| Revisión sistemática del tratamiento de la hipotensión ortostática después de lesión medular |
A systematic review of the management of orthostatic hypotension after spinal cord injury. Krassioukov A, Eng JJ, Warburton DE, Teasell R; Spinal Cord Injury Rehabilitation Evidence Research Team. International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada. krassioukov@icord.orgArch Phys Med Rehabil. 2009 May;90(5):876-85.AbstractOBJECTIVE: To review systematically the evidence for the management of orthostatic hypotension (OH) in patients with spinal cord injuries (SCIs). DATA SOURCES: A key word literature search was conducted of original and review articles as well as practice guidelines using Medline, CINAHL, EMBASE, and PsycInfo, and manual searches of retrieved articles from 1950 to July 2008, to identify literature evaluating the effectiveness of currently used treatments for OH. STUDY SELECTION: Included randomized controlled trials (RCTs), prospective cohort studies, case-control studies, pre-post studies, and case reports that assessed pharmacologic and nonpharmacologic intervention for the management of OH in patients with SCI. DATA EXTRACTION: Two independent reviewers evaluated the quality of each study, using the Physiotherapy Evidence Database score for RCTs and the Downs and Black scale for all other studies. Study results were tabulated and levels of evidence assigned. DATA SYNTHESIS: A total of 8 pharmacologic and 21 nonpharmacologic studies were identified that met the criteria. Of these 26 studies (some include both pharmacologic and nonpharmacologic interventions), only 1 pharmacologic RCT was identified (low-quality RCT producing level 2 evidence), in which midodrine was found to be effective in the management of OH after SCI. Functional electrical stimulation was one of the only nonpharmacologic interventions with some evidence (level 2) to support its utility. CONCLUSIONS: Although a wide array of physical and pharmacologic measures are recommended for the management of OH in the general population, very few have been evaluated for use in SCI. Further research needs to quantify the efficacy of treatment for OH in subjects with SCI, especially of the many other pharmacologic interventions that have been shown to be effective in non-SCI conditions. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108991/pdf/nihms1773.pdf |
| Parámetros hemodinámicos y el momento de la descompresión quirúrgica de la lesión aguda de la médula espinal cervical |
Hemodynamic parameters and timing of surgical decompression in acute cervical spinal cord injury. Tuli S, Tuli J, Coleman WP, Geisler FH, Krassioukov A. ICORD, University of British Columbia, Vancouver, BC, Canada. J Spinal Cord Med. 2007;30(5):482-90.Abstract BACKGROUND/OBJECTIVES: To evaluate the relationship between the severity of cervical spinal cord injury (SCI) (American Spinal Injury Association [ASIA] grade), presence of neurogenic shock, and timing of surgical intervention. This is a post-hoc analysis from the Sygen multicenter randomized controlled trial. METHODS: Blood pressure (BP) and heart rate (HR) data were collected when patients were first assessed in the emergency room (Time A) and at the time of randomization (Time B). Individuals were subdivided by ASIA grade and by the level of the systolic BP (SBP). RESULTS: Only individuals with cervical SCI from the Sygen trial (n = 577) were evaluated. Severe complete SCI (ASIA grade = A) was established in 57% of these patients. A total of 74 (13%) patients with neurogenic shock (SBP < 90 mmHg) at Time A were identified. The SBP increased significantly from Time A to Time B (P < 0.0001). The median time from SCI to surgical intervention, for ASIA A, was 80.9 hours for patients with initial SBP < 90 mmHg and 58 hours for patients with initial SBP > or = 90 mmHg (P = 0.025). Multivariable analysis after adjusting for confounders revealed a statistically significant difference in the time to surgical intervention based on SBP for ASIA A (P = 0.026), yet not for ASIA B or C/D. CONCLUSIONS: The presence of neurogenic shock was associated with a delay in the timing of surgical intervention in patients with cervical SCI. Detailed evaluation of autonomic dysfunctions following SCI including cardiovascular instability could improve our understanding of the complexities of clinical presentations and possible neurological outcomes. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2141731/pdf/i1079-0268-30-5-482.pdf |
| Consideraciones anestésicas en trauma agudo de la médula espinal |
Anesthetic considerations in acute spinal cord trauma.
Dooney N, Dagal A.
Department of Anaesthesia and Pain Medicine, Harborview Medical Centre, University of Washington, Seattle, WA, USA.
Int J Crit Illn Inj Sci. 2011 Jan;1(1):36-43.
Abstract
Patients with actual or potential spinal cord injury (SCI) are frequently seen at adult trauma centers, and a large number of these patients require operative intervention. All polytrauma patients should be assumed to have an SCI until proven otherwise. Pre-hospital providers should take adequate measures to immobilize the spine for all trauma patients at the site of the accident. Stabilization of the spine facilitates the treatment of other major injuries both in and outside the hospital. The presiding goal of perioperative management is to prevent iatrogenic deterioration of existing injury and limit the development of secondary injury whilst providing overall organ support, which may be adversely affected by the injury. This review article explores the anesthetic implications of the patient with acute SCI. A comprehensive literature search of Medline, Embase, Cochrane database of systematic reviews, conference proceedings and internet sites for relevant literature was performed. Reference lists of relevant published articles were also examined. Searches were carried out in October 2010 and there were no restrictions by study design or country of origin. Publication date of included studies was limited to 1990-2010.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210001/?tool=pubmed
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