sábado, 27 de abril de 2013

Analgesia postoperatoria/Postoperataive analgesia





http://www.smo.edu.mx/jornada2013/

Analgesia epidural controlada por el paciente con ropivacaína y fentanilo: experiencia con 2276 pacientes quirúrgicos


Patient-controlled Epidural Analgesia with Ropivacaine and Fentanyl: Experience with 2,276 Surgical Patients.
Kim SH, Yoon KB, Yoon DM, Kim CM, Shin YS.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Korean J Pain. 2013 Jan;26(1):39-45. doi: 10.3344/kjp.2013.26.1.39. Epub 2013 Jan 4.
Abstract
BACKGROUND: Good postoperative pain control is an important part of adequate postoperative care. Patient-controlled epidural analgesia (PCEA) provided better postoperative analgesia compared to other conventional analgesic methods, but several risks have been observed as well. We therefore surveyed the efficacy and safety of PCEA in this retrospective observational study. METHODS: We analyzed collected data on 2,276 elective surgical patients who received PCEA with ropivacaine and fentanyl. Patients were assessed by a PCA service team in the post-anesthesia care unit (PACU), at 1-6 h, 6-24 h, and 24-48 h postoperatively for adequate pain control. The presence of PCEA-related adverse events was also assessed. RESULTS: Numerical pain score (median [interquartile range]) were 3 [1-4], 5 [4-7], 4 [3-5], and 3 [3-5] in the PACU, at 1-6 h, 6-24 h, and 24-48 h postoperatively. Median pain scores in patients underwent major abdominal or thoracic surgery were higher than other surgical procedure in the PACU, at 1-6 h after surgery. Nausea and vomiting (20%) and numbness and motor weakness (15%) were revealed as major PCEA-related adverse events during the postoperative 48 h period. There were 329 patients (14%) for whom PCEA was ceased within 48 h following surgery. CONCLUSIONS: Our data suggest that the use of PCEA provides proper analgesia in the postoperative 48 h period after a wide variety of surgical procedures and that is associated with few serious complications. However, more careful pain management and sustainable PCEA monitoring considering the type of surgical procedure undergone is needed in patients with PCEA.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546209/pdf/kjpain-26-39.pdf


Guías para el manejo de dolor postoperatorio después de artroplastia total de rodilla.

Guidelines for the management of postoperative pain after total knee arthroplasty.
Korean Knee Society.
Knee Surg Relat Res. 2012 Dec;24(4):201-7. doi: 10.5792/ksrr.2012.24.4.201. Epub 2012 Nov 29.
Abstract
This clinical practice guideline was approved by Korean Knee Society on February 28, 2012. It is based on a systematic review of published studies on the management of postoperative pain after total knee arthroplasty and was developed to include the overall pain management modalities. The purpose of the guideline is to help improve treatment based on current best evidence. Eleven recommendations have been developed based on a systematic review of research evidence and the consensus opinions of a multidisciplinary working group of experts. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526756/pdf/ksrr-24-201.pdf


Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org


viernes, 26 de abril de 2013

Más sobre AINES/More on NSAIDs

                 http://www.smo.edu.mx/



Todas las causas de mortalidad en ancianos veteranos Australianos que usan AINES COX-2 selectivos o no selectivos: estudio longitudinal 
All-cause mortality of elderly Australian veterans using COX-2 selective or non-selective NSAIDs: a longitudinal study.
Kerr SJ, Rowett DS, Sayer GP, Whicker SD, Saltman DC, Mant A.
National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, NSW 2052, Australia.
Br J Clin Pharmacol. 2011 Jun;71(6):936-42. doi: 10.1111/j.1365-2125.2010.03702.x. Epub 2010 May 6.
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Previous studies have found varying impact of exposure to COX-2 selective and non-selective NSAIDs. WHAT THIS STUDY ADDS: * Individuals receiving a COX-2 selective NSAID had an increased risk of all-cause mortality after correction for age, sex and cardiovascular risk as measured by co-prescription. * Despite differences in the pharmacokinetic properties of the COX-2 selective inhibitor drugs, our study lends no support to clinicians preferring any one COX-2 selective inhibitor drug, or substituting one for another on the grounds of mortality risk alone. * The Australian Department of Veterans' Affairs data sets make it possible to conduct timely record linkage studies of all-cause mortality from use of medicines in a large and clinically relevant population. AIM: To determine hazard ratios for all-cause mortality in elderly Australian veterans taking COX-2 selective and non-selective NSAIDs. METHODS: Patient cohorts were constructed from claims databases (1997 to 2007) for veterans and dependants with full treatment entitlement irrespective of military service. Patients were grouped by initial exposure: celecoxib, rofecoxib, meloxicam, diclofenac, non-selective NSAID. A reference group was constructed of patients receiving glaucoma/hypothyroid medications and none of the study medications. Univariate and multivariate analyses were performed using Cox proportional hazards regression models. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated for each exposure group against each of the reference group. The final model was adjusted for age, gender and co-prescription as a surrogate for cardiovascular risk. Patients were censored if the gap in supply of study prescription exceeded 30 days or if another study medication was initiated. The outcome measure in all analyses was death. RESULTS: Hazard ratios and 95% CIs, adjusted for age, gender and cardiovascular risk, for each group relative to the reference group were: celecoxib 1.39 (1.25, 1.55), diclofenac 1.44 (1.28, 1.62), meloxicam 1.49 (1.25, 1.78), rofecoxib 1.58 (1.39, 1.79), non-selective NSAIDs 1.76 (1.59, 1.94). CONCLUSIONS: In this large cohort of Australian veterans exposed to COX-2 selective and non-selective NSAIDs, there was a significant increased mortality risk for those exposed to either COX-2-selective or non-selective NSAIDs relative to those exposed to unrelated (glaucoma/hypothyroid) medications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099381/pdf/bcp0071-0936.pdf 

