Papers by Cristina Honorato-Cia
Los pacientes sometidos a cirugia de trastornos del movimiento presentan un manejo anestesico com... more Los pacientes sometidos a cirugia de trastornos del movimiento presentan un manejo anestesico complejo. Se trata de pacientes que pueden sufrir trastornos de tipo rigido-acinetico (enfermedad de Parkinson) o de tipo hipercinetico (distonia o temblor). En segundo lugar, la cirugia consiste en localizar el nucleo de los ganglios de la base implicado en el trastorno y lesionarlo o anularlo mediante la estimulacion con un electrodo implantado en dicho nucleo. Para localizar el nucleo se emplean tecnicas de microrregistro (MER) neurofisiologico, ademas de la exploracion fisica seriada del paciente. Por este motivo, se requiere un paciente despierto y cooperador, pero al mismo tiempo confortable y tranquilo. Los sintomas de la enfermedad, mas el estres de la cirugia, pueden hacer dificil el control hemodinamico. La hipertension intraoperatoria ha sido relacionada con complicaciones severas como la hemorragia intracraneal (HIC), que tambien se ha relacionado con la duracion de la cirugia. Por eso, la sedacion seria aconsejable, pero los farmacos anestesicos pueden interferir con los MER, la cooperacion del paciente o su seguridad, al comprometer la via aerea. Su impacto en el resultado final no esta bien estudiado. Muchos grupos utilizan tan solo anestesico local (AL) o sedacion al inicio y al final del procedimiento; esta segunda opcion es la que usamos en nuestro centro. En este estudio comparamos retrospectivamente la incidencia de HIC, eventos neurologicos perioperatorios, episodios de hipertension intraoperatoria, tiempo de cirugia y resultado funcional final en 145 pacientes divididos en tres grupos: sometidos a cirugia de trastornos del movimiento con AL solamente, con sedacion con remifentanilo y con sedacion con dexmedetomidina. Todos ellos se llevaron a cabo en nuestra institucion por el mismo cirujano, en los ultimos 15 anos. Asimismo, se llevo a cabo una revision sistematica de la literatura publicada. La incidencia de HIC sintomatica (1,4%) esta dentro del rango de la estimacion puntual de la incidencia de HIC en los estudios incluidos en la revision sistematica. La incidencia global de HIC fue mayor en los pacientes sedados con dexmedetomidina frente a los sedados con remifentanilo o los que no recibieron sedacion, aunque la diferencia no es estadisticamente significativa. A diferencia de los resultados mostrados por otros trabajos, no hemos encontrado una asociacion estadisticamente significativa entre las cifras de presion arterial perioperatoria con la incidencia de HIC. Los pacientes sedados con dexmedetomidina tuvieron menos episodios de PAS > 160 mmHg que los del resto de los grupos, pero sin que hubiera una diferencia estadisticamente significativa. El grupo que mas antihipertensivos preciso durante la cirugia fue el sedado con remifentanilo. Los pacientes sin sedacion son mas susceptibles de sufrir ENPs que los pacientes con sedacion, aunque son pasajeros y sin secuelas neurologicas. El grupo sedado con dexmedetomidina, con una diferencia estadisticamente significativa, es el que menos episodios de ENP tuvo, lo que podria interpretarse como un efecto protector. No hemos encontrado asociaciones entre la tecnica anestesica empleada y la duracion de la cirugia, ni con el numero de trayectos. Ambos datos estan en consonancia con los resultados observados en la revision sistematica. La dexmedetomidina puede alterar signos clinicos como el temblor. No hemos encontrado una relacion con la dosis de carga, la dosis de betabloqueante utilizada durante la cirugia o la intensidad del temblor de reposo preoperatorio. La dosis maxima de mantenimiento mostro una relacion estadisticamente significativa inversa a lo esperado: los pacientes con una dosis maxima de mantenimiento menor mostraron mas probabilidad de presentar mejoria en el temblor durante la exploracion intraoperatoria. Por ultimo, no hemos encontrado diferencias estadisticamente significativas entre el resultado funcional y la tecnica anestesica empleada.
