Este gas milagroso
This Wonder-Working Gas
Kirk Hogan, MD, JD and Paul S. Myles, MD, MPH
Anesth Analg May 2013 * Volume 116 * Number 5
In this issue of the journal, Turan et al. report for the first time that noncardiac surgery patients receiving general anesthesia with nitrous oxide (N2O) experience 33% decreased odds of 30-day mortality, 17% decreased odds of in-hospital morbidity and mortality, and 41% decreased odds of pulmonary morbidity compared with patients anesthetized without N2O. In particular, 60 deaths within 30 days after surgery were observed in 10,746 patients who received anesthesia that included N2O compared with 89 deaths in 10,746 matched patients who did not. To derive their unforeseen results, the authors applied propensity score matching, a nonexperimental, retrospective causal inference method, to reduce bias in the analysis of clinical data originally collected for purposes other than research.
http://www.anesthesia-analgesia.org/content/116/5/955.full.pdf
Comparando manzanas con naranjas: ¿Solo decir NO al N2O?
Comparing Apples to Oranges: Just Say No to N2O?
Thomas R. Vetter, MD, MPH, and Gerald McGwin, Jr., MS, PhD
Anesth Analgh May 2013 * Volume 116 * Number 5
Nitrous oxide (N2O) was first isolated by Joseph Priestly in 1772 and was recognized as having analgesic properties by Humphrey Davy in 1799, based in part on his self-treatment of a toothache. Davy prophetically noted that because the agent "appears capable of destroying physical pain, it may probably be used with advantage during surgical operations." However, early and mid-19th century human use of N2O was more often as a recreational drug at the then common "laughing gas" parties and public demonstrations in theaters, music halls, and carnivals. Despite Horace Wells' unsuccessful initial public administration of N2O in 1845 at Massachusetts General Hospital, beginning in the 1860s, Gardner Quincy Colton and his colleagues subsequently mastered and promoted its widespread clinical use in America and Europe. In the intervening 150 years, N2O has remained a widely used inhaled anesthetic agent, which has been ostensibly administered safely to several billion surgical patients worldwide.
http://www.anesthesia-analgesia.org/content/116/5/959.full.pdf
Óxido nitroso y evolución cardiovascular: Perspectivas desde la prueba POISE
Nitrous Oxide and Cardiovascular Outcome: Perspective from the POISE Trial
Rachel Eshima McKay, MD
Anaesth Analg May 2013 * Volume 116 * Number 5
Although numerous trials have been conducted over the past 2 decades assessing strategies to decrease the risk of postoperative myocardial infarction (MI),clinicians are still left with limited answers regarding which interventions will improve outcomes for their patients. Unfortunately, rates of cardiovascular complications after noncardiac surgery continue to be as high as 6% in patients with risk factors for coronary artery disease, and these rates may increase over time. According to the US Census Bureau, between 2000 and 2010 the US population over age 65 years reached 40 million and the group aged 85 to 94 years experienced 30% increase in growth, a rate 3 times greater than that of the overall population. Recent observational studies have confirmed advanced age as a predictor of both postoperative myocardial damage and 30-day postoperative mortality. Assuming that the age distribution of our surgical population will change in accordance with that of the population at large, we should expect that a growing number of patients will suffer costly postoperative cardiovascular complications in the future, unless we identify and implement effective risk reduction measures. Although numerous small studies have explored strategies to reduce risk of postoperative MI within the past 2 decades, no large trial to date has offered conclusive evidence of a single, universally protective intervention.
http://www.anesthesia-analgesia.org/content/116/5/962.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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