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Diana Moyao-García

Publications and source records attributed to Diana Moyao-García.

10 recordsLinked to original sources
PubMed2006

A randomized trial comparing laryngeal mask airway to endotracheal tube in children undergoing upper gastrointestinal endoscopy.

Although the efficacy of laryngeal mask airway (LMA) has been demonstrated for securing patency of the airway in children, it has not yet been compared to endotracheal tube (ET) in this population. This study aimed to compare the safety and efficacy of LMA vs. ET in children undergoing elective diagnostic upper gastrointestinal endoscopies. Sixty ASA I-III patients were randomly allocated to ET (Group I) or LMA (Group II). A set of cardiovascular and respiratory parameters were obtained before, during and after the endoscopic procedure. The recovery time and the time to discharge were also registered. The cardiovascular and respiratory parameters evaluated in the study varied across the different evaluation periods. However, they remained within physiological ranges and were not different between groups. The median (range) recovery time was 4 (2-10) min and the time to discharge was 58 (36-88) min in the ET group and 3 (1-7) min and 50 (35-67) min in the LMA group (P > 0.10), respectively. In a 16 month-old, 80 cm and 10 kg girl, we failed to secure the patency of the airway with LMA. In conclusion, the LMA was as effective and safe as ET for securing the airway of children undergoing diagnostic upper endoscopies. However, the 3% failure rate occurred with LMA.

Age Factors↗
PubMed2005

Variable designs of clinical trials of neuromuscular blocking agents: an example of studies comparing rocuronium and vecuronium.

BACKGROUND: Published clinical trials on neuromuscular blocking (NMB) agents are being reported with large variations in their protocols and conflictiing results may emerge from these differences. Because they have been compared in several clinical trials, the study was focused on rocuronium and vecuronium in order to evaluate whether these NMB agents were compared under homogeneous conditions. MATERIAL/ METHOD: A search was made in PubMed, Embase Drugs and Pharmacology, Cochrane Controlled Trials Register, and Cochrane Database of Systematic Reviews. Studies on the neuromuscular response at the adductor pollicis to an i.v. bolus dose of rocuronium or vecuronium in humans were included. Quality of all reports was assessed by means of the 3-item Jadad et al. scale. Twenty-five studies met our inclusion criteria and all were retrieved. RESULTS: Randomization was performed in 21 (80.8%) studies. Blinding procedure for drug administration was mentioned in only one study without clarifying the procedure. Induction was most commonly performed with thiopental, followed by propofol. Two studies were performed in children and two in elderly patients. Withdrawals or dropouts were not mentioned in any paper. Electromyography and mechanomyography were the most common monitoring procedures. The time to maximal response, the maximum effect and the time to reach 25% recovery of neuromuscular function were the most used pharmacodynamic parameters. CONCLUSIONS: Clinical trials on neuromuscular blocking agents, e.g. vecuronium versus rocuronium, are being performed with large variability and without following established guidelines.

Adolescent↗
PubMed2004

Undocumented drug utilization and drug waste increase costs of pediatric anesthesia care.

The present study was performed in order to identify the cost of drugs used without documenting them in the patients' file and the wastage of drugs in a pediatric anesthesiology ward. In a prospective, blinded, observational design, drug utilization of 610 consecutive patients, undergoing an elective or emergency surgical procedure was evaluated. The number of undocumented drugs per 100 requested units and the number of wasted drugs per 100 requested units were computed and multiplied by its corresponding unitary cost. The median undocumented cost was 92.4 US dollars (95% CI 17.2-216.6 dollars) per 100 requested units. Succinylcholine (40 mg/2 mL) was the main undocumented drug; its use was not documented in approximately 50% cases in which this neuromuscular blocking agent was requested. However, rocuronium and nalbuphine had the highest unjustified cost, 770.6 dollars and 847.0 dollars per 100 requested units, respectively. Ketorolac, diclofenac, metamizol, furosemide, methylprednisolone, sodium bicarbonate, and cisatracurium were requested and documented. The median cost of wasted drug was 141.8 dollars (95% CI 55.8-448.2 dollars) per 100 requested drugs. More than 80% of adrenaline, naloxone, flunitrazepam, ephedrine, and cisatracurium were wasted. However, the highest cost of wasted drugs was for ondansetron, cisatracurium, methylprednisolone, and rocuronium. The uncontrolled availability and use of drugs may represent an important amount of resources wasted without any awareness of the staff in a department of pediatric anesthesia.