Los pacientes sometidos a cirugia de trastornos del movimiento presentan un manejo anestesico com... more Los pacientes sometidos a cirugia de trastornos del movimiento presentan un manejo anestesico complejo. Se trata de pacientes que pueden sufrir trastornos de tipo rigido-acinetico (enfermedad de Parkinson) o de tipo hipercinetico (distonia o temblor). En segundo lugar, la cirugia consiste en localizar el nucleo de los ganglios de la base implicado en el trastorno y lesionarlo o anularlo mediante la estimulacion con un electrodo implantado en dicho nucleo. Para localizar el nucleo se emplean tecnicas de microrregistro (MER) neurofisiologico, ademas de la exploracion fisica seriada del paciente. Por este motivo, se requiere un paciente despierto y cooperador, pero al mismo tiempo confortable y tranquilo. Los sintomas de la enfermedad, mas el estres de la cirugia, pueden hacer dificil el control hemodinamico. La hipertension intraoperatoria ha sido relacionada con complicaciones severas como la hemorragia intracraneal (HIC), que tambien se ha relacionado con la duracion de la cirugia. Por eso, la sedacion seria aconsejable, pero los farmacos anestesicos pueden interferir con los MER, la cooperacion del paciente o su seguridad, al comprometer la via aerea. Su impacto en el resultado final no esta bien estudiado. Muchos grupos utilizan tan solo anestesico local (AL) o sedacion al inicio y al final del procedimiento; esta segunda opcion es la que usamos en nuestro centro. En este estudio comparamos retrospectivamente la incidencia de HIC, eventos neurologicos perioperatorios, episodios de hipertension intraoperatoria, tiempo de cirugia y resultado funcional final en 145 pacientes divididos en tres grupos: sometidos a cirugia de trastornos del movimiento con AL solamente, con sedacion con remifentanilo y con sedacion con dexmedetomidina. Todos ellos se llevaron a cabo en nuestra institucion por el mismo cirujano, en los ultimos 15 anos. Asimismo, se llevo a cabo una revision sistematica de la literatura publicada. La incidencia de HIC sintomatica (1,4%) esta dentro del rango de la estimacion puntual de la incidencia de HIC en los estudios incluidos en la revision sistematica. La incidencia global de HIC fue mayor en los pacientes sedados con dexmedetomidina frente a los sedados con remifentanilo o los que no recibieron sedacion, aunque la diferencia no es estadisticamente significativa. A diferencia de los resultados mostrados por otros trabajos, no hemos encontrado una asociacion estadisticamente significativa entre las cifras de presion arterial perioperatoria con la incidencia de HIC. Los pacientes sedados con dexmedetomidina tuvieron menos episodios de PAS > 160 mmHg que los del resto de los grupos, pero sin que hubiera una diferencia estadisticamente significativa. El grupo que mas antihipertensivos preciso durante la cirugia fue el sedado con remifentanilo. Los pacientes sin sedacion son mas susceptibles de sufrir ENPs que los pacientes con sedacion, aunque son pasajeros y sin secuelas neurologicas. El grupo sedado con dexmedetomidina, con una diferencia estadisticamente significativa, es el que menos episodios de ENP tuvo, lo que podria interpretarse como un efecto protector. No hemos encontrado asociaciones entre la tecnica anestesica empleada y la duracion de la cirugia, ni con el numero de trayectos. Ambos datos estan en consonancia con los resultados observados en la revision sistematica. La dexmedetomidina puede alterar signos clinicos como el temblor. No hemos encontrado una relacion con la dosis de carga, la dosis de betabloqueante utilizada durante la cirugia o la intensidad del temblor de reposo preoperatorio. La dosis maxima de mantenimiento mostro una relacion estadisticamente significativa inversa a lo esperado: los pacientes con una dosis maxima de mantenimiento menor mostraron mas probabilidad de presentar mejoria en el temblor durante la exploracion intraoperatoria. Por ultimo, no hemos encontrado diferencias estadisticamente significativas entre el resultado funcional y la tecnica anestesica empleada.