  
Uso de AINES que elevan el riesgo cardiovascular: una revisión de las ventas y las listas de medicamentos esenciales en los países de ingreso bajo, mediano y alto. 
Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries.
McGettigan P, Henry D.
William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
PLoS Med. 2013 Feb;10(2):e1001388. doi: 10.1371/journal.pmed.1001388. Epub 2013 Feb 12.Abstract
BACKGROUND: Certain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib [Vioxx]) increase the risk of heart attack and stroke and should be avoided in patients at high risk of cardiovascular events. Rates of cardiovascular disease are high and rising in many low- and middle-income countries. We studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries. METHODS AND FINDINGS: Data on the relative risk (RR) of cardiovascular events with individual NSAIDs were derived from meta-analyses of randomised trials and controlled observational studies. Listing of individual NSAIDs on Essential Medicines Lists (EMLs) was obtained from the World Health Organization. NSAID sales or prescription data for 15 low-, middle-, and high-income countries were obtained from Intercontinental Medical Statistics Health (IMS Health) or national prescription pricing audit (in the case of England and Canada). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with a low risk. Diclofenac was listed on 74 national EMLs, naproxen on just 27. Rofecoxib use was not documented in any country. Diclofenac and etoricoxib accounted for one-third of total NSAID usage across the 15 countries (median 33.2%, range 14.7-58.7%). This proportion did not vary between low- and high-income countries. Diclofenac was by far the most commonly used NSAID, with a market share close to that of the next three most popular drugs combined. Naproxen had an average market share of less than 10%. CONCLUSIONS: Listing of NSAIDs on national EMLs should take account of cardiovascular risk, with preference given to low risk drugs. Diclofenac has a risk very similar to rofecoxib, which was withdrawn from worldwide markets owing to cardiovascular toxicity. Diclofenac should be removed from EMLs
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570554/pdf/pmed.
1001388.pdf  
 
Revisión sobre drogas analgésicas, antiinflamatorios no esteroideas 
Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs) Final Update 4 Report November 2010
http://www.ncbi.nlm.nih.gov/books/NBK53955/pdf/TOC.pdf 


Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org


Booksupdate. NYT

                   http://www.smo.edu.mx/jornada2013/


http://www.nytimes.com/indexes/2013/04/26/books/booksupdate/index.html


April 26, 2013
Books Update

On the Cover of Sunday's Book Review

'The Selected Letters of Willa Cather'
Edited by ANDREW JEWELL and JANIS STOUT
Reviewed by TOM PERROTTA


In her letters, the novelist Willa Cather emerges as a strong and vivid presence, a woman at once surprisingly modern and touchingly - if not always sweetly - old-fashioned.
Up Front: Tom Perrotta
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Also in the Book Review

Jonathan Franzen: By the Book


During a dark moment in his early 30s, the author of "The Corrections" and, most recently, "Farther Away: Essays" took solace from the self-help book "The Dance of Anger."
By the Book: Archive

'Above All Things'
By TANIS RIDEOUT
Reviewed by SARA WHEELER


Tanis Rideout's novel relates the story of George Mallory's third Mount Everest expedition.

'The Burgess Boys'
By ELIZABETH STROUT
Reviewed by SYLVIA BROWNRIGG


A fractious family comes together to defend a troubled relative in Elizabeth Strout's novel.

'All That Is'
By JAMES SALTER
Reviewed by MALCOLM JONES


James Salter's first novel in more than 30 years follows the loves and losses of a World War II veteran.

'The Mothers'
By JENNIFER GILMORE
Reviewed by MOLLY RINGWALD


Jennifer Gilmore's novel centers on the complexities of adoption.

'The Taste of Ashes'
By MARCI SHORE
Reviewed by ADAM HOCHSCHILD


Marci Shore examines the psyche of Eastern Europe in the wake of the revolutions of 1989.

'Life After Life'
By KATE ATKINSON
Reviewed by FRANCINE PROSE


Kate Atkinson's novel follows the many alternate courses her protagonist's destiny might have taken.
Magazine: Profile of Kate Atkinson

'The Flamethrowers'
By RACHEL KUSHNER
Reviewed by CRISTINA GARCÍA


In Rachel Kushner's second novel, an impressionable artist navigates the volatile worlds of New York and Rome in the 1970s.

