domingo, 7 de junio de 2015

Más de cirugía plástica / More on plastic surgery

Complicaciones anestésicas en cirugía plástica
Anaesthetic complications in plastic surgery.
Nath SS, Roy D, Ansari F, Pawar ST.
Indian J Plast Surg. 2013 May;46(2):445-52. doi: 10.4103/0970-0358.118626.
Anaesthesia related complications in plastic surgeries are fortunately rare, but potentially catastrophic. Maintaining patient safety in the operating room is a major concern of anaesthesiologists, surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential and pressure to avoid these complications in cosmetic surgery is increasing. Key aspects of patient safety in the operating room are outlined, including patient positioning, airway management and issues related to some specific conditions, essential for minimizing post-operative morbidity. Risks associated with extremes of age in the plastic surgery population, may be minimised by a better understanding of the physiologic changes as well as the pre-operative and post-operative considerations in caring for this special group of patients. An understanding of the anaesthesiologist's concerns during paediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients' experience and surgical outcome.
KEYWORDS: Anaesthesia; complications; plastic; surgery
Artículo en HTML/HTML article
Actualización y revisión. Cambiando el uso de anestesia local en la mano
Update/Review: changing of use of local anesthesia in the hand.
Al Youha S1, Lalonde DH1.
Plast Reconstr Surg Glob Open. 2014 Jun 6;2(5):e150. doi: 10.1097/GOX.0000000000000095. eCollection 2014
SUMMARY: Among the many advances in local anesthesia of the hand, some of the most significant changes in the last 5 years have been the following: (1) the acceptance of safety of locally infiltrated epinephrine with lidocaine for hemostasis, which has removed the need for sedation,brachial plexus blocks, and general anesthesia for most common hand surgery operations and minor hand trauma. (2) The elimination of the 2 injection finger block technique in favor of the single injection palmar block. (3) Local anesthesia can now be consistently injected in the hand with minimal pain. (4) Liposomal release of local anesthetic after injection into the surgical site can provide pain control up to 3 days. This article reviews the impact and best evidence related to these changes.
Profilaxis para prevenir tromboembolismo venoso; preocupaciones con respecto a la eficacia y ética.
Chemoprophylaxis for venous thromboembolism prevention: concerns regarding efficacy and ethics.
Swanson E.
Plast Reconstr Surg Glob Open. 2013 Jul 8;1(3):e23. doi: 10.1097/GOX.0b013e318299fa26. eCollection 2013.
SUMMARY: Chemoprophylaxis has been recommended for plastic surgery patients judged to be at increased risk for venous thromboembolism. Several investigators have encountered this complication in patients despite anticoagulation therapy. An increased rate of complications related to postoperative bleeding has been reported. This article examines the efficacy and safety of this intervention, along with ethical considerations, in an attempt to determine whether any benefits of chemoprophylaxis justify the additional risks. The statistical methods and conclusion of the VenousThromboembolism Prevention Study are challenged. Other preventative measures that do not cause negative side effects are discussed as safer alternatives.
El propofol en cirugía plástica en el consultorio.
Propofol in office-based plastic surgery.
Friedberg BL.
Semin Plast Surg. 2007 May;21(2):129-32. doi: 10.1055/s-2007-979214.
Propofol is the nearly ideal agent for office-based plastic surgery. Among all anesthetic agents, only propofol has the ability to elicit happiness in this special group of patients. Cosmetic surgery patients will tolerate discomfort in preferencPDFe to postoperative nausea and vomiting. Propofol is a powerful antiemetic agent. Patient safety will not be optimized unless the person responsible for the administration of propofol has airway management skills. Dedicated anesthesia providers are highly skilled in airway management. Although the short half-life of propofol is seductive for a fast-acting, rapid emerging anesthetic, interindividual differences in propofol response make measurement of the target organ (i.e., the brain) with a bispectral index (BIS) monitor very important. BIS levels < 45 for > 1 hour are associated with increased 1-year anesthesia mortality thought to be associated with an inflammatory response. The only currently available way to avoid overmedicating with propofol is to monitor with a level of consciousness monitor like BIS.
KEYWORDS: BIS monitor; Propofol; anesthesia; ketamine; office-based plastic surgery
Anestesia espinal para cirugía ambulatoria y de corta estancia en procedimientos de cirugía plástica
Spinal Anaesthesia for Ambulatory and Short-Stay Plastic Surgery Procedures
Víctor M. Whizar-Lugo, Juan C. Flores-Carrillo, Susana Preciado-Ramírez, Jaime Campos-León, Víctor Silva
"Topics in Spinal Anaesthesia", book edited by Victor M. Whizar-Lugo, ISBN 978-953-51-1720-9, Published: September 3, 2014 under CC BY 3.0 license.
Anestesia y Medicina del Dolor
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