Journal of Neurosurgical Anesthesiology, 2018
Clinical Oral Investigations, Apr 20, 2018
To evaluate the relationship between pharmacokinetic descriptors of dexmedetomidine (predicted ar... more To evaluate the relationship between pharmacokinetic descriptors of dexmedetomidine (predicted area under the curve during the procedure, predicted plasma level at the end of the procedure, and duration of procedure) and sedation depth (proportion of time with bispectral index < 85 during the procedure) with recovery time after ambulatory procedures. Clinical observational study of patients undergoing oral and maxillofacial ambulatory surgery with dexmedetomidine as sole sedative agent. Patients received a loading dose of dexmedetomidine (0.25-1 μg kg) followed by a maintenance infusion (0.2-1.4 μg kg h) to keep a bispectral index < 85 until 5 min before the end of the procedure, and were transferred to a post-anesthesia care unit until criteria for discharge were met. Data from 75 patients was analyzed. Sedation depth was directly associated with recovery time (Pearson correlation coefficient [r] = 0.26; p = 0.024). Around 7% of the variation in recovery time was explained by the proportion of time with bispectral index < 85. No association with procedure duration (r = 0.01; p = 0.9), predicted area under the curve (r = 0.1; p = 0.4), or predicted plasma level of dexmedetomidine at the end of the procedure (r = 0.12; p = 0.3) with recovery time was observed. Sedation depth with dexmedetomidine could play a role in increasing recovery time after oral and maxillofacial ambulatory surgery. In our study, the pharmacokinetic descriptors of dexmedetomidine did not seem to influence recovery time. Sedation depth with dexmedetomidine could play a role in increasing recovery time after ambulatory procedures.
BJA: British Journal of Anaesthesia, Mar 1, 2022
COVID-19 publications in anaesthesiology journals: a bibliometric analysis Antonio Martinez-Simon... more COVID-19 publications in anaesthesiology journals: a bibliometric analysis Antonio Martinez-Simon, Cristina Honorato-Cia, Elena Cacho-Asenjo, Irene Aquerreta, Alfredo Panadero-Sanchez and Jorge M. Nú~ nez-C ordoba* Department of Anaesthesia and Critical Care, Clı́nica Universidad de Navarra, Pamplona, Spain, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain, Pharmacy Service, Clı́nica Universidad de Navarra, Pamplona, Spain, Research Support Service, Central Clinical Trials Unit, Clı́nica Universidad de Navarra, Pamplona, Spain and Institute of Data Science and Artificial Intelligence, University of Navarra, Pamplona, Spain
European Journal of Anaesthesiology, Jun 1, 2013
Neurosciences myocardial infarction, new ventricular arrhy thmias, cardiogenic shock, cardiac arr... more Neurosciences myocardial infarction, new ventricular arrhy thmias, cardiogenic shock, cardiac arrest) or major infection (meningitis, pneumonia, sepsis) at any time during the 30-day follow-up. Data was collected from patient questionnaires and hospital records. The 30-day follow-up status was obtained by a structured phone interview to the patient or proxy. The predictive values of the mRS and the ASA class were determined by Pearson Chi square test. Results and Discussion: The informed consent was obtained from 366 (75.3%) out of 486 consecutive patients, who were thus included in the study. The median age was 55.9 years (range 18 to 87 years), and 62.0% of the patients were female. 30-day mortality was 1.4%, and 30-day major morbidity rate was 13.6%. Due to the low mortality rate, statistical analyses for mortality were unreliable. The mRS predicted 30-day major morbidity (p=0.007). The predictive value of the ASA class did not reach statistical significance. Conclusion(s): This first large scale study on an unselected patient population suggests that the mRS is a reliable predictor of major short-term morbidity in elective cranial neurosurgery. Further studies are necessary to assess whether these results are widely applicable and suitable for increasing patient safety.
