martes, 25 de agosto de 2015

Anestesia general/General anaesthesia

Anestesia y Medicina del Dolor
  
Anestesia general y riesgo de demencia en ancianos: conocimientos actuales
General anesthetic and the risk of dementia in elderly patients: current insights.
Clin Interv Aging. 2014 Sep 24;9:1619-28. doi: 10.2147/CIA.S49680. eCollection 2014.
Abstract
In this review, we aim to provide clinical insights into the relationship between surgery, general anesthesia (GA), and dementia, particularly Alzheimer's disease (AD). The pathogenesis of AD is complex, involving specific disease-linked proteins (amyloid-beta [Aβ] and tau), inflammation, and neurotransmitter dysregulation. Many points in this complex pathogenesis can potentially be influenced by both surgery and anesthetics. It has been demonstrated in some in vitro, animal, and human studies that some anesthetics are associated with increased aggregation and oligomerization of Aβ peptide and enhanced accumulation and hyperphosphorylation of tau protein. Two neurocognitive syndromes that have been studied in relation to surgery and anesthesia are postoperative delirium and postoperative cognitive dysfunction, both of which occur more commonly in older adults after surgery and anesthesia. Neither the route of anesthesia nor the type of anesthetic appears to be significantly associated with the development of postoperative delirium or postoperative cognitive dysfunction. A meta-analysis of case-control studies found no association between prior exposure to surgery utilizing GA and incident AD (pooled odds ratio =1.05, P=0.43). The few cohort studies on this topic have shown varying associations between surgery, GA, and AD, with one showing an increased risk, and another demonstrating a decreased risk. A recent randomized trial has shown that patients who received sevoflurane during spinal surgery were more likely to have progression of preexisting mild cognitive impairment compared to controls and to patients who received propofol or epidural anesthesia. Given the inconsistent evidence on the association between surgery, anesthetic type, and AD, well-designed and adequately powered studies with longer follow-up periods are required to establish a clear causal association between surgery, GA, and AD.
 
Técnica de anestesia, mortalidad, y tiempo de estancia después de cirugía de cadera
Anesthesia technique, mortality, and length of stay after hip fracture surgery.
JAMA. 2014 Jun 25;311(24):2508-17. doi: 10.1001/jama.2014.6499.
PDF 
Modulo CEEA Leon, Gto. 

          
Anestesiología y Medicina del Dolor
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