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"tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "202" "paginaFinal" => "203" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R.F. Lafuente-Urrez, Y. Gilaberte" "autores" => array:2 [ 0 => array:4 [ "nombre" => "R.F." "apellidos" => "Lafuente-Urrez" "email" => array:2 [ 0 => "fati1997@gmail.com" 1 => "rfz97@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Y." "apellidos" => "Gilaberte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Reina Sofía, Tudela, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital San Jorge, Huesca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sevoflurano, ¿una alternativa en el tratamiento de las úlceras vasculares?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Vascular ulcers are a major health problem because of their frequency, chronic nature, and high recurrence rate. The standard treatment, which consists of cleansing, debridement, and application of dressings, achieves cure rates of 65% to 85%.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The approaches used to accelerate scarring of these ulcers include dressings (biologic, synthetic, or biosynthetic), human amniotic membrane transplantation,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and autologous platelet-rich plasma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Options for analgesia to control the pain associated with vascular ulcers include topical anesthetics such as the creams Emla (lidocaine and prilocaine) and Lambdalina (lidocaine), oral analgesics, and even opiates. These products aid in the healing process and in pain control, although they can produce undesirable effects.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Sevoflurane is an inhaled general anesthetic from the halogenated ether family that is indicated for induction and maintenance of general anesthesia during hospital or outpatient surgery.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Its analgesic effect is both central<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and peripheral,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5-7</span></a> although it has traditionally been thought that halogenated anesthetics lack a peripheral analgesic effect.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Topical sevoflurane has been reported to be effective in the treatment of long-standing venous ulcers<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and ischemic ulcers<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> that are refractory to standard treatment; when irrigated topically over the painful ulcer bed, it produces a rapid, intense, and lasting analgesic effect, with a suitable safety profile that is well accepted by patients. In addition, it significantly reduces the size of the ulcer and the time necessary for epithelialization.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5-7</span></a> Its effect can be so intense that it is even possible to perform surgical debridement without the need for further analgesia.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Similarly, it has been suggested that direct application of sevoflurane has an antimicrobial effect on ulcers that are superinfected by multiresistant <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and a bactericidal effect has been reported in vitro against <span class="elsevierStyleItalic">Staphylococcus aureus</span>, <span class="elsevierStyleItalic">P. aeruginosa</span>, and <span class="elsevierStyleItalic">Escherichia coli</span>.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Sevoflurane (Sevorane) is marketed as a colorless volatile liquid with no additives or preservatives in a 250-mL amber-colored polyethylene naphthalate bottle with a safety cap and a filling adapter. Each milliliter of liquid contains 1<span class="elsevierStyleHsp" style=""></span>mL of sevoflurane (INN). It should be kept at room temperature and protected from sunlight.