Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
Total intravenous anesthesia for major burn surgery. Cancio LC, Cuenca PB, Walker SC, Shepherd JM. U.S. Army Institute of Surgical Research Fort Sam Houston, Texas, USA. Int J Burns Trauma. 2013 Apr 18;3(2):108-14. Print 2013. Abstract Total intravenous anesthesia (TIVA) is frequently used for major operations requiring general anesthesia in critically ill burn patients. We reviewed our experience with this approach. METHODS: During a 22-month period, 547 major burn surgeries were performed in this center's operating room and were staffed by full-time burn anesthesiologists. The records of all 123 TIVA cases were reviewed; 112 records were complete and were included. For comparison, 75 cases were selected at random from a total of 414 non-TIVA general anesthetics. Some patients had more than one operation during the study: as appropriate for the analysis in question, each operation or each patient was entered as an individual case. For inter-patient analysis, exposure to 1 or more TIVAs was used to categorize a patient as member of the TIVA group. RESULTS: Excision and grafting comprised 78.2% of the operations. 14 TIVA regimens were used, employing combinations of 4 i.v. drugs: ketamine (K, 91 cases); i.v. methadone (M, 62); fentanyl (F, 58); and propofol (P, 21). The most common regimens were KM (34 cases); KF (26); KMF (16); and K alone (8). Doses used often exceeded those used in non-burn patients. TIVA was preferred for those patients who were more critically ill prior to surgery, with a higher ASA score (3.87 vs. 3.11). Consistent with this, inhalation injury (26.7 vs. 1.6%), burn size (TBSA, 36.3 vs. 15.8%), and full-thickness burn size (FULL, 19.8 vs. 6.5%) were higher in TIVA than in non-TIVA patients. Despite this, intraoperative pressor use was as common in TIVA as in non-TIVA cases (23.9 vs. 22.7%). CONCLUSIONS: TIVA was used in patients whose inhalation injury rate and TBSA were greater than those of non-TIVA patients. TIVA cases were not associated with increased hemodynamic instability. TIVA is a viable approach to general anesthesia in critically ill burn patients. KEYWORDS: Total intravenous anesthesia (TIVA), burn, surgery http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636662/pdf/ijbt0003-0108.pdf
Manejo de la vía aérea en pacientes con cicatrices contráctiles postquemaduras mentoesternal y periorales
Managing difficult airway in patients with post-burn mentosternal and circumoral scar contractures Tae-Hyung Han, Hana Teissler, Richard J Han, Joshua D Gaines, and Tho Qynh Nguyen Int J Burns Trauma. 2012; 2(2): 80-85. Abstract Securing the airway is a crucial aspect during reconstructive surgeries of patients with extensive post-burn mentosternal scar contractures; however, the American Society of Anesthesiologists Difficult Airway Management Algorithm recommendation of initial direct laryngoscopy may not be appropriate for these complicated patients. Consequently, there is a significant risk for failure of intubation and airway emergency. We suggest that initial attempts at securing the airway be made with indirect laryngoscopy. Many airway techniques have been effectively used in burn patients, but the role of awake blind or fiberoptic bronchoscopy, although well established in the non-burn population, has yet to be evaluated in burn patients. We report a case series of successful management of difficult airways with fiberoptic bronchoscopy in patients with varying degrees of post-burn head and neck scar contractures. Keywords: Burn airway, neck contracture, fiberoptic bronchoscopy, laryngeal mask airway
Infiltración tumescente de lidocaína y adrenalina para cirugía de quemados
Tumescent infiltration of lidocaine and adrenaline for burn surgery. Gümüs N. Plastic, Reconstructive and Aesthetic Surgery Department, Cumhuriyet University Medical Faculty, Sivas, Turkeya. Ann Burns Fire Disasters. 2011 Sep 30;24(3):144-8. Abstract Tumescent infiltration is a widely used type of regional anaesthesia for cutaneous surgery. This technique makes it possible to administer high doses of lidocaine and adrenaline within the safety limits, leading to reduction in pain and bleeding during the operation. In this study, tumescent infiltration of lidocaine and adrenaline was used in routine procedures of burn surgery such as escharectomy, debridement, tangential excision, and skin grafting. In 17 patients with scald and flame burns, tumescent infiltration was performed prior to surgical procedures under either general anaesthesia or intravenous sedation. After 15 minutes, escharectomy, debridement of necrotic tissues, tangential excision of the burned skin, removal of the granulation tissue, and harvesting of the skin graft were performed. No complications occurred. All vital signs remained within safety limits during the operations. Haemorrhage was minimal and the operations were thus performed easily and rapidly. During removal of granulation tissue, very little blood loss occurred so that both the excision of granulation tissue and skin grafting were accomplished rapidly because of the minimal need of severe haemostasis. The duration of surgery was considerably reduced. No haematoma or bruising developed after surgery. No blood transfusions were required as the decline in haematocrit levels was not more than 3%. Postoperative analgesia was excellent for the first 8 h, eliminating the need of additional measures. Tumescent infiltration of adrenaline and lidocaine is a simple, effective and safe technique which facilitates anaesthesia in large areas of the burned body surface and leads to less bleeding and easy surgical dissection and hydrodissection, allowing fast, easy and painless burn surgery. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293232/pdf/Ann-Burns-and-Fire-Disasters-24-144.pdf
