1155/2017/7010854. Epub 2017 May 11.

Abstract

Critically ill patients have abnormal circadian and sleep homeostasis. This may be associated with higher morbidity and mortality. The aims of this pilot study were (1) to describe melatonin secretion in conscious critically ill mechanically ventilated patients and (2) to describe whether melatonin secretion and sleep patterns differed in these patients with and without remifentanil infusion. Eight patients were included. Blood-melatonin was taken every 4th hour, and polysomnography was carried out continually during a 48-hour period. American Academy of Sleep Medicine criteria were used for sleep scoring if sleep patterns were identified; otherwise, Watson's classification was applied. As remifentanil was periodically administered during the study, its effect on melatonin and sleep was assessed. Melatonin secretion in these patients followed a phase-delayed diurnal curve. We did not observe any effect of remifentanil on melatonin secretion. We found that the risk of atypical sleep compared to normal sleep was significantly lower (p < 0.001) under remifentanil infusion. Rapid Eye Movement (REM) sleep was only observed during the nonsedation period. We found preserved diurnal pattern of melatonin secretion in these patients. Remifentanil did not affect melatonin secretion but was associated with lower risk of atypical sleep pattern. REM sleep was only registered during the period of nonsedation.

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Congreso Nacional de Residentes de Anestesiología

7 al 9 de junio, 2018. Lima, Perú

X Foro Internacional de Medicina del Dolor y Paliativa

Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Ciudad de México, 7 al 9 de junio de 2018.

Información / Information

V Congreso Internacional de Vía Aérea, EVALa, México

Junio 7-9, 2018. Guadalajara. México

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

domingo, 20 de mayo de 2018

Melatonina en anestesia / Melatonine in anaesthesia

Mayo 20, 2018. No. 3086

Revisión sistemática sobre melatonina perioperatoria

A systematic review of peri-operative melatonin.

Andersen LP1, Werner MU, Rosenberg J, Gögenur I.

Anaesthesia. 2014 Oct;69(10):1163-71. doi: 10.1111/anae.12717. Epub 2014 May 19.

Abstract

We systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction; and safety. Compared with placebo, melatonin reduced the standardised mean difference (95% CI) pre-operative anxiety score by 0.88 (0.44-1.33) and postoperative pain score by 1.06 (0.23-1.88). The magnitude of effect was unreliable due to substantial statistical heterogeneity, with I(2) 87% and 94%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements.

Evaluación de la eficacia analgésica de la melatonina en pacientes sometidas a cesárea bajo anestesia espinal: un estudio prospectivo aleatorizado doble ciego.

Evaluation of the Analgesic Efficacy of Melatonin in Patients Undergoing Cesarean Section Under Spinal Anesthesia: A Prospective Randomized Double-blind Study.

Beigom Khezri M1, Delkhosh Reihany M2, Oveisy S3, Mohammadi N4.

Iran J Pharm Res. 2016 Fall;15(4):963-971.

Abstract

Melatonin has been suggested as a new natural pain killer in inflammatory pain and during surgical procedures. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy and also optimal preemptive dose of melatonin in patients undergoing cesarean section under spinal anesthesia . One hundred twenty patients scheduled for cesarean section under spinal anesthesiawere randomly allocated to one of three groups of 40 each to receive melatonin 3 milligram (mg) (group M3), melatonin 6 mg (group M6) or placebo (group P) sublingually 20 min before the spinal anesthesia. The time to first analgesic request, analgesic requirement in the first 24 h after surgery, hemodynamic variables, anxiety scores nd the incidence of adverse events were recorded. The duration of anesthesia and analgesia didn't show significant differences between three groups. Total analgesic request during 24 h after surgery was different among the three groups (P = 0.035). The incidence of headache in group M6 was significantly higher than others (P<0.001). However, after adjusting headache between groups of the study, we were unable to show the significant difference in the total analgesic request during 24 h after surgery among the three groups (p = 0.058). Although premedication of patients with 3 mg sublingual melatonin prolonged time to first analgesic request after cesarean delivery compared to placebo group, the difference was not statistically significant. Meanwhile increasing dose of melatonin to 6 mg failed to enhance analgesia and also increase the incidence of headache in patients undergoing cesarean section under spinal anesthesia.