'Tiger Writing'
By GISH JEN
Reviewed by WESLEY YANG


Gish Jen discusses the differences between Asian and Western approaches to identity.

'Cooked: A Natural History of Transformation'
By MICHAEL POLLAN
Reviewed by BEE WILSON


Michael Pollan on how to prepare your own food.

'Gulp'
By MARY ROACH
Reviewed by JON RONSON


Mary Roach on what happens after you eat.

'Finding Florida'
By T. D. ALLMAN
Reviewed by ALEXANDRA STARR


T. D. Allman traces five centuries of Florida history, from discovery to settlement to tourist destination.

'Al Capp: A Life to the Contrary'
By MICHAEL SCHUMACHER and DENIS KITCHEN
Reviewed by ANDY WEBSTER


For 43 years "Li'l Abner" entertained millions, but the comic strip's creator was a complicated, often unpleasant man.

Transgenred
By CHELSEA CAIN


Kit Reed's stories and novels are hard to categorize


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Nice Poem; I'll Take It
By SANDRA BEASLEY


How it feels to be the victim of a serial plagiarist.

Inside the List
By GREGORY COWLES


Iris Johansen, whose new novel, "Taking Eve," is at No. 5 on the hardcover fiction list, cites Ayn Rand as one of her favorite authors, but says, "I'm not aware of a Randian influence in my work."

Editors' Choice


Recently reviewed books of particular interest.

Paperback Row
By IHSAN TAYLOR


Paperback books of particular interest.

Book Review Podcast


This week, Tom Perrotta talks about the letters of Willa Cather; Julie Bosman has notes from the field; Alexandra Starr discusses T. D. Allman's "Finding Florida"; and Gregory Cowles has best-seller news. John Williams is the host, filling in for Pamela Paul.




Book Review Podcast: Willa Cather's Letters

Spymaster Makes Cameo in His Book Trailer

Granta Editor Stepping Down

REVIEWS BY THE TIMES'S CRITICS

'The New Digital Age'

'The Way of the Knife' by Mark Mazzetti

'The New Mind of the South' by Tracy Thompson

'Top of the Morning' by Brian Stelter

'Waiting to Be Heard' by Amanda Knox

CHILDREN'S BOOKS

Children's Books: Bouncing Back

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Editor's Note

Thanks for taking the time to read this e-mail. Feel free to send feedback; I enjoy hearing your opinions and will do my best to respond.

John Williams
Senior Staff Editor
The New York Times on the Web



ebooks. Alerta











El número de lectores de ebooks crece un 280 por ciento en dos años
ecodiario
El número de lectores de libros digitales o ebooks ha registrado un incremento del 280 por ciento respeto a los niveles que se registraban hace dos años, cuando el porcentaje ascendía al 5,86 por ciento. MADRID, 23 (EUROPA PRESS). En concreto, del 5 ...
Ver todos los artículos sobre este tema »

Día del Libro: rosas, e-books y apps
TICbeat (blog)
Con motivo del Día Internacional del Libro, distintos agentes del sector han puesto en marcha iniciativas que promueven el acceso legal a los e-books a través de promociones y descuentos. Durante todo el día, Amazon permitirá a los lectores de Kindle ...
Ver todos los artículos sobre este tema »
TICbeat (blog)

Así ha cambiado el hábito de la lectura con las «tablets» y los «e ...
ABC.es
De acuerdo a sus cifras, la facturación de eBooks o libros digitales (contenidos) en España se ha multiplicado por seis en 2012, frente a los dos millones de euros registrados en 2011. Por otra parte, en lo que va de año el aumento acumulado ha sido ...
Ver todos los artículos sobre este tema »
Cómo evitar la piratería de los eBooks
InfoBAE.com
DRM (digital rights management) es un sistema que pretende restringir la copia no autorizada deeBooks y también de otros bienes digitales como películas y música. Digo pretende porque no lo logra. La causa de esto es algo llamado Agujero Analógico: ...
Ver todos los artículos sobre este tema »

Cómo conseguir e-books gratis legalmente
androidsis (blog)
Continuando con la celebración del día de libro, hoy día de Sant jordi os queremos recomendar la manera de conseguir e-books gratis, o libros electrónicos de una manera legal y totalmente gratuita. Para ello, nuestro compañeros de Todo e-Readers han ...
Ver todos los artículos sobre este tema »
androidsis (blog)

