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Eventos adversos en el perioperatorio relacionados con el uso de bloqueantes neuromusculares comparado con no utilizarlos durante la anestesia general en adultos : revisión sistemática de la literatura

dc.contributor.advisorManrique Hernández, Rubén Darío
dc.creatorMoscote Rivera, Maria Isabel
dc.creatorPérez Carreño, Juan Guillermo
dc.creatorGutiérrez Pinzón, Vivian Patricia
dc.creator.degreeMagíster en epidemiologíaspa
dc.creator.degreetypeFull timespa
dc.date.accessioned2019-10-25T15:44:04Z
dc.date.available2019-10-25T15:44:04Z
dc.date.created2019-10-18
dc.descriptionIntroducción: Los bloqueadores neuromusculares (BNM) son de uso rutinario en anestesia pese a que no poseen propiedades anestésicas y se han asociado con eventos adversos y mortalidad. Muchas cirugías, incluso abdominales pueden ejecutarse sin BNM. Poco se ha profundizado en el exceso de riesgo de usarlos frente a omitirlos. Indicarlos en situaciones específicas puede disminuir eventos adversos y costo de la anestesia. Objetivo: Estimar la seguridad relativa en el perioperatorio de pacientes adultos sometidos a procedimientos quirúrgicos con anestesia general que han recibido BNM con respecto a aquellos que han recibido otras técnicas anestésicas que no incluyen BNM. Métodos: Revisión Sistemática de la Literatura. Criterios de Selección: Ensayos Clínicos o estudios observacionales en adultos sometidos a cirugías que requieran anestesia general, que reporten eventos adversos en el perioperatorio, con el uso y sin el uso de BNM. Fueron excluidos estudios en niños, pacientes obesos, embarazadas, traumatizados o sometidos a cirugía cardíaca. Búsqueda y Selección de artículos: En los últimos 15 años en PubMed, EMBASE, LILACS, Cochrane y literatura gris, sin exclusión de idiomas, usando términos y sinónimos Decs, Mesh o Emtree, con la estrategia de búsqueda usando términos: “Anaesthesia” (P) + “Neuromuscular Blocking Agent” (I) + “Adverse events” (D), incluyendo todos los sinónimos de interés. Se establecieron límites de fecha de publicación y edad. Se evaluaron ensayos clínicos y estudios observacionales de manera separada para definir la viabilidad de un metanálisis. Se aplicó el flujograma y la lista de chequeo PRISMA (Preferred Items for Systematic Reviews and Metanalisis). Antes de iniciar la búsqueda, el protocolo fue registrado en PROSPERO, con el número CRD42019128550, realizando solo, modificación en la estrategia de búsqueda y notificada a PROSPERO. La búsqueda se realizó el 18 de mayo de 2019. Se excluyeron estudios que no abordaban la pregunta o comparación de interés, así como aquellos que cumplieran criterios de exclusión. La calidad de los estudios fue evaluada usando CONSORT, STROBE, New Castle-Ottawa y la herramienta de riesgo de sesgos de Cochrane. Recolección de datos y análisis: Se utilizó Mendeley como gestor bibliográfico, tres revisores independientemente evaluaron la calidad. Los desacuerdos fueron resueltos por un cuarto revisor. Se utilizó Review Manager 5 para la extracción y análisis de datos. Se midió la frecuencia de eventos adversos, clasificándolos así: complicaciones respiratorias, despertar intraoperatorio y anafilaxia, así como la frecuencia de recurarización residual en los estudios seleccionados. Riesgo relativo y otras medidas fueron calculadas según la información disponible y homogeneidad de estudios. La calidad de la evidencia fue valorada por el sistema GRADE. Resultados: Se encontraron 433 estudios después de remover duplicados. Se seleccionaron 7 estudios, 4 de ellos observacionales con buena concordancia y calidad. Se realizó metanálisis de 4 estudios de cohortes prospectivos, encontrando un riesgo incrementado de complicaciones respiratorias cuando se usan BNM. (RR: 2,71 con IC95% 1,99-3,69). Otros eventos adversos de interés no pudieron ser evaluados. Conclusiones: Hay evidencia de calidad moderada que sugiere que existe un riesgo incrementado de complicaciones respiratorias postoperatorias cuando se usan BNM. Para establecer causalidad, deben realizarse estudios controlados.spa
