Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
Presentan Plibros, una editorial de ebooks peruanos Andina 17:45. Lima, abr. 01. La periodista y escritora Fietta Jarque fundó una editorial de libros electrónicos y una librería virtual llamada Kiputeca, con más ...
Castigan a editoriales de 'e-books' en Texas Conexión Total Austin, Texas.- Los residentes de Texas comenzarán a recibir créditos de cuentas o cheques esta semana, como resultado de los acuerdos con cinco ...
Todo eReaders
Calibre 1.30, un desarrollo imparable Todo eReaders Desde hace unos meses, son pocos los que hablan de Calibre, el popular gestor de ebooks, la razón de tal dejadez es simple: se desarrolla a un ...
Todo eReaders
La biblioteca de New York se asocia con Zola Books Todo eReaders Hace unas semanas, la librería virtual Zola Books anunció que compraba la web Bookish, especialista en recomendar ebooks o mejor dicho en ...
Otorgarán crédito a quienes compraron libros electrónicos Diario Metro de Puerto Rico Todos los consumidores que hayan comprado e-books durante el periodo de tiempo señalado deben verificar los correos electrónicos que hayan ...
Paro cardiaco no anticipado en anestesia raquídea: Un misterio no evitable con revisión de la literautra
Unanticipated cardiac arrest under spinal anesthesia: An unavoidable mystery with review of current literature. Kumari A, Gupta R, Bajwa SS, Singh A. Anesth Essays Res [serial online] 2014 [cited 2014 Mar 15];8:99-102. Cardiac arrest during anesthesia and perioperative period is a matter of grave concern for any anesthesiologist. But such mishaps have been reported for one reason or the other in the literary sciences. We are reporting the occurrence of unanticipated delayed cardiac arrest following spinal anesthesia in two young and healthy patients. Fortunately, these patients were successfully resuscitated with timely and appropriate cardiopulmonary resuscitative measures. Occurrence of such cases needs timely reporting and exploring all the possible causes of these unusual and possibly avoidable events. The present case reports are an important addition to a series of recently published mishaps that occurred during spinal anesthesia in young and healthy patients. Keywords: Asystole, bradycardia, cardiac arrest, spinal anesthesia http://www.aeronline.org/text.asp?2014/8/1/99/128923
Reanimación totalmente exitosa a pesar de un paro cardíaco prolongado
Fully successful resuscitation despite prolonged cardiac arrest. Asadi HK, Pollard J. Saudi J Anaesth. 2011 Jul;5(3):314-6. doi: 10.4103/1658-354X.84109. Abstract Sudden cardiac arrest following spinal anesthesia is a relatively common and often fatal complication. Careful patient selection, appropriate dosing of the local anesthetic, volume loading, close monitoring and prompt intervention at the first sign of cardiovascular instability should improve outcomes. KEYWORDS: Anesthesia-spinal, heart arrest, resuscitation
Paro cardiaco después de raquianestesia en Tahilandia. Cardiac arrest after spinal anesthesia in Thailand: a prospective multicenter registry of 40,271 anesthetics. Charuluxananan S, Thienthong S, Rungreungvanich M, Chanchayanon T, Chinachoti T, Kyokong O, Punjasawadwong Y. Anesth Analg. 2008 Nov;107(5):1735-41. doi: 10.1213/ane.0b013e31817bd143. Abstract BACKGROUND AND OBJECTIVES: As part of the Thai Anesthesia Incidents Study of anesthetic adverse outcomes, we evaluated the incidence and factors related to cardiac arrest during spinal anesthesia. METHODS: During a 12-mo period (March 1, 2003, to February 28, 2004), a prospective, multicenter registry of patients receiving anesthesia was initiated in 20 hospitals (7 university, 5 tertiary, 4 general, and 4 district hospitals) across Thailand. Anesthesia personnel reported patient-, surgery-, and anesthetic-related variables and adverse outcomes, including cardiac arrest during spinal anesthesia (defined as the time period from induction of spinal anesthesia until the end of operation). Adverse event specific forms were recorded within 24 h of an anesthetic procedure whenever a specific adverse event occurred. Univariate and multivariate analysis were used to identify factors related to cardiac arrest during spinal anesthesia. A P value <0.05 was considered significant. RESULTS: In the registry of 40,271 cases of spinal anesthesia, there were 11 cardiac arrests, corresponding to an incidence of 2.73 (95% CI: 1.12-4.34) per 10,000 