Adolescent↗
PubMed2002

Attitudes of Mexican anesthesiologists to indicate preoperative fasting periods: A cross-sectional survey.

BACKGROUND: In Mexico, guidelines for fasting periods, or any audits on this topic are unavailable, and therefore the attitudes of anesthesiologists for recommending preoperative fasting periods are unknown. MATERIAL AND METHODS: The study was a cross-sectional survey of anesthesiologists subscribed to the Annual Updated Course, organized by the Sociedad Mexicana de Anestesiologia in 2000. The response rate was 31.4%. RESULTS: Most respondents were general anesthesiologists, with 5 or more years experience in a clinical post, were working in both public and private hospitals, and were performing anesthetic procedures on both pediatric and adult patients and in both ambulatory and hospitalized patients. Approximately 23% of the respondents considered natural fruit juices to be clear liquids. For a pediatric patient ingesting breast milk 1 h before undergoing a surgical procedure, 45% thought that surgery should be delayed for 3h, followed by those delaying the surgical procedure for 6 to 8 h. Our results show that more than 50% of the anesthesiologists had better defined attitudes for fasting milk and clear liquids in patients of 6 month or under than for older children and adults. However, due to the poor definition or pre-operative fasting, using clear liquids, in all other patient groups, several patients are allowed to go without oral clear liquids administration for prolonged periods. CONCLUSION: Preoperative fasting periods recommended by Mexican anesthesiologists differ from international guidelines.

Journal Article↗
PubMed2002

Caudal block with 4 mg x kg-1 (1.6 ml x kg-1) of bupivacaine 0.25% in children undergoing surgical correction of congenital pyloric stenosis.

BACKGROUND: Since 1970, bupivacaine 0.25% in a dose of 4 mg x kg-1 (1.6 ml x kg-1) has been used at the Hospital Infantil de México for caudal block in children undergoing surgical correction of congenital pyloric stenosis (CPS). Although this dose is considered unsafe, in our experience, it has been associated with a high success rate and a low incidence of adverse events. This experience has not been previously documented. METHODS: A retrospective cohort of patients undergoing surgical correction of CPS was studied. Nineteen patients received general anaesthesia while 223 received caudal block. The latter were then grouped according to the sedation technique. The rate of successful caudal blocks and complications were considered the major outcomes of the study, whereas the postsurgical fasting period and hospital stay were considered secondary outcomes. RESULTS: The rate of success of caudal block was 96%. Anaesthetic complications related to bupivacaine were present in 1.3%. Mortality occurred in the postoperatory period in one septic patient who also was suffering from gastroschisis that required general anaesthesia. Postoperatory fasting period and hospital stay tended to be higher with general anaesthesia than caudal block. However, of the 19 patients receiving general anaesthesia, five suffered serious comorbidity and nine were failed caudal blocks. CONCLUSIONS: Caudal block with bupivacaine 0.25% (4 mg x kg-1) was associated with a low rate of anaesthetic complications. Further prospective studies to clarify the risks and benefits are required.

Anesthesia, Caudal↗
PubMed2001

Effect of mivacurium 200 and 250 &mgr;g/kg in infants during isoflurane anesthesia: a randomized controlled trial [ISRCTN07742712].