KEYWORDS: Analgesia; Cesarean section; Melatonin; Spinal anesthesia

Concentraciones de melatonina CSF preoperatoria y la aparición de delirium en pacientes con fractura de cadera anterior: un estudio preliminar.

Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients: A Preliminary Study.

Scholtens RM1, de Rooij SE1,2, Vellekoop AE3, Vrouenraets BC4, van Munster BC2,5.

PLoS One. 2016 Dec 9;11(12):e0167621. doi: 10.1371/journal.pone.0167621. eCollection 2016.

Abstract

BACKGROUND: Delirium is characterized by disturbances in circadian rhythm. Melatonin regulates our circadian rhythm. Our aim was to compare preoperative cerebrospinal fluid (CSF) melatonin levels in patients with and without postoperative delirium. METHODS: Prospective cohort study with hip fracture patients ≥ 65 years who were acutely admitted to the hospital for surgical treatment and received spinal anaesthesia. CSF was collected after cannulation, before administering anaesthetics. Melatonin was measured by radioimmunoassay (RIA). Data on delirium was obtained from medical and nursing records. Nurses screened every shift for delirium using the Delirium Observation Screening Scale (DOSS). If the DOSS was ≥3, a psychiatrist was consulted to diagnose possible delirium using the DSM-IV criteria. At admission, demographic data, medical history, and information on functional and cognitive status was obtained. RESULTS: Seventy-six patients met the inclusion criteria. Sixty patients were included in the analysis. Main reasons for exclusion were technical difficulties, insufficient CSF or exogenous melatonin use. Thirteen patients (21.7%) experienced delirium during hospitalisation. Baseline characteristics did not differ between patients with and without postoperative delirium. In patients with and without postoperative delirium melatonin levels were 12.88 pg/ml (SD 6.3) and 11.72 pg/ml (SD 4.5) respectively, p-value 0.47. No differences between patients with and without delirium were found in mean melatonin levels in analyses stratified for cognitive impairment or age.

CONCLUSION: Preoperative CSF melatonin levels did not differ between patients with and without postoperative delirium. This suggests that, if disturbances in melatonin secretion occur, these might occur after surgery due to postoperative inflammation.

Efectos analgésicos, ansiolíticos y anestésicos de la melatonina. Novedosos usos potenciales en pediatría

Analgesic, anxiolytic and anaesthetic effects of melatonin: new potential uses in pediatrics.

Marseglia L1, D'Angelo G2, Manti S3, Aversa S4, Arrigo T5, Reiter RJ6, Gitto E7.

Int J Mol Sci. 2015 Jan 6;16(1):1209-20. doi: 10.3390/ijms16011209.

Abstract

Exogenous melatonin is used in a number of situations, first and foremost in the treatment of sleep disorders and jet leg. However, the hypnotic, antinociceptive, and anticonvulsant properties of melatonin endow this neurohormone with the profile of a drug that modulates effects of anesthetic agents, supporting its potential use at different stages during anesthetic procedures, in both adults and children. In light of these properties, melatonin has been administered to children undergoing diagnostic procedures requiring sedation or general anesthesia, such as magnetic resonance imaging, auditory brainstem response tests and electroencephalogram. Controversial data support the use of melatonin as anxiolytic and antinociceptive agents in pediatric patients undergoing surgery. The aim of this review was to evaluate available evidence relating to efficacy and safety of melatonin as an analgesic and as a sedative agent in children. Melatonin and its analogs may have a role in antinociceptive therapies and as an alternative to midazolam in premedication of adults and children, although its effectiveness is still controversial and available data are clearly incomplete.

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Congreso Nacional de Residentes de Anestesiología

7 al 9 de junio, 2018. Lima, Perú

Primer Congreso Nacional de Residentes de Anestesiología

Ecuador, Agosto 2018

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people