Journal of Neurosurgical Anesthesiology, Jan 19, 2021
To the Editor: Reducing unnecessary preoperative cross-match testing provides an opportunity to i... more To the Editor: Reducing unnecessary preoperative cross-match testing provides an opportunity to improve the efficiency of blood transfusion management in neurosurgery.1–6 We estimated the rate of unnecessary preoperative cross-matching according to actual need for blood transfusion, and calculated indexes of efficiency for perioperative blood transfusion management,7 in brain tumor resection procedures. Secondarily, we evaluated the role of preoperative hemoglobin (preHb) concentration as an objective predictor of actual perioperative blood transfusion requirements.7,8 This retrospective study was approved by the University of Navarra Ethics Committee (2020.045; July 2, 2020) with waiver of consent. Following retrieval of relevant data from clinical records, patients were categorized into 4 groups according to whether preoperative cross-match testing had or had not been performed, and according to actual transfusion requirements before discharge from hospital. International indexes of efficiency for perioperative blood management were calculated: cross-match to transfusion ratio, transfusion probability, and transfusion index. Logistic regression was used to estimate odds ratios and 95% confidence intervals (95% CI) for transfusion requirements based on preHb. The area under the receiver operating characteristic curve was used to quantify the overall ability of preHb to discriminate patients that did not require red cell transfusion from those that required transfusion. A detailed description of the study methodology and definition of indexes of transfusion efficiency are available in the supplementary material (Supplemental Digital Content 1: Materials andMethods, http://links. lww.com/JNA/A338). Seven hundred thirty eight patients that underwent craniotomy for brain tumor resection between 2008 and 2018 were included in the analysis (Supplemental Digital Content 2: Supplementary Table 1: Baseline Patient Characteristics, http://links.lww.com/JNA/A339). The distributions of preoperative cross-match testing and actual transfusion requirements among study participants are shown in Figure 1. The cumulative incidence of preoperative cross-match testing was 70.2% (95% CI: 66.8%-73.4%); of the 518 patients that had preoperative cross-match testing, 485 (93.6%, 95% CI: 91.2%95.5%) did not require red cell transfusion. Overall, 5.1% (95% CI: 3.8%-7.0%) of patients required perioperative red cell transfusion. The proportion of patients in the whole study population that required red cell transfusion in the absence of preoperative cross-match testing was 0.7% (95% CI: 0.2%1.6%), and the proportion in the subgroup that did not have cross-match testing was 2.3% (95% CI: 0.8%-5.4%). Thus, the percentage of patients that did not have preoperative crossmatch testing but required red cell transfusion (Fig. 1, Quadrant A) or had preoperative cross-match but did not require red blood cell transfusion (Fig. 1, Quadrant D) was 66.4% (95% CI: 62.9%-69.7%). Both these situations represent inefficient perioperative transfusion management and are potential targets for improvement actions. Moreover, the cross-match to transfusion ratio was 16.35, transfusion probability 7.34%, and transfusion index 0.15; these values are also indicative of inefficiencies in cross-matching/transfusion processes (see Supplemental Digital Content 1: Materials and Methods, http://links.lww.com/JNA/A338). There was an inverse association between preHb and transfusion requirements; mean (±SD) preHb in patients that Received for publication November 2, 2020; accepted November 27, 2020. From the Departments of *Neurosurgery, Neurology and Neurosciences; †Anesthesia, Perioperative Medicine and Critical Care; ∥Research Support Service, Central Clinical Trials Unit, Clínica Universidad de Navarra, University of Navarra; ‡IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona; and §Department of Neurosurgery, Neurology and Neurosciences, Hospital Universitario Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Antonio Martinez-Simon, MD, PhD. E-mail: amartinezs@unav.es. Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.jnsa. com. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/ANA.0000000000000753 RESEARCH LETTER
Revista española de anestesiología y reanimación, Apr 1, 2017
Introduction: Dexdor ® do not include the possibility of loading dose, which could increase time ... more Introduction: Dexdor ® do not include the possibility of loading dose, which could increase time to achieve adequate sedation for ambulatory procedures. The objective of this study was to evaluate the effect of several loading dose of dexmedetomidine in the time to achieve and maintain an optimal level of sedation and its clinical haemodynamic repercussion. Material and methods: The IRB approved this observational study for patients that underwent oral and maxillofacial ambulatory surgery under dexmedetomidine at the University of Navarra Clinic from February 2013 to November 2014. According to the loading dose the patients were grouped into 3 categories: <0.5, 0.5, and >0.5 g/kg. Optimal level of sedation was defined as bispectral index <85. Data were analyzed using survival analysis techniques. Vasoactive drugs requirements were evaluated using exact logistic regression. Results: Eighty-one patients were evaluated. Hazard ratios for patients in 0.5 and >0.5 g/kg loading dose categories for achieving a bispectral index <85 were 1.5 (95% CI 0.9, 2.6) and 1.8 (95% CI 0.8, 3.9), respectively, compared with the lowest category. Five patients (6.2%) required atropine for bradycardia. Patients in the group >0.5 g/kg showed greater risk of requiring atropine compared with the group <0.5 g/kg (odds ratio 2.2; 95% CI 0.03, 183). Conclusion: Loading dose of dexmedetomidine >0.5 g/kg appears minimize the time to achieve and maintain an optimal level of sedation during the first 60 min of procedure. Further
Revista de Medicina de la Universidad de Navarra, May 4, 2017
Dentro de las arritmias supraventriculares podemos encontrar a la fibrilación auricular, el flute... more Dentro de las arritmias supraventriculares podemos encontrar a la fibrilación auricular, el fluter, las taquicardias paroxísticas supraventriculares y las taquicardias auriculares. La más frecuente es la fibrilación auricular. En la presente revisión repasamos su fisiopatología, clínica, y posibles tratamientos, prestando atención a las posibles aplicaciones del esmolol.
