C. Ramírez-Paesano, Claudia Rodiera Clarens, José Carlos Torres Mandujano, Milen Bonev Bonev, Karen Salazar Loaiza, F. Borghetti, María Martínez Alberici, Josep Rodiera Olivé, Jesús Santaliestra Fierro
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They include analgesic and anti-inflammatory drugs that act by modulating the nociceptive pathways with an opioid-sparing effect and even opioid-free anesthesia (OFA). In OFA plus postoperative analgesia (OFAA) techniques, ketamine plays a fundamental role as an analgesic with its antagonist action on the N-Methyl-D-Aspartate-receptors (NMDAr). However, ketamine is limited to use at sub-anesthetic doses (“low-doses”) due to its dose-dependent side effects. Consequently, other analgesic drugs with anti-NMDAr effects like magnesium sulfate and other non-opioid analgesics such as lidocaine and alpha-2-adrenergic agonists are often used in OFAA techniques. The aim of this text is to present a summary of the importance of the use of ketamine in OFA based on nociceptive pathophysiology. Additionally, the perioperative protocol (OFAA) with the anti-hyperalgesic approach of ketamine, lidocaine and dexmedetomidine co-administration in our center will be described. 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引用次数: 1
摘要
越来越多的证据表明,谷氨酰胺能通路的持续激活、中枢致敏、痛觉过敏和慢性疼痛之间存在密切关系。阿片类药物长期以来一直是围手术期使用的标准镇痛药。然而,它们的副作用,即阿片类药物引起的痛觉过敏、阿片类药物耐受性和术后依赖,促使麻醉师开发替代麻醉技术。它们包括镇痛药和抗炎药,它们通过调节伤害感受途径发挥作用,具有阿片类药物节约效应,甚至是无阿片类药物麻醉(OFA)。在OFA +术后镇痛(OFAA)技术中,氯胺酮作为一种镇痛药发挥着重要作用,它对n -甲基- d -天冬氨酸受体(NMDAr)具有拮抗剂作用。然而,由于其剂量依赖性副作用,氯胺酮仅限于在亚麻醉剂量(“低剂量”)下使用。因此,其他具有抗nmdar作用的镇痛药物,如硫酸镁和其他非阿片类镇痛药物,如利多卡因和α -2-肾上腺素能激动剂,经常用于OFAA技术。本文的目的是根据伤害性病理生理学,总结氯胺酮在OFA中使用的重要性。此外,本中心将介绍氯胺酮、利多卡因和右美托咪定联合给药的围手术期方案(OFAA)。将提到OFAA协议的一些主要指示。
Role of Ketamine as Part of the Anti-Hyperalgesic Approach in Opioid-Free Anesthesia (OFA) and Postoperative Analgesia (OFAA)
There is increasing evidence of the close relationship between persistent activation of the glutaminergic pathway, central sensitization, hyperalgesia and chronic pain. Opioids have long been the standard analgesics used in the perioperative. However, their side effects, namely opioid-induced hyperalgesia, opioid tolerance and post-operative dependence in patients with chronic pain that are to undergo aggressive surgeries have motivated anesthesiologists to develop alternative anesthetic techniques. They include analgesic and anti-inflammatory drugs that act by modulating the nociceptive pathways with an opioid-sparing effect and even opioid-free anesthesia (OFA). In OFA plus postoperative analgesia (OFAA) techniques, ketamine plays a fundamental role as an analgesic with its antagonist action on the N-Methyl-D-Aspartate-receptors (NMDAr). However, ketamine is limited to use at sub-anesthetic doses (“low-doses”) due to its dose-dependent side effects. Consequently, other analgesic drugs with anti-NMDAr effects like magnesium sulfate and other non-opioid analgesics such as lidocaine and alpha-2-adrenergic agonists are often used in OFAA techniques. The aim of this text is to present a summary of the importance of the use of ketamine in OFA based on nociceptive pathophysiology. Additionally, the perioperative protocol (OFAA) with the anti-hyperalgesic approach of ketamine, lidocaine and dexmedetomidine co-administration in our center will be described. Some of the main indications for the OFAA protocol will be mentioned.