martes, 5 de marzo de 2019

Balance de líquidos en el niño grave / Children, critical care and fluid balance

Sobrecarga de líquidos en niños críticamente enfermos.
Fluid Overload in Critically Ill Children.
Front Pediatr. 2018 Oct 29;6:306. doi: 10.3389/fped.2018.00306. eCollection 2018.
Background: A common practice in the management of critically ill patients is fluid resuscitation. An excessive administration of fluids can lead to an imbalance in fluid homeostasis and cause fluid overload (FO). In pediatric critical care patients, FO can lead to a multitude of adverse effects and increased risk of morbidity. Objectives: To review the literature highlighting impact of FO on a multitude of outcomes in critically-ill children, causative vs. associative relationship of FO with critical illness and current pediatric fluid management guidelines. Data Sources: A literature search was conducted using PubMed/Medline and Embase databases from the earliest available date until June 2017. Data Extraction: Two authors independently reviewed the titles and abstracts of all articles which were assessed for inclusion. The manuscripts of studies deemed relevant to the objectives of this review were then retrieved and associated reference lists hand-searched. Data Synthesis: Articles were segregated into various categories namely pathophysiology and sequelae of fluid overload, assessment techniques, epidemiology and fluid management. Each author reviewed the selected articles in categories assigned to them. All authors participated in the final review process. Conclusions: Recent evidence has purported a relationship between mortality and FO, which can be validated by prospective RCTs (randomized controlled trials). The current literature demonstrates that "clinically significant" degree of FO could be below 10%. The lack of a standardized method to assess FB (fluid balance) and a universal definition of FO are issues that need to be addressed. To date, the impact of early goal directed therapy and utility of hemodynamic parameters in predicting fluid responsiveness remains underexplored in pediatric resuscitation.
KEYWORDS: acute kidney injury; critical care; fluid overload; intensive care; pediatric nephrology
Síndrome de dificultad respiratoria aguda pediátrica: manejo de líquidos en la UCIP.
Pediatric Acute Respiratory Distress Syndrome: Fluid Management in the PICU.
Front Pediatr. 2016 Mar 21;4:21. doi: 10.3389/fped.2016.00021. eCollection 2016.
The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS). Patients with ARDS have widespread damage of the alveolar-capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes.
KEYWORDS: PARDS; children; critical care; fluid balance; lung edema; management
International Symposium on Ultrasound, ISURA
May 9-1. Porto, Portugal
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lunes, 4 de marzo de 2019

Una célula madre recién descubierta que mantiene los huesos en crecimiento.