El número de lectores de 'ebooks' se cuadruplica
Diario de Sevilla
El porcentaje de lectores de ebooks se ha multiplicado casi por cuatro en dos años, pero esto apenas ha afectado a lectura de libros tradicionales, lo que implica que están surgiendo lectores mixtos, consumidores de literatura tanto en formato ...
Ver todos los artículos sobre este tema »
Gandia celebra la Setmana del Llibre con presentaciones y talleres ...
Las Provincias
A lo largo de la semana, se han programado también una serie de charlas formativas, tituladas Los E-readers y los E-books, para alumnos de a partir de 3º de ESO. Los alumnos podrán manipular y practicar con los dispositivos disponibles en la biblioteca.
Ver todos los artículos sobre este tema »
De cines y libros - Diario de Sevilla
Diario de Sevilla
Triunfan los ebooks y desde los años 70 los cines fueron cerrando, sustituidos por los multicines que después fueron reemplazados por las multisalas de los centros comerciales. El disfrute en casa de las películas sin pérdida de calidad es un hecho ...
Ver todos los artículos sobre este tema »
Los libros digitales crecerán en un 23 por ciento en el próximo trienio
eldia.es
... de la Asociación Multisectorial de Empresas de la Electrónica, Tecnologías de la Información y Comunicación revela que la edición ha alcanzo el pasado año los 201 millones de euros de facturación, de los cuales 72,6 fueron aportados por los e-books.
Ver todos los artículos sobre este tema »



Blogs 1 resultado nuevo de E-Books


El minidocumental viaja hacia las fronteras del `e-book´ – Literatura ...
según David González | aviondepapel.tv
Joan Planas y Ana Salvá recorren Asia para rodar, fotografiar y relatar los testimonios de personas anónimas en su web documental `Buscando Historias´. Financian con `crowdfunding´ este proyecto web multimedia -híbrido entre el ...
Tecnología Noticias, vídeos...

eBooks - PlanetadeLibros.com
Colecciones. (Fuera de colección) · Novela romántica · Áncora & Delfin · Autores Españoles e Iberoamericanos · Para Dummies. Los eBooks más destacados ...
www.planetadelibros.com/seleccion-editorial-ebooks-5.html
El número de lectores de ebooks crece un 280 por ... - Eldiario.es
El número de lectores de libros digitales o ebooks ha registrado un incremento del 280 por ciento respeto a los niveles que se registraban hace dos años, ...
www.eldiario.es/.../numero-lectores-ebooks-crece-ciento_0_12...
Celebra el día del libro con varios eBooks gratuitos - Todo eReaders
Hoy 23 de abril se celebra el Día del Libro y con motivo de esta celebración muchos periódicos, librerías o editoriales están ofreciendo un gran número.
www.todoereaders.com/celebra-el-dia-del-libro-con-varios-eb...
JOSE MANUEL DA NETA PRIETO MARTINEZ: libros, eBooks ...
Comprar libros y eBooks de JOSE MANUEL DA NETA PRIETO MARTINEZ en tu librería onlinecasadellibro.com.
www.casadellibro.com/libros-ebooks/jose...da.../20088038
Sorteo de ebooks para el día del libro - Todo eReaders
Y queremos organizar un pequeño sorteo para regalar unos ebooks. Para participar tan solo tienes que twittear lo siguiente (acuérdate de cambiar las palabras ...
www.todoereaders.com/sorteo-de-ebooks-para-el-dia-del-libro...

jueves, 25 de abril de 2013

Anestesia regional en neonatos/Regional anesthesia in neonates



http://www.smo.edu.mx/jornada2013/



Anestesia regional en el neonato


Regional anaesthesia and analgesia in the neonate
Per-Arne Lönnqvist, MD, DEAA, FRCA, PhD, Professor of Paediatric
Anaesthesia &; Intensive Care, Senior Consultant
http://web.clas.ufl.edu/users/msscha/PremedCSS/analgesics_infants.pdf

Consideraciones anestésicas en emergencias quirúrgicas neonatales
Anaesthetic consideration for neonatal surgical emergencies.
Pani N, Panda CK.
Indian J Anaesth [serial online] 2012 [cited 2013 Mar 9];56:463-9.
A newborn requires constant vigilance, rapid recognition of the events and swift intervention during anaesthesia. The anaesthetic considerations in neonatal surgical emergencies are based on the physiological immaturity of various body systems, poor tolerance of the anaesthetic drugs, associated congenital disorders and considerations regarding the use of high concentration of oxygen. The main goal is for titration of anaesthetics to desired effects, while carefully monitoring of the cardiorespiratory status. The use of regional anaesthesia has shown to be safe and effective. Advancements in neonatology have resulted in the improvement of the survival of the premature and critically ill newborn babies. Most of the disorders previously considered as neonatal surgical emergencies in the past no longer require immediate surgery due to new technology and new methods of treating sick neonates. This article describes the common neonatal surgical emergencies and focuses on factors that affect the anaesthetic management of patients with these disorders.
Keywords: Anaesthesia, emergency surgeries, neonate
http://www.ijaweb.org/text.asp?2012/56/5/463/103962


Manejo anestésico para laparotomía urgente en un neonato con artrogriposis congénita múltiple