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Once the ulcer has been cleansed with saline solution, sevoflurane is applied directly on the ulcer bed, ensuring that the liquid is distributed throughout the tissue and taking care that it does not come into contact with the surrounding healthy skin. It is necessary to wait 2<span class="elsevierStyleHsp" style=""></span>minutes before applying standard wound care<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> and placing the dressing. A compression bandage should also be applied when necessary.</p><p id="par0045" class="elsevierStylePara elsevierViewall">To date, 12 patients have been treated with topical sevoflurane, and 2 of these cases have been published.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> The case of an immunodepressed patient with a postsurgical wound superinfected by multiresistant <span class="elsevierStyleItalic">P. aeruginosa</span> who was cured after several applications of sevoflurane is pending publication.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> At the 17<span class="elsevierStyleSup">th</span> Annual Meeting of the European Society of Regional Anesthesia in Barcelona in October 2011, a series of 9 patients was presented (6 women and 3 men with diabetes). The patients had painful venous ulcers on the lower limbs that were refractory to regular analgesics and were treated with sevoflurane on an outpatient basis to control the pain.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In all cases, the reduction in pain at rest was rapid (less than 2 minutes), intense (7.4<span class="elsevierStyleHsp" style=""></span>[0.5] to 2.1<span class="elsevierStyleHsp" style=""></span>[0.6] points with the first application and 7.2<span class="elsevierStyleHsp" style=""></span>[1.3] to 1.1<span class="elsevierStyleHsp" style=""></span>[0.6] points with all of the remaining 67 applications), and lasting (from 7 to 16<span class="elsevierStyleHsp" style=""></span>hours). The ulcers were cured in 4 cases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The risk-benefit ratio of sevoflurane has proven very favorable to date.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> The only undesirable effects of topical application are pruritus at the borders of the wound and irritation of the surrounding skin with repeated applications.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Sevoflurane has not been reported to have sensitizing potential. Similarly, local irrigation with sevoflurane was well tolerated in patients with heart disease.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5-7</span></a> Systemic absorption of sevoflurane applied to an ulcer involving circulatory compromise is thought to be slow and incomplete,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> although blood levels have not been measured in patients treated with this procedure.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The mechanism underlying the analgesic, epithelializing, and antimicrobial effects of sevoflurane remains unknown. Inhaled sevoflurane has no peripheral analgesic effect<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>; however, topical or subcutaneous administration does produce a peripheral effect.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> When a halogenated agent is inhaled, the partial pressure reached in the peripheral nociceptors may not be sufficient to block transmission of a painful stimulus; however, with direct application, the nociceptors are exposed to sufficient partial pressure to block transmission of painful stimuli.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, topical sevoflurane could prove to be a promising strategy for analgesia and epithelialization in the treatment of vascular ulcers.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lafuente-Urrez RF, Gilaberte Y. 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año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 7 | 9 | 16 |