Líquidos iv en perioperatorio / IV fluids in surgery

Marzo 4,  2019.  No. 3357

Convocatoria para Capítulos sobre Anestésicos Locales
Call for Book Chapters on Local Anesthetics
Conceptos actuales de manejo de fluidos en vías de recuperación mejoradas.
Current concepts of fluid management in enhanced recovery pathways.
Br J Anaesth. 2018 Feb;120(2):376-383. doi: 10.1016/j.bja.2017.10.011. Epub 2017 Nov 24.
Perioperative fluid management impacts outcomes and plays a pivotal role in enhanced recovery pathways (ERPs). There have been major advances in understanding the effects of fluid therapy and administration during the perioperative period. Improving fluid management during this period leads to a decrease in complications, decrease in length of stay (LOS), and enhanced patient outcomes. It is important to consider preoperative and postoperative fluid management to be just as critical as intraoperative management given multiple associated benefits to the patients. Preoperative hydration with (complex) carbohydrate drinks up until 2 h before surgery is safe and should be encouraged, as this helps improve metabolism, decrease insulin resistance, reduce anxiety, and reduce nausea and vomiting. During the intraoperative period, the goals of fluid management are to maintain euvolemia using an individualized plan for fluid and haemodynamic management, matching the needs for monitoring with patient and surgical risk through goal-directed therapy (GDT). By combining the use of fluids and inotropes, GDT uses measurements and indicators of cardiac output and stroke volume to improve blood flow intraoperatively, and ultimately reduce LOS and complications. In the postoperative period, an early transition to oral hydration helps to enhance the conditions for healing and recovery from surgery. I.V. fluid therapy should be kept at a minimum, and urine output should not be the driving force for fluid administration. The optimization of perioperative fluid management is critical to ERPs as it helps improve pulmonary function, tissue oxygenation, gastrointestinal motility, and wound healing.
KEYWORDS: fluid therapy; perioperative care; perioperative period
Terapia de fluidos en el contexto perioperatorio: una revisión clínica.
Fluid therapy in the perioperative setting-a clinical review.
J Intensive Care. 2016 Apr 16;4:27. doi: 10.1186/s40560-016-0154-3. eCollection 2016.
BACKGROUND: Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. RESULTS: Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well-being and muscular strength and to reduce insulin resistance. Hence, the intake of fluid (preferably containing carbohydrates) should be encouraged up to 2 h prior to surgery in order to avoid dehydration. Excessive intravenous fluid administration adds to tissue inflammation and edema formation, thereby compromising tissue healing. During major abdominal surgery a "zero-balance" intraoperative fluid strategy aims at avoiding fluid overload (and comparable to the so-called restrictive approach) as well as goal-directed fluid therapy (GDT). Both proved to significantly reduce postoperative complications when compared to "standard fluid therapy". Trials comparing "restrictive" or zero-balance and GDT have shown equal results, as long as fluid overload is avoided in the GDT group as well (categorized as "zero-balance GDT"). It is possible that high-risk surgical patients, such as those undergoing acute surgery, may benefit from the continuous monitoring of circulatory status that the GDT provides. Data on this group of patients is not available at present, but trials are ongoing. CONCLUSION: In elective surgery, the zero-balance approach has shown to reduce postoperative complications and is easily applied for most patients. It is less expensive and simpler than the zero-balance GDT approach and therefore recommended in this review. In outpatient surgery, 1-2 L of balanced crystalloids reduces postoperative nausea and vomiting and improves well-being.
KEYWORDS: Fluid therapy; Goal-directed fluid therapy; Outcome of surgery; Postoperative complications; Restricted; Third space; Third space loss
La administración perioperatoria de líquido intravenoso cristaloide tamponado versus no tamponado para mejorar los resultados después de procedimientos quirúrgicos en adultos: una revisión sistemática Cochrane
Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures: a Cochrane systematic review.
Perioper Med (Lond). 2018 Dec 13;7:27. doi: 10.1186/s13741-018-0108-5. eCollection 2018.
BACKGROUND: Buffered intravenous fluid preparations contain substrates to maintain acid-base status. The objective of this systematic review was to compare the effects of buffered and non-buffered fluids administered during the perioperative period on clinical and biochemical outcomes. METHODS: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library until May 2017 and included all randomised controlled trials that evaluated buffered versus non-buffered fluids, whether crystalloid or colloid, administered to surgical patients. We assessed the selected studies for risk of bias and graded the level of evidence in accordance with Cochrane recommendations. ....CONCLUSIONS: Small effect sizes for biochemical outcomes and lack of correlated clinical follow-up data mean that robust conclusions on major morbidity and mortality associated with buffered versus non-buffered perioperative fluid choices are still lacking. Buffered fluid may have biochemical benefits, including a significant reduction in postoperative hyperchloraemia and metabolic acidosis.
KEYWORDS: Fluid therapy; Plasma substitutes; Surgery
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Anestesiología y Medicina del Dolor

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martes, 19 de febrero de 2019

Factores que predicen los re-desgarres del manguito rotador: un análisis de 1000 reparaciones consecutivas del manguito rotador

La tasa de re-desgarres después de la reparación del manguito rotador varía de 11% a 94%. Un re-desgarre se asocia con resultados clínicos subjetivos y objetivos más pobres que la reparación intacta.
Este estudio fue diseñado para determinar qué factores preoperatorios y / o intraoperatorios tuvieron la mayor asociación con los re-desgarres después de la reparación artroscópica del manguito rotador.
El re-desgarre del manguito rotador es un proceso multifactorial en el que ningún factor preoperatorio o intraoperatorio único lo predice de manera abrumadora. Sin embargo, el tamaño del desgarro del manguito rotador (dimensiones del desgarro, área del desgarro y grosor del desgarro) mostró asociaciones más fuertes con los re-desgarres a los 6 meses de la cirugía que las mediciones de la calidad del tejido y las lesiones concomitantes del hombro.
 2014 May;42(5):1134-42. doi: 10.1177/0363546514525336. Epub 2014 Apr 18.

Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs.


arthroscopic rotator cuff repair; retear; rotator cuff tear; shoulder
PMID:24748610    DOI:10.1177/0363546514525336
[Indexed for MEDLINE]
Copyright © 2019 by SAGE Publications

Tratamiento del desgarro parcial del ligamento cubital en el codo con plasma rico en plaquetas

Los estudios han demostrado el potencial del plasma rico en plaquetas (PRP) para curar el tejido dañado. Hasta la fecha, no hay informes publicados de resultados clínicos de desgarros parciales del ligamento colateral cubital (UCL) del codo tratado con PRP.
Los resultados de este estudio indican que el PRP es una opción eficaz para tratar con éxito los desgarros UCL parciales del codo en atletas.
 2013 Jul;41(7):1689-94. doi: 10.1177/0363546513487979. Epub 2013 May 10.

Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma.


platelet-rich plasma; ulnar collateral ligament
PMID:23666850  DOI:10.1177/0363546513487979
[Indexed for MEDLINE]

Copyright © 2019 by SAGE Publications

Una técnica quirúrgica para la osteotomía correctiva de una deformidad humeral distal compleja mediante el uso de tecnología de impresión tridimensional

La osteotomía correctiva para la corrección de deformidades complejas es un procedimiento desafiante, tanto en su planificación como en su ejecución. Las técnicas tradicionales de planificación, particularmente cuando se aplican a la deformidad periarticular, son generalmente inexactas y el resultado de una osteotomía posterior puede ser subóptimo. En esta técnica descrita, se generaron modelos tridimensionales impresos a partir de exploraciones tomográficas computadas preoperatorias para ayudar tanto en la planificación como en la ejecución de una osteotomía humeral distal. Se describe un caso único de cúbito valgo de 40 grados con deformidad por flexión fija después de la no unión de una fractura del cóndilo lateral del húmero. 