Anesthetic management of a neonate with arthrogryposis multiplex congenita for emergency laparotomy.
Chowdhuri R, Samui S, Kundu AK.
Department of Anesthesiology, R.G.Kar Medical College, Kolkata, India.
J Anaesthesiol Clin Pharmacol. 2011 Apr;27(2):244-6. doi: 10.4103/0970-9185.81831.
Abstract
Arthrogryposis multiplex congenita is a rare disease, characterized by non-progressive, multiple joint contractures since birth. Anesthetic issues include difficult intravenous access, difficult airway management and regional anesthesia. We report the anesthetic management of a six-day-old neonate presenting to the emergency with features of intestinal obstruction, who was detected for the first time to have arthrogryposis multiplex congenita. General anesthesia along with caudal analgesia for peroperative and postoperative pain relief was used. There was an episode of intraoperative hyperthermia, which was tackled successfully. The child had an uneventful post-anesthesia recovery.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127309/




Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Anestésicos, Pre-condicionamiento y Protección Cerebral

                      http://www.smo.edu.mx/jornada2013/




Anestésicos, Pre-condicionamiento y Protección Cerebral
Rogean Rodrigues Nunes, Gastao Fernandes Duval Neto, Julio Cesar Garcia de Alencar, Suyane Benevides Franco, Nayanna Quezado de Andrade, Danielle Maia Holanda Dumaresq, Sara Lucia Cavalcante
Rev Bras Anestesiol. 2013;63(1):119-138
Justificativa y objetivos: Diversos estudios han demostrado el pre-condicionamiento cerebral como un mecanismo protector frente a una situacion de estres. Estan descritos algunos factores determinantes del PC, como tambien la neuroproteccion proporcionada por los agentes anestésicos y no anestesicos. Contenido: Se hizo la revision con base en los principales articulos de la literatura que engloban la fi siopatologia de la isquemia-reperfusion y la lesion neuronal, y los factores no farmacológicos (infl amacion, glucemia y temperatura), y farmacologicos relacionados con el cambio de la respuesta a la isquemia-reperfusion, ademas de la neuroproteccion inducida por el uso de los anestesicos. Conclusiones: El cerebro tiene la capacidad de protegerse contra la isquemia cuando se le estimula. La elucidación de ese mecanismo posibilita la aplicacion de sustancias inductoras del precondicionamiento cerebral, como algunos anestesicos, otros farmacos y medidas no farmacologicas, como la hipotermia, con el fi n de inducir la tolerancia a las lesiones isquemicas.
http://www.scielo.br/pdf/rba/v63n1/es_v63n1a11.pdf 

Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org


AINES y corazón/Nonsteroidal Anti-Inflammatory and cardiovascular risk

                                                   http://www.smo.edu.mx/jornada2013/



Diclofenaco prolonga la repolarización del músculo ventricular con daño en la repolarización de reserva 
Diclofenac prolongs repolarization in ventricular muscle with impaired repolarization reserve.
Kristóf A, Husti Z, Koncz I, Kohajda Z, Szél T, Juhász V, Biliczki P, Jost N, Baczkó I, Papp JG, Varró A, Virág L.
Division of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary.
PLoS One. 2012;7(12):e53255. doi: 10.1371/journal.pone.0053255. Epub 2012 Dec 31.
Abstract
BACKGROUND: The aim of the present work was to characterize the electrophysiological effects of the non-steroidal anti-inflammatory drug diclofenac and to study the possible proarrhythmic potency of the drug in ventricular muscle. METHODS: Ion currents were recorded using voltage clamp technique in canine single ventricular cells and action potentials were obtained from canine ventricular preparations using microelectrodes. The proarrhythmic potency of the drug was investigated in an anaesthetized rabbit proarrhythmia model. RESULTS: Action potentials were slightly lengthened in ventricular muscle but were shortened in Purkinje fibers by diclofenac (20 µM). The maximum upstroke velocity was decreased in both preparations. Larger repolarization prolongation was observed when repolarization reserve was impaired by previous BaCl(2) application. Diclofenac (3 mg/kg) did not prolong while dofetilide (25 µg/kg) significantly lengthened the QT(c) interval in anaesthetized rabbits. The addition of diclofenac following reduction of repolarization reserve by dofetilide further prolonged QT(c). Diclofenac alone did not induce Torsades de Pointes ventricular tachycardia (TdP) while TdP incidence following dofetilide was 20%. However, the combination of diclofenac and dofetilide significantly increased TdP incidence (62%). In single ventricular cells diclofenac (30 µM) decreased the amplitude of rapid (I(Kr)) and slow (I(Ks)) delayed rectifier currents thereby attenuating repolarization reserve. L-type calcium current (I(Ca)) was slightly diminished, but the transient outward (I(to)) and inward rectifier (I(K1)) potassium currents were not influenced. CONCLUSIONS: Diclofenac at therapeutic concentrations and even at high dose does not prolong repolarization markedly and does not increase the risk of arrhythmia in normal heart. However, high dose diclofenac treatment may lengthen repolarization and enhance proarrhythmic risk in hearts with reduced repolarization reserve.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534043/pdf/pone.0053255.pdf
 