anesthetics. The mortality rate was 90.9% among patients who arrested. Among 11 patients who arrested, there were 5 cases of cesarean delivery and 6 cases of extremity surgery, including hip surgery. In 4 patients (36.3%), the anesthetic contributed directly to the arrest (high sympathetectomy, local anesthetic overdose, or lack of electrocardiography monitoring), whereas some arrests were associated with specific events (cementing of prosthesis, massive bleeding, suspected pulmonary embolism, and suspected myocardial infarction). From multivariate analysis, the risks of cardiac arrest during anesthesia were shorter stature (odds ratio 0.944 [95% CI: 0.938-0.951], P < 0.001), longer duration of surgery (odds ratio 1.003 [95% CI: 1.001-1.005], P = 0.002), and spinal anesthesia administered by the surgeon (odd ratio 23.508 [95% CI: 6.112-90.415], P < 0.001), respectively. CONCLUSION:The incidence of cardiac arrest during spinal anesthesia was infrequent, but was associated with a high mortality rate. If the surgeon performed the spinal anesthetic, this was a significant factor associated with cardiac arrest. Increasing the number of anesthesiologists, improving monitoring guidelines for spinal anesthesia and improving the nurse-anesthetist training program may decrease the frequency of arrest and/or improve patient outcome.
Bradicardia y asistolia perioperatoria: relación con síncope vasovagal y el reflejo de Bezold-Jarisch.
Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex. Kinsella SM, Tuckey JP. Br J Anaesth. 2001 Jun;86(6):859-68. Abstract Reflex cardiovascular depression with vasodilation and bradycardia has been variously termed vasovagal syncope, the Bezold-Jarisch reflex and neurocardiogenic syncope. The circulatory response changes from the normal maintenance of arterial pressure, to parasympathetic activation and sympathetic inhibition, causing hypotension. This change is triggered by reduced cardiac venous return as well as through affective mechanisms such as pain or fear. It is probably mediated in part via afferent nerves from the heart, but also by various non-cardiac baroreceptors which may become paradoxically active. This response may occur during regional anaesthesia, haemorrhage or supine inferior vena cava compression in pregnancy; these factors are additive when combined. In these circumstances hypotension may be more severe than that caused by bradycardia alone, because of unappreciated vasodilation. Treatment includes the restoration of venous return and correction of absolute blood volume deficits. Ephedrine is the most logical choice of single drug to correct the changes because of its combined action on the heart and peripheral blood vessels. Epinephrine must be used early in established cardiac arrest, especially after high regional anaesthesia.
La depresión cardiovascular refleja con vasodilatación y bradicardia ha sido denominada con diversos nombres como síncope vasovagal, reflejo de Bezold-Jarisch y síncope neurocardiogénico. El reflejo de Bezold-Jarisch es un epónimo para la triple respuesta del cuerpo caracterizada con bradicardia, hipotensión arterial y apnea que se presenta después de la inyección del alcaloide veratrum en los estudios en animales. Esto fue reportado inicialmente por Bezold y Hirt en 1867 y confirmado por Jarisch en 1938-1940. La triada depende del nervio vago intacto y está mediada por los centros neurales medulares que controlan la respiración, la frecuencia cardiaca y el tono vasomotor. Los cambios de la respuesta circulatoria del mantenimiento normal de la presión arterial cambian a la activación parasimpática e inhibición simpática produciendo hipotensión arterial que puede ser severa. Esta alteración hemodinámica es disparada por un reducido retorno venoso al corazón, al igual lo puede ser por mecanismos de dolor o el miedo. Lo más probable es que sea mediado por vía neural aferente desde el corazón y también por varios barorreceptores no cardiacos que se activan en forma paradójica. Esta respuesta también puede suceder durante la hemorragia, la anestesia regional, la compresión supina de la vena cava o en combinación. El manejo consiste en el restablecimiento inmediato del retorno venoso, al igual que la corrección del volumen circulante. La efedrina es el fármaco de elección debido a sus acciones sobre el lecho vascular periférico y sobre el corazón. La adrenalina debe de usarse tempranamente cuando hay paro cardiaco.