Intubación traqueal con GlideScope® con y sin relajantes musculares. Estudio clínico prospectivo y randomizado
GlideScope® Tracheal Intubation with and without Muscle Relaxation: A Prospective, Randomized Clinical Trial Kay B. Leissner, Sascha Beutler, Luca Bigatello and Venkatesh Srinivasa VA Boston Healthcare System and Massachusetts General Hospital, USA The Open Anesthesiology Journal, 2013, 7, 5-11 Abstract: Purpose: GlideScope® videolaryngoscope (GVL, Verathon Medical Inc., Bothell, WA, USA) assisted orotracheal intubation is a useful technique for patients who are difficult to intubate, but who can be mask ventilated. The effect of muscle relaxants on the success of GVL intubation has not been evaluated. The authors conducted a prospective, placebo-controlled study to assess the effectiveness and incidence of complications of GVL-assisted tracheal intubation performed during general anesthesia with and without the use of a muscle relaxant in patients with seemingly normal airway anatomy. Material and Methods: 52 patients who required orotracheal intubation were prospectively included. Anesthesia was induced using midazolam (0.01-0.03 mg/kg), fentanyl (1-3 μg/kg) and propofol (1-3 mg/kg). Patients were randomly assigned to one of two groups to receive rocuronium 0.6 mg/kg (n = 26 for rocuronium group) or saline intravenously (n = 26 for placebo group). GVL-assisted intubation was initiated after 90 s. The number of successful intubations, the number of attempts and their duration were recorded. Events during the procedure, such as airway trauma, blood pressure changes and movements were also recorded. Results: The success rate of GVL intubation was 100% in the placebo group and 100% in the rocuronium group. Patients in both groups received the same number of intubation attempts and the intubation time were alike (53± 15 vs. 55 ± 18 s; p=0.63). The Placebo group experienced a greater incidence of events during intubation (81 vs. 35%; P < 0.001) than patients in the rocuronium group. Conclusions: Omitting muscle relaxants in patients with apparently normal airways is not associated with a higher failure rate, increased intubation attempts or intubation time when performing GVL assisted orotracheal intubation, but is associated with a higher rate of patient movement. Keywords: Airway, Airway Management, GlideScope, Muscular Relaxation, Tracheal Intubation, Video Laryngoscope. http://www.benthamscience.com/open/toatj/articles/V007/5TOATJ.pdf
Meningitis iatrogénica despues de anestesia raquídea
IATROGENIC MENINGITIS AFTER SPINAL ANESTHESIA R. Hashemi and A. Okazi UNESCO Chair of Human Rights, Peace and Democracy, Bioethics Group, Shahid Beheshiti University, Tehran, Iran. Medicolegal Organization of Mazandaran, Sari, Iran Acta Medica Iranica 2008; 46(5): 434-436. Abstract. Bacterial meningitis after spinal and epidural anesthesia is a very rare but serious complication. We report a case of meningitis developing a number of hours after a spinal block for Caesarean section. No organism was grown but the CSF pattern was suggestive of bacterial meningitis. Severe neurological sequelae were present after three months of hospitalization. Meningitis is a serious complication and its early diagnosis and effective treatment is essential. Meningitis should always be considered as a possible differential diagnosis in patients suspected of having post spinal headache, convulsion and changes in mental statues. A thorough knowledge and practice of aseptic techniques is crucial in performing spinal and epidural anesthesia. Key words: Bacterial meningitis, spinal anesthesia, epidural anesthesia http://journals.tums.ac.ir/upload_files/pdf/_/12267.pdf
Meningitis despues de raquianestesia
Meningitis after spinal anaesthesia. SEBRECHTS J. Br Med J. 1947 Aug 9;2(4518):226. SIR,-Dr. C. A. Vuylsteke (B.M.J., Feb. 1, p. 179) reported four cases of pseudomonas meningitis following spinal anaesthesia. Three of these, caused by the melanogenes variety of Ps. pyocyanea, were fatal; one, caused by true Ps. pyocyanea, recovered after sulphathiazole treatment. Patients had been operated upon by three different surgeons at two surgical clinics whose nursing personnel belonged to the same school. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2055521/pdf/brmedj03741-0032f.pdf
Hematoma subaracnoideo despues de raquianestesia
Spinal subarachnoid hematoma after spinal anesthesia. Jeon SB, Ham TI, Kang MS, Shim HY, Park SL. Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea. Korean J Anesthesiol. 2013 Apr;64(4):388-9. doi: 10.4097/kjae.2013.64.4.388.