  
Nuevas acciones de los AINES sobre los canales iónicos vasculares: La contabilización de los efectos secundarios cardiovasculares e identificación de nuevas aplicaciones terapéuticas. 
Novel Actions of Nonsteroidal Anti-Inflammatory Drugs on Vascular Ion Channels: Accounting for Cardiovascular Side Effects and Identifying New Therapeutic Applications.
Brueggemann LI, Mani BK, Mackie AR, Cribbs LL, Byron KL.
Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Maywood, Illinois.
Mol Cell Pharmacol. 2010;2(1):15-19.
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used medications for the treatment of both acute and chronic pain. Selective cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib (Celebrex(®)), rofecoxib (Vioxx(®)), and diclofenac, have been among the most widely prescribed NSAIDs because they prevent the generation of prostaglandins involved in inflammation and pain, but avoid some of the gastrointestinal complications associated with less selective COX-1/COX-2 inhibitors. In 2004, rofecoxib (Vioxx(®)) was voluntarily withdrawn from the market because of adverse cardiovascular side effects. This led to an explosion of research into the cardiovascular effects of the 'coxibs', which revealed differential cardiovascular risk profiles among the members of this drug class. The differential risk profiles may relate to the tendency of some of the drugs to elevate blood pressure (BP). An important component of BP regulation is dependent on the contractile state of vascular smooth muscle cells (VSMCs), which is controlled to a large extent by the activities of KCNQ (Kv7 family) potassium channels and L-type calcium channels. Our recently published data indicate that celecoxib, but not rofecoxib or diclofenac, at therapeutically relevant concentrations, acts as a Kv7 potassium channel activator and a calcium channel blocker, causing relaxation of VSMCs and decreasing vascular tone. These vasorelaxant ion channel effects may account for the differential cardiovascular risk profiles among the different COX-2 inhibitors. We further speculate that these properties may be exploited for therapeutic benefit in the treatment of cardiovascular diseases or other medical conditions.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915785/pdf/nihms-184534.pdf 

Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

miércoles, 24 de abril de 2013

Bibliotecas. Alerta






http://www.smo.edu.mx/jornada2013/


Las diez bibliotecas públicas más asombrosas del planeta
Qué.es
Las bibliotecas suelen ser lugares muy tranquilos en los que es fácil olvidarse del ruidoso mundo que nos rodea, atrapados en la lectura de sus libros. Sin embargo, algunos de estos edificios compiten en belleza y originalidad con las obras que ...
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Las bibliotecas municipales de Ourense ofrecen talleres infantiles ...
La Voz de Galicia
Las actividades, que son totalmente gratuitas, se desarrollarán el lunes 25, el martes 26, el miércoles 27 y el lunes 1 de abril entre las once de la mañana y la una de la tarde y el único requisito es ser socio de la biblioteca, que tampoco tiene ...
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BIBLIOTECAS Defienden redefinir el papel de las bibliotecas para ...
Ideal Digital
Granada, 22 mar (EFE).- Investigadores de la Universidad de Granada defienden que las bibliotecasse adapten a la era de internet y cambien su papel, de forma que ofrezcan servicios como enseñar a los usuarios a iniciar un negocio, rellenar un ...
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Presentación de “Las Bibliotecas para la Sociedad” - Granada
El próximo miércoles, 20 de marzo, a las 12,30 horas en el Salón Rojo del Hospital Real, tendrá lugar la presentación de “Las Bibliotecas para la Sociedad” , ...
canal.ugr.es/.../63832-presentación-de-“las-bibliotecas-para-la-...


AulaSurURJC: La URJC cierra todas sus bibliotecas durante las ...
Fuenlabrada | José Luis Blanco.- Las bibliotecas de los campus de la Universidad Rey Juan Carlos permanecerán cerradas desde el día 23 de marzo hasta el ...
aulasururjc.blogspot.com/.../la-urjc-cierra-todas-sus-bibliotecas...


AulaSurURJC: Encuesta | ¿Qué piensa del cierre de las bibliotecas ...
Bernal Crespo (19, Ciencias del Mar). "Si fuese en mi universidad perjudicaría a algunas personas que no pueden estudiar en casa. La biblioteca es un recurso ...
aulasururjc.blogspot.com/.../encuesta-que-piensa-del-cierre-de...


Red de Bibliotecas del Instituto Cervantes - Google+ - Español ...
Español adecuado para no insultar en Recife: 22 de marzo - La Biblioteca Carmen de Burgos celebra una nueva tertulia cuyo objetivo es minimizar la brecha…
https://plus.google.com/.../posts/MV83UwEaKs5