dc.description.abstractIntroduction: Neuromuscular Blockers Agents (NMBA) are routinely used in anaesthesia, although they don´t have anaesthetic properties and adverse events and mortality have been reported. Muscular relaxation is more a result of quality of anaesthesia that a muscular paralysis. Like this, abdominal surgeries are realized under anaesthesia without NMBA. Efforts made to avoid Postoperative Residual Curarization and intraoperative awareness have not diminished their incidence, and risk of use NMBA is not established. Judicious use of NMBA in specific situations may decrease adverse effects and cost of anaesthesia. Objective: Make a comparison of frequency of adverse events on perioperative period of adult patients, who suffer surgical procedures under general anaesthesia, in whose received NMBA with respect those received other techniques without NMBA. Methods: Systematic Review of literature. Eligibility criteria: Clinical trial if were published, observational studies in adults with surgery that reporting adverse events and mortality during perioperative period with use or without NMBAs. Studies on paediatric or obese patient, trauma, obstetric and cardiac surgery were excluded. Search and select Methods: Last fifteen years in PubMed, EMBASE, LILACS, Cochrane, and grey literature, without exclusion languages, seeking with Decs, Mesh, emtree and synonymous. Search strategy was: "Anaesthesia" (P) + "Neuromuscular Blocking Agents" (I) + “Adverse Effects” (O), including synonymous. We will use PRISMA (Preferred Items for Systematic Reviews and Metanalysis) flow chart and checklist. The protocol was registered on PROSPERO with the number CRD42019128550 and only was modified search strategy before beginning. Collect and analysis: Mendeley will be selected as reference manager. Independently, three reviewers seemed, selected and evaluated quality of articles. In disagreement case, a fourth reviewer decided. PRISMA checklist will be used to design of review, Review Manager 5 to analyse cuantitative data. Frequency of adverse events was measured, incidence of residual neuromuscular blockade, relative risk and others according information available and homogeneity of studies. Checklist CONSORT, STROBE, New Castle-Ottawa and risk of bias tool of Cochrane and GRADE System for certainty of evidence. Results: 433 studies were founded after duplicated to be removed. Seven studies were select, and four of them, observational studies with good agreement, methodological and report quality. Metanalysis of four prospective cohort studies were performed, finding an increased risk of postoperative respiratory complications when using NMBA (RR: 2,71 with IC95% 1,99-3,69). Other adverse events of interest could not be evaluated. Conclusions: There is evidence that suggest an increased risk of postoperative respiratory complications when NMBA were used. To establish causality, controlled trials should be performed. There is not enough information about other adverse events.spa
dc.description.embargo2019-10-25 10:50:01: Script de automatizacion de embargos. No se encontró correo, se envío correo al autor: Cordial saludo respetado autor:Se ha realizado la publicación de su documento " Eventos adversos en el perioperatorio relacionados con el uso de bloqueantes neuromusculares comparado con no utilizarlos durante la anestesia general en adultos : revisión sistemática de la literatura " en el Repositorio Institucional EdocUR de la Universidad del Rosario. Usted escogió la opción "Restringido (Temporalmente bloqueado)", por lo que el documento ha quedado con embargo hasta el 26 de octubre de 2021, en concordancia con las Políticas de Acceso Abierto de la Universidad. Si usted desea dejarlo con acceso abierto antes de finalizar dicho periodo o si por el contrario desea extender el embargo al finalizar este tiempo, puede enviar un correo a esta misma dirección realizando la solicitud. Tenga en cuenta que los documentos en acceso abierto propician una mayor visibilidad de su producción académica y científica. Quedo atento a cualquier inquietud o sugerencia"
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_20488
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/20488
dc.language.isospaspa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentMaestría en Actividad Física y Saludspa
dc.publisher.otherUniversidad CESspa
dc.publisher.programMaestría en Epidemiologíaspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectAnestesia generalspa
dc.subjectComplicaciones postoperatoriasspa
dc.subjectDespertar intraoperatoriospa
dc.subjectAnafilaxiaspa
dc.subjectSeguridad del pacientespa
dc.subject.ddcCiencias médicas, Medicinaspa
dc.subject.keywordGeneral anaesthesiaspa
dc.subject.keywordAnaphylaxisspa
dc.subject.keywordAdverse effectsspa
dc.subject.keywordPatient safetyspa
dc.subject.keywordPostoperative complicationsspa
dc.subject.keywordIntraoperative awarenessspa
dc.subject.lembMedicinaspa
dc.subject.lembEpidemiologíaspa
dc.titleEventos adversos en el perioperatorio relacionados con el uso de bloqueantes neuromusculares comparado con no utilizarlos durante la anestesia general en adultos : revisión sistemática de la literaturaspa
dc.typemasterThesiseng
dc.type.documentTrabajo de gradospa
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTesis de maestríaspa
local.department.reportEscuela de Medicina y Ciencias de la Saludspa
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