AEA CERCA DE TI: Rodilla y Hombro

lunes, 18 de febrero de 2019



🔴 #Dolor intenso que aparece cuando se está corriendo y en su estado más avanzado también cuando se baja cuestas o se sube y baja escaleras.

🔴 Crujidos y “clics” en la rodilla.

🔴 Fallos en la rodilla y pérdida repentina de fuerza.

🔴 En estado avanzado el cartílago se desgasta tanto que los extremos de los huesos se tocan y puede haber deformación en el aspecto de la rodilla.


⚠️ EXISTEN varias opciones que utilizamos con buenos resultados:

✔️ Equilibrar la mecánica: Corrección de los ejes articulares mediante osteotomía
✔️ Reconstrucción de meniscos
✔️ Reconstrucción de ligamentos
✔️ Indicaciones precisas de tratamientos fisioterapéuticos para fortalecimiento muscular y estiramientos.
✔️ Tratamiento con células madre mesenquimales
✔️ Sustitución y prótesis

Recuerda que puedo atender tus dudas básicas en


✅ Traumatología
✅ Ortopedia
✅ Artroscopia
✅ Artroplastia (Prótesis)

🔴 Hombro 🔴 Rodilla 🔴 Codo

📞 Puedes pedir cita al (55)
🏨 Mi Consultorio es el #730 del Hospital Angeles Metropolitano en Tlacotalpan #59 en la #CDMX

#MiPrioridadTuMovilidad #Traumatologo #TraumatologíaDeportiva #Hombro #Codo #Rodilla #CDMX

jueves, 14 de febrero de 2019

Insulinas / Insulins

Febrero 10,  2020 No. 3335

Convocatoria para Capítulos sobre Anestésicos Locales
Call for Book Chapters on Local Anesthetics
Guía definitiva de insulina
Ultimate Guide to Insulin
King Khalid University
The book presents a qualitative and quantitative approach to understand, manage and enforce the integration of insulin into diabetes mellitus. Utilizing a sound theoretical and practical foundation and illustrating procedural techniques through scientific examples, the book bridges the gap between insulin and diabetes mellitus management. Detailed procedures have been omitted because of the variety of equipment and commercial kits used in today's clinical laboratories.
Análogos de la insulina de acción corta versus insulina humana regular en la glucosa posprandial e hipoglucemia en la diabetes mellitus tipo 1: una revisión sistemática y un metanálisis.
Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus: a systematic review and meta-analysis.
Diabetol Metab Syndr. 2019 Jan 3;11:2. doi: 10.1186/s13098-018-0397-3. eCollection 2019.
INTRODUCTION: Strict glucose control using multiple doses of insulin is the standard treatment for type 1 diabetes mellitus (T1DM), but increased risk of hypoglycemia is a frequent drawback. Regular insulin in multiple doses is important for achieving strict glycemic control for T1DM, but short-acting insulin analogues may be better in reducing hypoglycemia and postprandial glucose levels....... CONCLUSIONS: Short-acting insulin analogues are superior to regular human insulin in T1DM patients for the following outcomes: total hypoglycemic episodes, nocturnal hypoglycemia, severe hypoglycemia, postprandial glucose, and HbA1c.
KEYWORDS: Aspart insulin; Diabetes mellitus; Glulisine insulin; Insulin; Lispro insulin; Meta-analysis; Systematic review; Type 1 diabetes
Insulinas concentradas en la práctica clínica actual.
Concentrated insulins in current clinical practice.
Diabetes Res Clin Pract. 2018 Dec 21;148:93-101. doi: 10.1016/j.diabres.2018.12.007. [Epub ahead of print]
New concentrated insulins (exceeding 100 units/mL) and dedicated devices have recently become available, offering new treatment options for people with diabetes, for basal and prandial insulin supplementation. The concentrated insulin formulations range from 2-fold concentration (insulin lispro 200 units/mL) with rapid-acting prandial action to 5-fold concentration (human regular insulin, 500 units/mL) with basal and short-acting prandial actions. Long-acting basal insulins include degludec 200 units/mL and glargine 300 units/mL. Concentrated insulins have been developed with the goal of easing insulin therapy by reducing the volume and number of injections and in some cases making use of altered pharmacokinetic and pharmacodynamic properties. This review summarizes the unique characteristics of each concentrated insulin to help healthcare providers and people with diabetes understand how to best use them.
KEYWORDS: Concentrated; Diabetes; Insulin; Pharmacokinetic; Prandial
Congresos Médicos por Especialidades en todo Mundo
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Anestesiología y Medicina del Dolor

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