AINES y riesgo CV/Nonsteroidal anti-inflammatory drugs and CV risk




Riesgo cardiovascular causa-específico asociado con los AINES entre los pacientes con infarto del miocardio. Un estudio a nivel nacional 
Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs among myocardial infarction patients--a nationwide study.
Olsen AM, Fosbøl EL, Lindhardsen J, Andersson C, Folke F, Nielsen MB, Køber L, Hansen PR, Torp-Pedersen C, Gislason GH.
Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark. amschjerning@gmail.com
PLoS One. 2013;8(1):e54309. doi: 10.1371/journal.pone.0054309. Epub 2013 Jan 30.
Abstract
BACKGROUND: Non steroidal anti-inflammatory drugs (NSAIDs) increase mortality and morbidity after myocardial infarction (MI). We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients. METHODS AND RESULTS: By individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark, patients aged >30 years admitted with first-time MI during 1997-2009 and their subsequent NSAID use were identified. The risk of three cardiovascular specific endpoints: cardiovascular death, the composite of coronary death and nonfatal MI, and the composite of fatal and nonfatal stroke, associated with NSAID use was analyzed by Cox proportional hazard analyses. Of 97,698 patients included 44.0% received NSAIDs during follow-up. Overall use of NSAIDs was associated with an increased risk of cardiovascular death (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.36-1.49). In particular use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with increased risk of cardiovascular death (HR 1.96 [1.79-2.15] and HR1.66 [1.44-1.91], respectively) with a dose dependent increase in risk. Use of ibuprofen was associated with increased risk of cardiovascular death (HR 1.34[1.26-1.44]), whereas naproxen was associated with the lowest risk of (e.g., HR 1.27[1.01-1.59].CONCLUSION: Use of individual NSAIDs is associated with different cause-specific cardiovascular risk and in particular rofecoxib and diclofenac were associated with increased cardiovascular morbidity and mortality. These results support caution with use of all NSAIDs in patients with prior MI.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559685/pdf/pone.
0054309.pdf 
  
Riesgo cardiovascular con AINES: Revisión sistemática de estudios poblacionales observacionales controlados 
Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies.
McGettigan P, Henry D.
Hull York Medical School, Hull, United Kingdom.
PLoS Med. 2011 Sep;8(9):e1001098. doi: 10.1371/journal.pmed.1001098. Epub 2011 Sep 27.
Abstract
BACKGROUND: Randomised trials have highlighted the cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) in high doses and sometimes atypical settings. Here, we provide estimates of the comparative risks with individual NSAIDs at typical doses in community settings. METHODS AND FINDINGS: We performed a systematic review of community-based controlled observational studies. We conducted comprehensive literature searches, extracted adjusted relative risk (RR) estimates, and pooled the estimates for major cardiovascular events associated with use of individual NSAIDs, in different doses, and in populations with low and high background risks of cardiovascular events. We also compared individual drugs in pair-wise (within study) analyses, generating ratios of RRs (RRRs). Thirty case-control studies included 184,946 cardiovascular events, and 21 cohort studies described outcomes in >2.7 million exposed individuals. . CONCLUSIONS: This review suggests that among widely used NSAIDs, naproxen and low-dose ibuprofen are least likely to increase cardiovascular risk. Diclofenac in doses available without prescription elevates risk. The data for etoricoxib were sparse, but in pair-wise comparisons this drug had a significantly higher RR than naproxen or ibuprofen. Indomethacin is an older, rather toxic drug, and the evidence on cardiovascular risk casts doubt on its continued clinical use. Please see later in the article for the Editors' Summary.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181230/pdf/pmed.1
001098.pdf 
 
La duración del tratamiento con medicamentos anti-inflamatorios no esteroideos y el impacto en el riesgo de muerte e infarto de miocardio recurrente en pacientes con infarto de miocardio previo: un estudio de cohorte nacional 
Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study.
Schjerning Olsen AM, Fosbøl EL, Lindhardsen J, Folke F, Charlot M, Selmer C, Lamberts M, Bjerring Olesen J, Køber L, Hansen PR, Torp-Pedersen C, Gislason GH.
Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark. aols0073@geh.regionh.dk
Circulation. 2011 May 24;123(20):2226-35. doi: 10.1161/CIRCULATIONAHA.110.004671. Epub 2011 May 9.
Abstract
BACKGROUND: Despite the fact that nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated among patients with established cardiovascular disease, many receive NSAID treatment for a short period of time. However, little is known about the association between NSAID treatment duration and risk of cardiovascular disease. We therefore studied the duration of NSAID treatment and cardiovascular risk in a nationwide cohort of patients with prior myocardial infarction (MI). METHODS AND RESULTS: Patients ≥30 years of age who were admitted with first-time MI during 1997 to 2006 and their subsequent NSAID use were identified by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. Risk of death and recurrent MI according to duration of NSAID treatment was analyzed by multivariable time-stratified Cox proportional-hazard models and by incidence rates per 1000 person-years. Of the 83 677 patients included, 42.3% received NSAIDs during follow-up. There were 35 257 deaths/recurrent MIs. Overall, NSAID treatment was significantly associated with an increased risk of death/recurrent MI (hazard ratio, 1.45; 95% confidence interval, 1.29 to 1.62) at the beginning of the treatment, and the risk persisted throughout the treatment course (hazard ratio, 1.55; 95% confidence interval, 1.46 to 1.64 after 90 days). Analyses of individual NSAIDs showed that the traditional NSAID diclofenac was associated with the highest risk (hazard ratio, 3.26; 95% confidence interval, 2.57 to 3.86 for death/MI at day 1 to 7 of treatment). CONCLUSIONS: Even short-term treatment with most NSAIDs was associated with increased risk of death and recurrent MI in patients with prior MI. Neither short- nor long-term treatment with NSAIDs is advised in this population, and any NSAID use should be limited from a cardiovascular safety point of view.
http://circ.ahajournals.org/content/123/20/2226.full.pdf 


Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org


martes, 23 de abril de 2013

Núcleo ceruleus/Locus coeruleus

                         http://www.smo.edu.mx/jornada2013/sociales.htm#DE

Las neuronas noradrenérgicas en el núcleo ceruleus contribuyen al dolor neuropático 
Noradrenergic neurons in the locus coeruleus contribute to neuropathic pain.
Brightwell JJ, Taylor BK.
Department of Pharmacology, School of Medicine, Tulane University, New Orleans, LA 70112, USA.
Neuroscience. 2009 Apr 21;160(1):174-85. doi: 10.1016/j.neuroscience.2009.02.023. Epub 2009 Feb 14.
Abstract
Current theories of neuropathic hypersensitivity include an imbalance of supraspinal inhibition and facilitation. Our overall hypothesis is that the locus coeruleus (LC), classically interpreted as a source of pain inhibition, may paradoxically result in facilitation after tibial and common peroneal nerve transection (spared sural nerve injury--SNI). We first tested the hypothesis that non-noxious tactile hind paw stimulation of the spared sural innervation territory increases neuronal activity in the LC in male rats. We observed a bilateral increase in the stimulus-evoked expression of transcription factors Fos and phosphorylated CREB (pCREB) in LC after SNI but not sham surgery; these markers of neuronal activity correlated with the intensity of tactile allodynia. We next tested the hypothesis that noradrenergic neurons contribute to the development of neuropathic pain. To selectively destroy these neurons, we delivered antidopamine-beta-hydroxylase saporin (anti-DbetaH-saporin) into the i.c.v. space 2 weeks before SNI. We found that anti-DbetaH-saporin, but not an IgG-saporin control, reduced behavioral signs of tactile allodynia, mechanical hyperalgesia, and cold allodynia from 3 to 28 days. after SNI. Our final experiment tested the hypothesis that the LC contributes to the maintenance of neuropathic pain. We performed SNI, waited 2 weeks for maximal allodynia and hyperalgesia to develop, and then administered the local anesthetic lidocaine (4%) directly into the LC parenchyma. Lidocaine reduced all behavioral signs of neuropathic pain in a reversible manner, suggesting that the LC contributes to pain facilitation. We conclude that, in addition to its well-known inhibition of acute and inflammatory pain, the LC facilitates the development and maintenance of neuropathic pain in the SNI model. Further studies are needed to determine the facilitatory pathways emanating from the LC.
Plasticidad molecular y celular inducida por opioides en las neuronas catecolaminérgicas del área tegmentaria ventral y el locus ceruleus  
Opiate-induced molecular and cellular plasticity of ventral tegmental area and locus coeruleus catecholamine neurons.
Mazei-Robison MS, Nestler EJ.
Fishberg Department of Neuroscience and Friedman Brain Institute, Mount Sinai School of Medicine, New York, New York, USA.
Cold Spring Harb Perspect Med. 2012 Jul;2(7):a012070
. doi: 10.1101/cshperspect.a012070.
Abstract
The study of neuronal adaptations induced by opiate drugs is particularly relevant today given their widespread prescription and nonprescription use. Although much is known about the acute actions of such drugs on the nervous system, a great deal of work remains to fully understand their chronic effects. Here, we focus on longer-lasting adaptations that occur in two catecholaminergic brain regions that mediate distinct behavioral actions of opiates: ventral tegmental area (VTA) dopaminergic neurons, important for drug reward, and locus coeruleus (LC) noradrenergic neurons, important for physical dependence and withdrawal. We focus on changes in cellular, synaptic, and structural plasticity in these brain regions that contribute to opiate dependence and addiction. Understanding the molecular determinants of this opiate-induced plasticity will be critical for the development of better treatments for opiate addiction and perhaps safer opiate drugs for medicinal use.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385942/pdf/cshperspectmed-ADD-a012070.pdf 

  
Núcleo Coeruleus. Neurotransmisores, Funciones y Patología. 
Dr. Mauricio Valenzuela-Harrington, Dr. Vicente Negrete-Díaz, Dr. Antonio Rodríguez-Moreno
Anestesia en México 2007;19:155-166.
El Nucleus Coeruleus es la principal fuente de noradrenalina en el sistema nervioso central. Este complejo nuclear debido a sus aferencias y eferencias está involucrado en diversas y variadas funciones. Además está involucrado en diversas enfermedades y alteraciones del sistema nervioso central cuando su funcionamiento no es correcto. En esta revisión se describen estas funciones del nucleus coeruleus así como la forma en que participa en enfermedades del sistema nervioso tales como Enfermedad de Alzheimer, Parkinson, Depresión y estrés y su papel en procesos de drogodependencia y síndrome de abstinencia.
Palabras claves: Locus Coeruleus, noradrenalina, neuromodulador, receptores a y b adrenérgicos.
http://www.anestesiaenmexico.org/RAM9/RAM2007-19-3/007.pdf 


Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org