IGI Global eBooks, 2022
Foreseeing the needs and availability of anaesthesiologists across Europe is a challenging task. ... more Foreseeing the needs and availability of anaesthesiologists across Europe is a challenging task. This is influenced by different factors that include the composition of the workforce and the organization and structure of health services in every country. Some trends call for attention, such as changes in work patterns brought about by an ageing specialist population, the increasing numbers of women in anaesthesia, or cultural and societal shifts towards work-life balance. Anaesthesiology is a challenging specialty with an expanding scope of practice, requiring highly motivated professionals, frequent long work hours, and addressing stressful situations often. To ensure quality anaesthesia provision, the wellbeing of this diverse population of anaesthesiologists should be addressed. Achieving rational and flexible work hours, adequate compensation, and promotion of a workplace culture that fosters safety, motivation to learn, and equal opportunities for leadership or academia positions are challenges to be addressed to make sure that excellence in patient care is maintained.
World Neurosurgery, May 1, 2017
Revista española de anestesiología y reanimación, Nov 1, 2012
Recomendaciones-Guía clínica de neuroanestesiología en cirugía de fosa posterior Consideraciones ... more Recomendaciones-Guía clínica de neuroanestesiología en cirugía de fosa posterior Consideraciones preoperatorias y manejo neuroanestesiológico intraoperatorio Consideraciones y conducta neuroanestesiológica postoperatoria
Movement Disorders Clinical Practice, Apr 18, 2021
Background Background: During magnetic resonance-guided focused ultrasound for essential or parki... more Background Background: During magnetic resonance-guided focused ultrasound for essential or parkinsonian tremor, adverse events (headache, nausea/vomiting, or anxiety) may alter the outcome of the procedure despite being mostly transient and mild. Objectives Objectives: Our aim was to analyze the relationship between demographic, procedural, and anesthetic characteristics with magnetic resonance/ultrasound-related events. Methods Methods: This was a retrospective study at the Clinica Universidad de Navarra of patients undergoing thalamotomy with magnetic resonance-guided focused ultrasound between September 2018 and October 2019. The anesthesia protocol included headache and nausea/vomiting prophylaxis and rescue therapy. Dexmedetomidine was used for anxiolysis in some patients after thorough multidisciplinary assessment. Results Results: A total of 123 patients were included. Headache was directly related to skull density ratio (P < 0.001) and skull thickness (P = 0.02). Patients with a skull density ratio less than 0.48 had 3 times the odds of experiencing moderate or severe headache (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.21-7.82) and had a higher odds of aborting sonication due to pain. Sex was associated with increased nausea (P = 0.007). Women had 4 times the odds of nausea than men (OR, 4.4; 95% CI, 1.61-12.11). Dexmedetomidine did not reduce headache or nausea incidence. Patients who received dexmedetomidine had a higher number (P = 0.01) and total minutes of sonication (P = 0.01). Conclusions Conclusions: Patients with lower skull density ratios and higher skull thicknesses could benefit from an aggressive analgesic prophylaxis. Women are more likely to experience nausea. Dexmedetomidine did not reduce headache and nausea, but increased the number and duration of sonications. Its exact effect on tremor is still unclear.
Revista española de anestesiología y reanimación, Nov 1, 2012
Recomendaciones-Guía clínica de neuroanestesiología en cirugía de fosa posterior Consideraciones ... more Recomendaciones-Guía clínica de neuroanestesiología en cirugía de fosa posterior Consideraciones preoperatorias y manejo neuroanestesiológico intraoperatorio Consideraciones y conducta neuroanestesiológica postoperatoria
Stereotactic and Functional Neurosurgery, 2015
Introduction: Dexmedetomidine is an α2-agonist recently proposed as a potentially ideal drug for ... more Introduction: Dexmedetomidine is an α2-agonist recently proposed as a potentially ideal drug for sedation during the surgical treatment of Parkinsonʼs disease (PD). This report documents the incidence of changes in motor symptoms (especially tremor) in PD patients sedated with dexmedetomidine for deep brain stimulation or ablation procedures. Methods: We reviewed a retrospective cohort of 22 patients who underwent surgery for PD with dexmedetomidine sedation at a single institution from 2010 to 2014. A logistic regression analysis was performed to analyze possible confounding factors. Results: 14 cases of tremor reduction or suppression were recorded (cumulative incidence: 63.6%; 95% CI: 40.7-82.8). No association could be identified between loading dose, β-blocker use and preoperative total Unified Parkinson's Disease Rating Scale III, with tremor changes. The maintenance dose of dexmedetomidine was higher in patients who did not experience changes [median and range for patients with and without tremor alteration 0.75 (0.2-1.0) and 1.0 µg × kg-1 × h-1 (0.7-1.4), respectively; p = 0.021]. Conclusion: Dexmedetomidine provides adequate sedation during surgery for PD, but it might affect motor signs making intraoperative testing difficult or even impossible. Dosage appears not to be the determining factor in motor changes, whose cause remains unclear.