Moen et al. reported that spinal hematoma occurred in 8 out of 1,260,000 cases of spinal anesthesia in Sweden, and subarachnoid hematoma is known to be very rare. We report a case of subarachnoid hematoma after spinal anesthesia in a patient without coagulopathy. http://ekja.org/Synapse/Data/PDFData/0011KJAE/kjae-64-388.pdf
Tratamiento conservador de un hematoma despues de anestesia espinal: informe de caso y revisión de la literatura
Conservative treatment of hematoma after spinal anesthesia: case report and literature review. Segabinazzi D, Brescianini BC, Schneider FG, Mendes FF. FFCMPA. Rev Bras Anestesiol. 2007 Apr;57(2):188-94. Abstract BACKGROUND AND OBJECTIVES: Spinal anesthesia caries the risk of bleeding. Compression of nervous tissue secondary to the formation of a hematoma can cause neurological damage, which, if not diagnosed and treated in a timely fashion, can be permanent. The identification of risk factors, diagnosis, and early treatment are important for the prognosis. The objective of this report was to describe the case of a hematoma after spinal anesthesia treated conservatively, and review the literature. CASE REPORT: Male patient, 73 years old, 65 kg, 1.67 m, and ASA physical status III, underwent spinal anesthesia for removal of a peritoneal dialysis catheter. During the puncture, the patient experienced paresthesia of the right lower limb. Fifteen milligrams of 0.5% hyperbaric bupivacaine without vasoconstrictor were administered. Twenty-four hours later, saddle anesthesia and lumbar pain persisted and, after 48 hours, the patient presented urinary incontinence. An MRI demonstrated the presence of an expansive subarachnoid process compressing the nerve roots (L4 and S1). After evaluation by the neurosurgeon, conservative treatment was instituted. The patient was discharged from the hospital on the 18th postoperative day, asymptomatic. CONCLUSIONS: The case reported here presented a good evolution with the conservative treatment. http://www.scielo.br/pdf/rba/v57n2/en_08.pdf
http://www.medigraphic.com/pdfs/orthotips/ot-2009/ot091j.pdf Prevención de lesiones deportivas Mariano Fernández Fairen,* José María Busto Villarreal** POR QUÉ SE LESIONAN LOS ATLETAS Las lesiones deportivas se pueden dividir en tres grandes categorías, atendiendo a cómo se han producido: por contacto, cuando colabora activamente otro deportista, antagonista o no del lesionado; por autoagresión, cuando es el propio lesionado el que se lesiona, y por sobrecarga, cuando la lesión es debida a la repetición cíclica de un gesto deportivo por encima de la capacidad resistiva de los tejidos solicitados. Las dos primeras clases obedecen a un episodio en el que se dispensa alta energía y dan pie a lesiones agudas, en tanto que las últimas ocurren después de un cierto tiempo de práctica deportiva y suelen tener un fondo de cronicidad.1 Hay deportes que favorecen la producción de lesiones de quienes los practican por la energía dispensada en el mismo, por su violencia, o por la frecuencia e inevitabilidad del contacto.2,3 Hay que citar, como ejemplos, el motociclismo, la equitación o el esquí, el boxeo y las diferentes modalidades de lucha; también el baloncesto, en los que grandes masas entran en contacto violento permanentemente. Además, puede haber también una cierta especificidad según sexo en la causalidad de accidentes en un determinado deporte.3,4 En la figura 1 se aprecian claramente esas diferencias, quedando clara la pasión con la que la mujer se ha incorporado al mundo del fútbol, como ejemplo de deporte de contacto, donde incluso hay mayor porcentaje de lesiones que entre los hombres.5 * Médico adscrito al Instituto de Cirugía Ortopédica y Traumatología de Barcelona, España. ** Médico adscrito a la Clínica de Medicina Deportiva del Club de Fútbol Pachuca, México. Dirección para correspondencia: Dr. José María Busto Villarreal. Libramiento Circuito de la Concepción Km 2 s/n, Col. La Concepción, 42160 San Agustín Tlaxiaca, Hidalgo. Correo electrónico: jose.busto@tuzos.com.mx