Las complicaciones en medicina son parte de nuestra práctica profesional ya que errar es parte del ser humano. Un grupo de complicaciones no relacionadas con nuestros errores son secundarias a las respuestas fisiológicas del organismo a los procedimientos médicos o a alergias no esperadas. Hoy iniciamos envíos con información sobre complicaciones. Disfrute su lectura Complications in medicine are part of our practice since err is part of being human. A group of complications unrelated to our mistakes are secondary to the physiological responses of the organism to unexpected medical procedures or allergies. Today we begin with fresh information on complications. Enjoy your reading.
Complicações na medicina fazem parte da nossa prática desde err faz parte do ser humano. Um grupo de complicações não relacionadas com os nossos erros são secundárias às respostas fisiológicas do organismo aos procedimentos médicos inesperados ou alergias. Hoje começamos com novas informações sobre complicações. Boa leitura.
Definiendo los errores relacionados a la tecnología en salud: novedades desde errar es humano
Defining health information technology-related errors: new developments since to err is human. Sittig DF, Singh H. Arch Intern Med. 2011 Jul 25;171(14):1281-4. doi: 10.1001/archinternmed.2011.327. Abstract Despite the promise of health information technology (HIT), recent literature has revealed possible safety hazards associated with its use. The Office of the National Coordinator for HIT recently sponsored an Institute of Medicine committee to synthesize evidence and experience from the field on how HIT affects patient safety. To lay the groundwork for defining, measuring, and analyzing HIT-related safety hazards, we propose that HIT-related error occurs anytime HIT is unavailable for use, malfunctions during use, is used incorrectly by someone, or when HIT interacts with another system component incorrectly, resulting in data being lost or incorrectly entered, displayed, or transmitted. These errors, or the decisions that result from them, significantly increase the risk of adverse events and patient harm. We describe how a sociotechnical approach can be used to understand the complex origins of HIT errors, which may have roots in rapidly evolving technological, professional, organizational, and policy initiatives http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677061/pdf/nihms476207.pdf
Errar es Humano Informe de casos de dos accidentes militares aéreos: Posibles mecanismos
To Err is Human Case Reports of Two Military Aircraft Accidents: Possible mechanisms of human failure. Dikshit MB. Sultan Qaboos Univ Med J. 2010 Apr;10(1):120-5. Epub 2010 Apr 17. Abstract It has been postulated that pilot error or in-flight incapacitation may be the main contributory factors to 70-80% of aircraft accidents. Two fatal aircraft accidents are presented in which either of the above possibilities may have played a role. The first case report describes an erroneous decision by a fighter pilot to use a seat position adjustment of the ejection seat leading to fatal injuries when he had to eject from his aircraft. Injuries to the body of the pilot, and observations on the state of his flying clothing and the ejection seat were used to postulate the mechanism of fatal injury and establish the cause of the accident. The second case report describes the sequence of events which culminated in the incapacitation of a fighter pilot while executing a routine manouevre. This resulted in a fatal air crash. Possible contributions of environmental factors which may have resulted in failure of his physiological mechanisms are discussed. KEYWORDS:Aviation accident, Ejection seat, Flying clothing, Gravity-induced loss of consciousness, Incapacitation, Injury, Pilot error, Spatial disorientation, in-flight
Trauma y la compasión inducido medicamente: reflexiones desde la punta de la atención. Medically induced trauma and compassion: Reflections from the sharp end of care. Pelt Fv. Indian J Anaesth [serial online] 2010 [cited 2014 Mar 23];54:283-5. Since the Institute of Medicine's landmark report 'To Err is Human' in 1999, wherein it has been estimated that up to 100,000 patient lives are lost each year in the United States due to medical error, healthcare in the United States as well as globally has invested great effort and resources in the improvement of quality and patient safety. Although research and reporting is typically focused on process improvement methodologies and the changes being implemented in healthcare delivery, very little attention has been focused on the management of adverse medical events, specifically the impact that these events have on patients, families and care providers. It would be a rare care provider who has not been directly involved in an adverse medical event or who has not witnessed a colleague having been involved in an adverse event. Most adverse medical events are shrouded in secrecy and gaining the opportunity to share the experience in an open and meaningful way is extremely difficult.
