[Translated article] Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers.

Objective: To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers .

Methods: Retrospective observational study analysing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months.

Multidimensional Analysis of Quality of Life in Patients with Chronic Non-Cancer Pain and Short- and Long-Term Intrathecal Analgesic Therapy.

Intrathecal drug delivery (IDD) is part of the fourth analgesic step. Evidence on the quality of life of patients with refractory chronic non-cancer pain (CNCP) using these devices and their long-term outcomes is scarce. This study aims to evaluate patients with IDD to assess their HRQoL.

[Translated article] Safe administration of noradrenaline by the peripheral route: A systematic review.

Purpose: To review and analyse the available literature on peripheral administration of noradrenaline (NA) with the aim of providing recommendations to ensure correct use and patient safety.

Methods: Systematic review on the databases PubMed, ISI Web of Science, SCOPUS, and Science Direct, using the following search terms: ("Noradrenaline" [Mesh]) AND ("Norepinephrine" [Mesh]) AND ("Vasopressors" [Mesh]) AND ("Peripheral infusions" [Mesh]) OR ("Extravasations" [Mesh]). A total of 1040 articles were identified.

Safe administration of noradrenaline by the peripheral route: A systematic review.

Purpose: To review and analyze the available literature on peripheral administration of noradrenaline (NA) with the aim of providing recommendations to ensure correct use and patient safety.

Methods: Systematic review on the databases PubMed, ISI Web of Science, SCOPUS and Science Direct, using the following search terms: ("Noradrenaline" [Mesh]) AND ("Norepinephrine" [Mesh]) AND ("Vasopressors" [Mesh]) AND ("Peripheral infusions" [Mesh]) OR ("Extravasations" [Mesh]). A total of 1,040 articles were identified.

Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers.

Objective: To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers.

Methods: Retrospective observational study analyzing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months.

At-home Topical Sevoflurane Added to the Conventional Analgesic Treatment for Painful leg Ulcers Greatly Improved the Analgesic Effectiveness and Reduced Opioid Consumption in a Single-Center Retrospective Comparative Study with one-Year Follow-up.

The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. This study was aimed to compare the analgesic effectiveness and safety of systemic analgesics alone or plus at-home topical sevoflurane for the management of patients with painful nonrevascularizable leg ulcers who were referred to a Pain Clinic by their attending vascular surgeons. We reviewed charts of patients treated in a single Pain Clinic with analgesic Standard of Care either alone (group SoC) or plus at-home topical sevoflurane (group SoC + Sevo), according to safety criteria.

Topical sevofluran: a galenic experience.

Sevoflurane is a volatile liquid from the family of ether-derived alogenated hydrocarbons that is approved for the induction and  maintenance of inhalational general anesthesia in the hospital setting. This review describes the pioneering experience of a Spanish Pain Unit in the  home treatment of complicated painful wounds using topical sevoflurane  instillations according to a protocol approved for off-label use. Aspects of  safety and efficacy, both analgesic, antimicrobial and pro-healing are  addressed, and some future lines of research are discussed in terms of  new formulations for topical use.

Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.

Objectives: The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. We conducted a Bayesian cost-effectiveness analysis (CEA) comparing the addition of domiciliary topical sevoflurane to conventional analgesics (SEVOFLURANE, n = 38) versus conventional analgesics alone (CONVENTIONAL, n = 26) for the treatment of nonrevascularizable painful leg ulcers in an outpatient Pain Clinic of a Spanish tertiary hospital.

Methods: We used real-world data collected from charts to conduct this CEA from a public healthcare perspective and with a one-year time horizon.

Review of binary, ternary and quaternary mixtures for induction and maintenance of opioid free anesthesia.

Objective: To describe and organize the current information available on  binary, ternary and/or quaternary mixtures used in opioid-free anesthesia (OFA), as well as their physicochemical stability, in order to  facilitate its correct administration, optimize its use, and prevent potential  effectiveness and safety issues.

Method: A systematic review of the literature on OFA was conducted in  PubMed/Medline, Trissel, Micromedex, Lexicomp,  ww.ahfsdruginformation.

Pain reduction of topical sevoflurane vs intravenous opioids in pressure ulcers.

Recently, it has been reported that topical irrigations of liquid sevoflurane on the bed of painful wounds produce a rapid, intense, and lasting analgesic effect. In this paper, A cohort of 112 patients with painful pressure ulcers who were refractory to opioids (or who exhibited undesirable adverse events to them) was treated with topical sevoflurane as per local institutional policy. These patients were recruited from an intensive care unit for a period of 3 years.

Occupational exposure to sevoflurane following topical application to painful wounds.

Background: Occupational exposure to halogenated anesthetics employed for general anesthesia has been extensively studied. Conversely, a new modality of treatment of painful wounds with topical sevoflurane lacks exposure studies.

Objectives: To evaluate the magnitude of acute occupational exposure to sevoflurane following topical application to painful wounds.

Palliative analgesia with topical sevoflurane in cancer-related skin ulcers: a case report.

A Caucasian 39-year-old male patient with a poorly-differentiated infiltrating epidermoid penile carcinoma with urethral invasion was diagnosed. The patient received concomitant adjuvant chemotherapy with radiotherapy in the palliative setting, which produced painful ulceration of tumour lesions at loco-regional level (Numerical Rate Scale, NRS=9). The patient consented for treatment with direct topical sevoflurane instillations, at initial doses of 1 mL/cm of ulcerated area, as per unit protocol.

Characterization of post-surgical critical patients with infections associated with healthcare after prolonged perfusion of remifentanil.

Introduction: Healthcare associated infections (HAI) are the most frequent complication of hospitalized patients. The aim of this study was to describe the clinical and epidemiological characteristics of critically ill post-surgical patients with a diagnosis of healthcare associated infections, after a pattern of sedoanalgesia of at least 4 days.

Methods: All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected.

Opioids and immunosupression in oncological postoperative patients.

Introduction: Recent animal studies demonstrated immunosuppressive effects of opioid withdrawal resulting in a higher risk of infection. The aim of this study was to determine the impact of remifentanil discontinuation on Post-Anesthesia Care Unit (PACU)-acquired infection after a schedule of sedoanalgesia of at least 6 days.

Method: All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected.

Efficacy and safety of topical sevoflurane in the treatment of chronic skin ulcers.

Purpose: Results of efficacy and safety assessments of topical sevoflurane use in patients with long-term treatment-refractory vascular ulcers are reported.

Methods: Patients were randomly assigned to receive sevoflurane instillations (1 mL per cm of ulcer area 1-4 times daily) plus standard wound care (ulcer cleaning, debridement, and dressing changes) or standard care only. Topical sevoflurane was initiated during hospitalization, with self- or nurse-administered instillations continued after discharge.

[Ambulatory surgery in a urology department. Analysis of the period 2003-2006].

Objectives: When talking about day surgery we have to differentiate between minor and major ambulatory surgery. Ambulatory surgery enables the patient to stay in the hospital not more than a few hours, showing similar safety and efficacy than conventional surgery. The objective of this paper is to evaluate the results of an ambulatory surgery program.

[Analysis of outpatients readmitted to an ambulatory surgery program].

Objectives: To quantify readmission rates due to both major and minor complications per year of study in an ambulatory surgery program and to assess the effect of including patients with greater severity on the results.

Patients And Method: We performed a retrospective study of patients undergoing surgery in an ambulatory surgery program in our health center between 1998 and 2003. During the study period, 25,553 patients met the selection criteria for elective ambulatory surgery.