Aparición tardía de aracnoiditis espinal tras un bloqueo caudal
Delayed occurrence of spinal arachnoiditis following a caudal block. Na EH, Han SJ, Kim MH. School of Medicine, Ewha Womans University, Seoul, Republic of Korea. J Spinal Cord Med. 2011 Nov;34(6):616-9. doi:10.1179/2045772311Y.0000000035. Abstract CONTEXT: Spinal arachnoiditis is a rare disease caused by fibrosis and adhesion of the arachnoid membrane due to chronic inflammation. The causes of arachnoiditis are infection, spinal surgery, intraspinal injection of steroid or myelography dye, and spinal anesthesia. METHOD: Case report.FINDINGS: A 60-year-old woman presented with progressive weakness and sensory change of both legs and urinary symptoms. She had received a single caudal block 6 months before symptom onset. Magnetic resonance imaging of the thoraco-lumbar spine showed an intradural extramedullary tumor at the T5-T7 level. She underwent laminectomy and tumor resection. The pathological finding was arachnoiditis. After surgery, a rehabilitation program of strengthening exercises of both lower extremities and gait training was started. At 2-month follow-up, she was able to walk with orthoses and performed daily activities with minimal assistance. CONCLUSION: Symptoms of spinal arachnoiditis occurred 6 months after a single caudal block in this woman. Clinicians should be aware of this possible delayed complication. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237290/pdf/scm-34-616.pdf
Bloqueo epidural obstétrico y aracnoiditis crónica adhesiva
Obstetric epidurals and chronic adhesive arachnoiditis. Rice I, Wee MYK, Thomson K. Br J Anaesth 2004; 92: 109-20 It has been suggested that obstetric epidurals lead to chronic adhesive arachnoiditis (CAA). CAA is a nebulous disease entity with much confusion over its symptomatology. This review outlines the pathological, clinical, and radiological features of the disease. The proposed diagnostic criteria for CAA are: back pain that increases on exertion, with or without leg pain; neurological abnormality on examination; and characteristic MRI findings. Using these criteria, there is evidence to show that epidural or subarachnoid placement of some contrast media, preservatives and possibly vasoconstrictors, may lead to CAA. No evidence was found that the preservative-free, low concentration bupivacaine with opioid mixtures or plain bupivacaine currently used in labour lead to CAA. http://bja.oxfordjournals.org/content/92/1/109.full.pdf
Aracnoiditis crónica adhesiva Chronic adhesive arachnoiditis J. A. Aldrete Birmingham, AL, USA British Journal of Anaesthesia 93 (2): 301-7 (2004) Editor-The review on the topic of 'chronic adhesive arachnoiditis' (CAA) from obstetric epidurals by Rice and colleagues1 was apparently triggered by a series of articles that appeared in one of the London tabloids, fostered by some of the members of the Arachnoiditis Trust. These articles were unreasonable to many of us that remember the statistics of maternal deaths in the 1970s in the UK,2 when general anaesthesia was the predominant form of analgesia; aspiration of gastric contents and difficulty with tracheal intubation were the main culprits. I also feel that it is the right of women in labour to ask for pain relief, and anaesthetists ought to provide it for them. But we cannot deny that neuroaxial anaesthesia produces morbidity and that neurological deficits are probably one of the most serious. Unfortunately, the authors of the review lost the opportunity to assess the subject of neurological deficit and arachnoiditis (ARC) after epidural anaesthesia. Instead of being impartial, they attempted to prove that adhesive arachnoiditis does not happen as frequently as the patrons of the 'Trust' claimed it did and, when it does occur, they dismissed it as irrelevant. http://bja.oxfordjournals.org/content/93/2/301.full.pdf+html