Desarrollo de las bibliotecas del país La Nación.com.py Recientemente la Secretaría Nacional de Cultura de Paraguay ha formalizado su adhesión al Programa Iberoamericano deBibliotecas Públicas, ...
El periódico del Emprendedor
Las bibliotecas se prestan a la creación de nuevas empresas El periódico del Emprendedor La impresionante Biblioteca Central de Manchester abrió de nuevo sus puertas este fin de semana con la misión de inspirar a una nueva generación ...
Bibliotecas y consensos Andalucía Información Vuelve a equivocarse la alcaldesa, si es que no propone lo que propone intencionadamente, al anunciar que la nueva biblioteca de Ronda se ...
Bibliotecas sin libros Vanguardia Liberal Con esa medida, les dije, ustedes hubiesen quemado otra vez la biblioteca de Alejandría, ahora que mediante un gran esfuerzo mundial la UNESCO ...
15 bibliotecas entran a programa El Meridiano de Córdoba Montería. Este año la estrategia Tutores Departamentales, del Ministerio de Cultura, implementará una serie de proyectos en 15 bibliotecas del ...
Crea y aprende con Laura ⋅ Jesús Hernández Manifiesto de la UNESCO en favor de las Bibliotecas Públicas ... Manifiesto de Alejandría sobre Bibliotecas: la Sociedad de la Información en Acción ...
Lettering Time ⋅ Lettering Time En octubre del pasado año te contábamos la historia de "La preciosa biblioteca que fue demolida". Hoy he encontrado este enlace en la web de la ...
RecBib - Recursos Bibliotecarios ⋅ CMaite Con la colaboración de la Xarxa de Biblioteques Judicials de Catalunya y el Centre d´Estudis Juridics i Formación Especialitzada de la Generalitat de ...
Hacia la Evaluación y Acreditación de Bibliotecas Universitarias ⋅ cefemaria Una visita a las bibliotecas académicas y especializadas de la ciudad de Arequipa realizó la representante de la Dirección de Bibliotecas ...
Blog literario para escritores y lectores con herramientas, consejos, concursos, guías, libros, y noticias sobre la actualidad literaria ⋅ AEN Mañana en el Bibliotren... las Bibliotecas. ¿Cual es el papel de las Bibliotecas en la actualidad? Contaremos en directo con la bibliotecaria de la ...
Bibliotecas escolares y recursos educativos ⋅ @bibliotescolar ... Universitarias: 'Alfabetización Informacional. Reflexiones y experiencias' · Biblioteca Escolar de Pinfereto: FORMACIÓN DE USUARIOS → ...
Bibliotecas escolares y recursos educativos ⋅ @bibliotescolar Esta entrada fue publicada en Uncategorized. Guarda el enlace permanente. ← Biblioteca Escolar de Pinfereto: FORMACIÓN DE USUARIOS ...