2024 Octubre | 72 | 49 | 121 |
2024 Septiembre | 66 | 27 | 93 |
2024 Agosto | 89 | 63 | 152 |
2024 Julio | 84 | 31 | 115 |
2024 Junio | 77 | 35 | 112 |
2024 Mayo | 77 | 51 | 128 |
2024 Abril | 77 | 24 | 101 |
2024 Marzo | 68 | 20 | 88 |
2024 Febrero | 64 | 27 | 91 |
2024 Enero | 58 | 34 | 92 |
2023 Diciembre | 60 | 14 | 74 |
2023 Noviembre | 78 | 34 | 112 |
2023 Octubre | 79 | 21 | 100 |
2023 Septiembre | 84 | 27 | 111 |
2023 Agosto | 53 | 18 | 71 |
2023 Julio | 50 | 32 | 82 |
2023 Junio | 52 | 23 | 75 |
2023 Mayo | 54 | 27 | 81 |
2023 Abril | 52 | 26 | 78 |
2023 Marzo | 54 | 21 | 75 |
2023 Febrero | 47 | 24 | 71 |
2023 Enero | 52 | 32 | 84 |
2022 Diciembre | 53 | 69 | 122 |
2022 Noviembre | 28 | 32 | 60 |
2022 Octubre | 38 | 29 | 67 |
2022 Septiembre | 45 | 42 | 87 |
2022 Agosto | 88 | 34 | 122 |
2022 Julio | 35 | 45 | 80 |
2022 Junio | 33 | 38 | 71 |
2022 Mayo | 72 | 39 | 111 |
2022 Abril | 63 | 36 | 99 |
2022 Marzo | 53 | 46 | 99 |
2022 Febrero | 40 | 35 | 75 |
2022 Enero | 72 | 34 | 106 |
2021 Diciembre | 37 | 39 | 76 |
2021 Noviembre | 46 | 42 | 88 |
2021 Octubre | 49 | 66 | 115 |
2021 Septiembre | 41 | 44 | 85 |
2021 Agosto | 38 | 40 | 78 |
2021 Julio | 35 | 32 | 67 |
2021 Junio | 39 | 36 | 75 |
2021 Mayo | 33 | 34 | 67 |
2021 Abril | 93 | 42 | 135 |
2021 Marzo | 95 | 30 | 125 |
2021 Febrero | 81 | 31 | 112 |
2021 Enero | 56 | 27 | 83 |
2020 Diciembre | 65 | 11 | 76 |
2020 Noviembre | 35 | 20 | 55 |
2020 Octubre | 49 | 16 | 65 |
2020 Septiembre | 50 | 18 | 68 |
2020 Agosto | 44 | 19 | 63 |
2020 Julio | 38 | 18 | 56 |
2020 Junio | 60 | 42 | 102 |
2020 Mayo | 52 | 18 | 70 |
2020 Abril | 40 | 17 | 57 |
2020 Marzo | 50 | 16 | 66 |
2020 Febrero | 10 | 0 | 10 |
2019 Diciembre | 8 | 8 | 16 |
2019 Noviembre | 4 | 7 | 11 |
2019 Octubre | 0 | 7 | 7 |
2019 Septiembre | 4 | 13 | 17 |
2019 Agosto | 4 | 11 | 15 |
2019 Julio | 8 | 11 | 19 |
2019 Junio | 2 | 17 | 19 |
2019 Mayo | 6 | 27 | 33 |
2019 Abril | 2 | 17 | 19 |
2019 Marzo | 0 | 10 | 10 |
2019 Febrero | 4 | 9 | 13 |
2019 Enero | 0 | 1 | 1 |
2018 Diciembre | 1 | 3 | 4 |
2018 Noviembre | 3 | 8 | 11 |
2018 Octubre | 2 | 0 | 2 |
2018 Marzo | 0 | 1 | 1 |
2018 Febrero | 36 | 7 | 43 |
2018 Enero | 35 | 6 | 41 |
2017 Diciembre | 40 | 7 | 47 |
2017 Noviembre | 26 | 10 | 36 |
2017 Octubre | 38 | 10 | 48 |
2017 Septiembre | 35 | 26 | 61 |
2017 Agosto | 28 | 14 | 42 |
2017 Julio | 21 | 12 | 33 |
2017 Junio | 47 | 17 | 64 |
2017 Mayo | 30 | 20 | 50 |
2017 Abril | 26 | 28 | 54 |
2017 Marzo | 27 | 28 | 55 |
2017 Febrero | 20 | 13 | 33 |
2017 Enero | 22 | 15 | 37 |
2016 Diciembre | 31 | 16 | 47 |
2016 Noviembre | 53 | 16 | 69 |
2016 Octubre | 59 | 21 | 80 |
2016 Septiembre | 49 | 18 | 67 |
2016 Agosto | 50 | 10 | 60 |
2016 Julio | 48 | 12 | 60 |
2016 Junio | 16 | 8 | 24 |
2016 Mayo | 8 | 11 | 19 |
2016 Abril | 2 | 14 | 16 |
2016 Marzo | 3 | 1 | 4 |
2016 Febrero | 14 | 1 | 15 |
2016 Enero | 11 | 3 | 14 |
2015 Diciembre | 12 | 1 | 13 |
2015 Noviembre | 7 | 4 | 11 |
2015 Octubre | 11 | 12 | 23 |
2015 Septiembre | 8 | 7 | 15 |
2015 Agosto | 10 | 4 | 14 |
2015 Julio | 30 | 7 | 37 |
2015 Junio | 33 | 12 | 45 |
2015 Mayo | 51 | 18 | 69 |
2015 Abril | 28 | 7 | 35 |
2015 Marzo | 33 | 4 | 37 |
2015 Febrero | 28 | 4 | 32 |
2015 Enero | 40 | 4 | 44 |
2014 Diciembre | 30 | 6 | 36 |
2014 Noviembre | 20 | 4 | 24 |
2014 Octubre | 41 | 4 | 45 |
2014 Septiembre | 31 | 2 | 33 |
2014 Agosto | 20 | 6 | 26 |
2014 Julio | 20 | 4 | 24 |
2014 Junio | 26 | 6 | 32 |
2014 Mayo | 37 | 12 | 49 |
2014 Abril | 76 | 8 | 84 |
2014 Marzo | 8 | 8 | 16 |