Aracnoiditis. Sumario breve de la literatura
Arachnoiditis. A brief summary of the literature Peter Day This report is a brief descriptive summary review on arachnoiditis in the form of a background paper. A comprehensive and evidence-based systematic review of the literature is not presented here. This review is a synthesis of information available in the literature that addresses the following: a summary of available literature, the nature and etiology of arachnoiditis, the characteristics of diagnosis, estimates of the prevalence and incidence of arachnoiditis, prognosis, treatment and future outlook for the condition, prevention, and arachnoiditis as a public health concern in New Zealand. The report was commissioned by the Ministry of Health. http://www.otago.ac.nz/christchurch/otago014038.pdf
On the Cover of Sunday's Book Review 'TransAtlantic' By COLUM McCANN Reviewed by ERICA WAGNER
Colum McCann's wide-ranging new novel, "TransAtlantic," tells the stories of men and women who chose to leap across the ocean from Ireland to the New World or back again.
The author of "The Da Vinci Code" and, most recently, "Inferno" made "the mistake" of reading "The Exorcist" at age 15: "It was the first and last horror book I've ever opened." By the Book: Archive 'Joyland' By STEPHEN KING Reviewed by WALTER KIRN
Stephen King's lovelorn narrator takes a summer job at a haunted Southern amusement park. 'The Fall of Arthur' By J. R. R. TOLKIEN. Edited by CHRISTOPHER TOLKIEN. Reviewed by ANDREW O'HEHIR
An unfinished poem by J. R. R. Tolkien explores the tale of King Arthur. 'Bad Boy' By ERIC FISCHL and MICHAEL STONE Reviewed by LAURA KIPNIS
Alongside painters like Julian Schnabel and David Salle, Eric Fischl came of age in the frenzied New York art world of the 1980s.
In this memoir, an Afghan family's attempts to escape the horrors of war show them new ways of seeing their world. 'On Sal Mal Lane' By RU FREEMAN Reviewed by CRISTINA GARCÍA
A looming civil war threatens to engulf the multiethnic Sri Lankan street of Ru Freeman's novel. 'Questions of Travel' By MICHELLE de KRETSER Reviewed by RANDY BOYAGODA
Robert Kuttner champions the cause of indebted students, families and states. 'Conscience and Its Enemies' By ROBERT P. GEORGE Reviewed by KAY S. HYMOWITZ
From Chinese economic reform to the Iranian revolution, Christian Caryl sees 1979 as a crucial doorway into the present era. 'My Struggle: Book 2: A Man in Love' By KARL OVE KNAUSGAARD. Translated by DON BARTLETT. Reviewed by LELAND de la DURANTAYE
The second installment of Karl Ove Knausgaard's six-volume autobiographical novel. Illiberal Arts By ANDREW DELBANCO
In her centenary year, Barbara Pym's "spry little domestic novels" command a loyal readership. Show Some Spine By CHLOË SCHAMA
Why is the faceless woman so ubiquitous on book covers? Inside the List By GREGORY COWLES
For the title character of his new novel, "Bad Monkey," which is No. 3 on the hardcover fiction list, Carl Hiaasen wanted "sort of a Lindsay Lohan of monkeys."
This week, Andrew Delbanco discusses two new books about the state of higher education; Julie Bosman has notes from the field; Andrew O'Hehir talks about "The Fall of Arthur," by J. R. R. Tolkien; and Gregory Cowles has best-seller news. Pamela Paul is the host.