Universo Abierto ⋅ julio David Ramírez-Ordóñez- Guía de derecho de autor para bibliotecas. Biblioteca Nacional de Colombia, [2011] . ISBN 978-958-716-446-6 Descargar ...
Manejo de calidad y la cultura de la seguridad en la medicina ¿Los informes de calidad estándar proporcionan una visión del factor humano de la seguridad del paciente? Quality management and safety culture in medicine - Do standard quality reports provide insights into the human factor of patient safety? Wischet W, Schusterschitz C. Ger Med Sci. 2009 Dec 15;7:Doc30. doi: 10.3205/000089. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795368/pdf/GMS-07-30.pdf
El informe ¨Errar es Humano¨ y la literatura de seguridad de pacientes The "To Err is Human" report and the patient safety literature. Stelfox HT, Palmisani S, Scurlock C, Orav EJ, Bates DW. Qual Saf Health Care. 2006 Jun;15(3):174-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464859/pdf/174.pdf
El error médico en la prescripción de medicamentos y el impacto de una intervención educativa Antonio Lavalle-Villalobos, Teresita de Jesús Payro-Cheng, Karina Alicia Martínez-Cervantes, Patricia Torres-Narváez, Lorena Hernández-Delgado, Gerardo Flores-Nava, Bol Med Hosp Infant Mex Vol. 64, marzo-abril 2007 http://www.scielo.org.mx/pdf/bmim/v64n2/v64n2a3.pdf
Plan para la calidad para mejorar la seguridad del paciente en el sitio de atención Plan for quality to improve patient safety at the point of care. Ehrmeyer SS. Ann Saudi Med. 2011 Jul-Aug;31(4):342-6. doi: 10.4103/0256-4947.83203. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156507/
Un equipo de investigadores de cinco universidades suecas, liderado por el Instituto Karolinska y el Laboratorio de Ciencias de la Vida, han identificado una nueva forma de tratar el cáncer. El concepto, detallado en la revista 'Nature', se basa en la inhibición de una enzima específica llamada MTH1, que las células de cáncer, a diferencia de las normales, requieren para sobrevivir, de forma que sin ella, los nucleótidos oxidados se incorporan al ADN, formando ADN letal de doble filamento que se rompe en las células cancerosas.
Consideraciones para el uso de opioides de acción breve en anestesia general
Considerations for the use of short-acting opioids in general anesthesia. Mandel JE. J Clin Anesth. 2014 Feb;26(1 Suppl):S1-7. doi: 10.1016/j.jclinane.2013.11.003. Epub 2014 Jan 29. Abstract Anesthesiologists play a critical role in facilitating a positive perioperative experience and early recovery for patients. Depending on the kind of procedure or surgery, a wide variety of agents and techniques are currently available to anesthesiologists to administer safe and efficaciousanesthesia. Notably, the fast-track or ambulatory surgery environment requires the use of agents that enable rapid induction, maintenance, and emergence combined with minimal adverse effects. Short-acting opioids demonstrate a safe and rapid onset/offset of effect; that short effect is both predictable and precise. It also ensures easier titration and reduced or rapidly reversed side effects. Due to their distinct pharmacokinetic and pharmacodynamic properties, and, in one case, rapid extra-hepatic clearance of remifentanil, these agents have several applications in general anesthesia. http://download.journals.elsevierhealth.com/pdfs/journals/0952-8180/PIIS0952818013003735.pdf