BACKGROUND: Infants usually respond differently to a neuromuscular relaxant compared to children or adults. Isoflurane is commonly used as an anesthetic gas in infants. In an RCT design, we investigated whether a dose of mivacurium 250 &mgr;g/kg results in faster onset of action than 200 &mgr;g/kg in infants under isoflurane anesthesia. Spontaneous recovery times and cardiovascular response were also evaluated. METHODS: Twenty-four low surgical risk children, aged 6-24 months, undergoing an elective surgery and requiring tracheal intubation were selected. After anesthetic induction, patients randomly received an iv bolus dose of mivacurium 200 or 250 &mgr;g/kg. After maximal relaxation, the patient was intubated. Isoflurane was administered to maintain anesthetic level during the surgical procedure. Neuromuscular function was monitored by accelerometry (TOF-Guard) at the adductor pollicies. The first twitch (T) of the TOF and the T4/T1 were measured. The time-course of heart rate and systolic and diastolic blood pressure were analysed by transforming them into their respective areas under the curve. RESULTS: Mivacurium 250 &mgr;g/kg produced a maximal T block faster than 200 &mgr;g/kg, i.e. 2.4 +/- 1.1 vs. 3.5 +/- 1.4 min (p < 0.05). Spontaneous recovery times were similar in both groups. Heart rate was similar between doses while systolic and diastolic blood pressures were lower with the higher dose (p < 0.05). Flushing was observed in two cases, one in each group. CONCLUSIONS: The maximal effect of mivacurium 250 &mgr;g/kg, in infants under isoflurane anesthesia, was present one minute faster than 200 &mgr;g/kg. However, it produced a significant cardiovascular response.

Journal Article↗
PubMedDate not supplied

Meta-analysis of the differences in the time to onset of action between rocuronium and vecuronium.

1. The aim of the present study was to conduct a meta-analysis of the magnitude of differences in the onset of action (T(max)) between rocuronium and vecuronium. 2. A search was made in PubMed, EMBASE Drugs and Pharmacology, Cochrane Controlled Trials Register and Cochrane Database on Systematic Reviews. Studies comparing the T(max) at the adductor policies between rocuronium and vecuronium administered as an intravenous bolus were included in the study. Twenty-nine effect sizes obtained from 21 studies were included. 3. The result of the meta-analysis of differences was -57.9 s (95% confidence interval -71.4 to -44.3 s), favouring rocuronium over vecuronium. The smallest difference in T(max) between these neuromuscular-blocking agents was observed in children (-19.1 s). The difference in T(max) between rocuronium and vecuronium in female patients was -38.7 s. The difference in T(max) between rocuronium and vecuronium measured by electromyography was approximately 50% shorter than that determined by acceleromyography or mechanomyography. In a subanalysis between rocuronium 600 mg/kg versus vecuronium 100 mg/kg, the difference in T(max) between them was very similar to that obtained in the general meta-analysis. 4. According to subanalyses of patient age and sex, drug dose and neuromuscular monitoring systems, the T(max) of rocuronium was approximately 20-70 s faster than that of vecuronium.

Adult↗
PubMedDate not supplied

[Practice guidelines for the management of acute perioperative pain].

The inadequacy of perioperative management causes a severe adverse outcome, a prolonged time of hospitalization and unnecessary suffering. Therefore, it is important to provide an effective management approach to the patient with perioperative pain. A task force with experience in this field systematically develops practice guidelines and the primary goal is to facilitate, to health care professionals, decision-making regarding pain relief. The well-known concept of "administer as needed" is inaccurate and must be eliminated from hospital's management protocols in order to facilitate the staff education to decrease the painful experience. A method to evaluate and document pain in an objective and periodic way shall be implemented. Also, analgesic therapy shall be individualized and chosen regarding pain intensity in every surgical procedure. The treatment options include the use of non-opiate and opiate drugs, regional analgesia and nonpharmacological techniques. The best analgesic will be the one that shall provide the highest relief of pain with the fewest side effects. In the pediatric and obstetric populations, special considerations for the ambulatory patient must be taken. Finally, these practice guidelines could be the reference for future practice guidelines on pain management in Mexico.

Acute Disease↗