Biblioteca Nembro / Archea | Plataforma Arquitectura según Karina Duque La intención era hacer el edificio a disposición de los ciudadanos, mediante la renovación y ampliación del edificio original, que se convertiría en la nueva biblioteca municipal y por lo tanto en un centro de cultura. La planta en forma de “C” ... Plataforma Arquitectura Diario El Mundo » El Salvador se integra en la Biblioteca Digital del ... según Karla Recinos Los recursos digitalizados de la Biblioteca Nacional de El Salvador se han incorporado ayer a laBiblioteca Digital del Patrimonio Iberoamericano (BDPI), portal de consulta y recuperación del patrimonio cultural digital, pionero en el ámbito ... Diario El Mundo
Biblioteca abandonada Los Andes (Argentina) El motivo de la presente es denunciar un verdadero atentado a la cultura que muestra una negligencia e inoperancia imperdonables para una repartición estatal, resulta un daño patrimonial que no podrá repararse y perjudica a miles de habitantes de ... Ver todos los artículos sobre este tema »
Emulsión de lípidos intravenosos: un nuevo antídoto para uso en resucitación
Intravenous lipid emulsion:a new antidote for use in resuscitation SANTIAGO NOGUÉ, NURIA COROMINAS, DOLORS SOY, JUAN CINO. Sección de Toxicología Clínica. Área de Urgencias. Servicio de Farmacia. Servicio de Cardiología. Hospital Clínic. Barcelona, Spain. 4Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS. Barcelona, Spain. Emergencias 2011;23:378-385 This review examines the pharmacologic and pharmacokinetic aspects of the intravenous infusion of lipid emulsion and surveys the literature on the indications for using this treatment in cases of intoxication. Although the level of evidence is low, intravenous lipid emulsion seems now to occupy an undisputed position as an antidote, not only in cardiotoxicity induced by local anesthetics but also in resuscitation after other toxic insults affecting the cardiovascular system. Key words: Intravenous lipid emulsion. Cardiovascular toxicity. Local anesthetics. http://www.semes.org/revista/vol23_5/8_ing.pdf
Rescate con lípidos para sobredosis masiva de verapamil: informe de caso
Lipid rescue of massive verapamil overdose: a case report. Liang CW, Diamond SJ, Hagg DS. Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97201 USA.haggda@ohsu.edu. J Med Case Rep. 2011 Aug 20;5:399. doi: 10.1186/1752-1947-5-399. Abstract INTRODUCTION: Massive intentional verapamil overdose is a toxic ingestion which can cause multiorgan system failure and has no currently known antidote.CASE PRESENTATION: The patient is a 41-year-old Caucasian woman who ingested 19.2 g of sustained release verapamil in a suicide attempt. Our patient became hypotensive requiring three high-dose vasopressors to maintain arterial pressure. She also developed acute respiratory failure, bradycardic ventricular rhythm necessitating continuous transvenous pacing, and anuric renal failure. Our patient was treated with intravenous calcium, bicarbonate, hyperinsulinemic euglycemic therapy and continuous venovenous hemodialysis without success. On the fourth day after hospital admission continuous intravenous lipid therapy was initiated. Within three hours of beginning lipid therapy, our patient's vasopressor requirement decreased by half. Within 24 hours, she was on minimal vasopressor support and regained an underlying junctional rhythm. After three days of lipid infusion, she no longer required inotropic agents to maintain blood pressure or pacing to maintain stable hemodynamics. CONCLUSIONS: Intravenous fat emulsion therapy may be an effective antidote for massive verapamil toxicity. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169500/pdf/1752-1947-5-399.pdf
Insulina vs emulsión lipídico en un modelo de conejos para la toxicidad severa de propranolol. Estudio piloto
Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study. Harvey M, Cave G, Lahner D, Desmet J, Prince G, Hopgood G. Department of Emergency Medicine, Waikato Hospital, Pembroke Street, Hamilton 3204, New Zealand. Crit Care Res Pract. 2011;2011:361737. doi: 10.1155/2011/361737. Epub 2011 Mar 31. Abstract Background and objective. Beta-blocker overdose may result in intractable cardiovascular collapse despite conventional antidotal treatments. High dose insulin/glucose (ING), and more recently intravenous lipid emulsion (ILE), have been proposed as potentially beneficial therapies in beta blocker intoxication. We compare efficacy of the novel antidotes ING, with ILE, in a rabbit model of combined enteric/intravenous propranolol toxicity....... Conclusions. High dose insulin resulted in greater rate pressure product compared with lipid emulsion in this rabbit model of severe enteric/intravenous propranolol toxicity. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085310/pdf/CCRP2011-361737.pdf
Atentamente Dr. Juan C. Flores-Carrillo Anestesiología y Medicina del Dolor www.anestesia-dolor.org