Comparación entre el tiempo de recuperación de alfentanil y fenatanil en sedación balanceada con propofol en gastro y colonoscopia Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study. Ho WM1, Yen CM, Lan CH, Lin CY, Yong SB, Hwang KL, Chou MC. BMC Gastroenterol. 2012 Nov 21;12:164. doi: 10.1186/1471-230X-12-164. Abstract BACKGROUND:There is increasing interest in balanced propofol sedation (BPS) titrated to moderate sedation (conscious sedation) for endoscopic procedures. However, few controlled studies on BPS targeted to deep sedation for diagnostic endoscopy were found. Alfentanil, a rapid and short-acting synthetic analog of fentanyl, appears to offer clinically significant advantages over fentanyl during outpatient anesthesia.It is reasonable to hypothesize that low dose of alfentanil used in BPS might also result in more rapid recovery as compared with fentanyl. METHODS:A prospective, randomized and double-blinded clinical trial of alfentanil, midazolam and propofol versus fentanyl, midazolam and propofol in 272 outpatients undergoing diagnostic esophagogastroduodenal endoscopy (EGD) and colonoscopy for health examination were enrolled. Randomization was achieved by using the computer-generated random sequence. Each combination regimen was titrated to deep sedation. The recovery time, patient satisfaction, safety and the efficacy and cost benefit between groups were compared.RESULTS:260 participants were analyzed, 129 in alfentanil group and 131 in fentanyl group. There is no significant difference in sex, age, body weight, BMI and ASA distribution between two groups. Also, there is no significant difference in recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between two groups. Though deep sedation was targeted, all cardiopulmonary complications were minor and transient (10.8%, 28/260). No serious adverse events including the use of flumazenil, assisted ventilation, permanent injury or death, and temporary or permanent interruption of procedure were found in both groups. However, fentanyl is New Taiwan Dollar (NT$) 103 (approximate US$ 4) cheaper than alfentanil, leading to a significant difference in total cost between two groups.CONCLUSIONS:This randomized, double-blinded clinical trial showed that there is no significant difference in the recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between the two most common sedation regimens for EGD and colonoscopy in our hospital. However, fentanyl is NT$103 (US$ 4) cheaper than alfentanil in each case.
Comparación de la mecánica respiratoria entre anestesia con sevorano y propofol-remifentanil para colectomía laparoscópica
Comparison of respiratory mechanics between sevoflurane and propofol-remifentanil anesthesia for laparoscopic colectomy. Bang SR, Lee SE, Ahn HJ, Kim JA, Shin BS, Roe HJ, Sim WS. Korean J Anesthesiol. 2014 Feb;66(2):131-5. doi: 10.4097/kjae.2014.66.2.131. Epub 2014 Feb 28. Abstract BACKGROUND:The creation of pneumoperitoneum and Trendelenburg positioning during laparoscopic surgery are associated with respiratory changes. We aimed to compare respiratory mechanics while using intravenous propofol and remifentanil vs. sevoflurane during laparoscopic colectomy.METHODS: SIXTY PATIENTS UNDERGOING LAPAROSCOPIC COLECTOMY WERE RANDOMLY ALLOCATED TO ONE OF THE TWO GROUPS: group PR (propofol-remifentanil group; n = 30), and group S (sevoflurane group; n = 30). Peak inspiratory pressure (PIP), dynamic lung compliance (Cdyn), and respiratory resistance (Rrs) values at five different time points: 5 minutes after induction of anesthesia (supine position, T1), 3 minutes after pneumoperitoneum (lithotomy position, T2), 3 minutes after pneumoperitoneum while in the lithotomy-Trendelenburg position (T3), 30 minutes after pneumoperitoneum (T4), and 3 minutes after deflation of pneumoperitoneum (T5).RESULTS: In both groups, there were significant increases in PIP and Rrs while Cdyn decreased at times T2, T3, and T4 compared to T1 (P < 0.001). The Rrs of group PR for T2, T3, and T4 were significantly higher than those measured in group S for the corresponding time points (P < 0.05). CONCLUSIONS: Respiratory mechanics can be adversely affected during laparoscopic colectomy. Respiratory resistance was significantly higher during propofol-remifentanil anesthesia than sevoflurane anesthesia. KEYWORDS:Laparoscopy, Propofol, Remifentanil, Respiratory mechanics, Sevoflurane