Neurocritical Care, Jul 27, 2022
Background: The use of processed electroencephalography (pEEG) for depth of sedation (DOS) monito... more Background: The use of processed electroencephalography (pEEG) for depth of sedation (DOS) monitoring is increasing in anesthesia; however, how to use of this type of monitoring for critical care adult patients within the intensive care unit (ICU) remains unclear. Methods: A multidisciplinary panel of international experts consisting of 21 clinicians involved in monitoring DOS in ICU patients was carefully selected on the basis of their expertise in neurocritical care and neuroanesthesiology. Panelists were assigned four domains (techniques for electroencephalography [EEG] monitoring, patient selection, use of the EEG monitors, competency, and training the principles of pEEG monitoring) from which a list of questions and statements was created to be addressed. A Delphi method based on iterative approach was used to produce the final statements. Statements were classified as highly appropriate or highly inappropriate (median rating ≥ 8), appropriate (median rating ≥ 7 but < 8), or uncertain (median rating < 7) and with a strong disagreement index (DI) (DI < 0.5) or weak DI (DI ≥ 0.5 but < 1) consensus. Results: According to the statements evaluated by the panel, frontal pEEG (which includes a continuous colored density spectrogram) has been considered adequate to monitor the level of sedation (strong consensus), and it is recommended by the panel that all sedated patients (paralyzed or nonparalyzed) unfit for clinical evaluation would benefit from DOS monitoring (strong consensus) after a specific training program has been performed by the ICU staff. To cover the gap between knowledge/rational and routine application, some barriers must be broken, including lack of knowledge, validation for prolonged sedation, standardization between monitors based on different EEG analysis algorithms, and economic issues.
British Journal of Anaesthesia
Stereotactic and Functional Neurosurgery, 2015
BackgroundThe literature related to the use of processed EEG (pEEG) for depth of sedation (DOS) m... more BackgroundThe literature related to the use of processed EEG (pEEG) for depth of sedation (DOS) monitoring is increasing, however it is unclear how to use this type of monitoring for critical care patients within the intensive care unit (ICU).MethodsWe performed a systematic review of the literature according to the Grade of Recommendation assessment, Development, and Evaluation (GRADE) approach. The modified Delphi method was utilised by a team of experts to produce statements and recommendations derived from study questions. Three separate online rounds discussing 89 statements categorized into four domains were formulated. The panelists rated the appropriateness of each statement and were able to suggest modifications or addition of statements. An analysis of anonymised ratings of the statements by part of the panel followed each Delphi round and previously validated criteria were used to define appropriateness and consensus.ResultsLevel of evidence regarding the four domains was...
Revista Española de Anestesiología y Reanimación (English Edition), 2020
The aim of this narrative review is to confirm that acute pain after craniotomy is frequent and p... more The aim of this narrative review is to confirm that acute pain after craniotomy is frequent and presents moderate to severe intensity. It also aims to report on the importance of treating not only the pain after craniotomy but also to prevent it in order to reduce the incidence of chronic pain. We should understand that among the current options we not only have conventional analgesics for the postoperative period (Non-steroidal anti-inflammatory, paracetamol, cyclooxygenase inhibitors 2, opioids). Performing a scalp block prior to surgical incision or after surgery, the use of intraoperative dexmedetomidine and the perioperative administration of pregabalin are alternatives that are gaining strength. The management of postcraniotomy pain should focus on a multimodal analgesia throughout the perioperative period, framed within the current concept of theënhaced recovery after surgery(ERAS).
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Papers by Cristina Honorato-Cia