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Los huracanes y los terremotos han golpeado a México de una manera cruel. La devastación, la muerte y mil desgracias son el tema actual, y nosotros los Mexicanos nos hemos unido en gran apoyo a aquellos que han sido afectados por la Madre Naturaleza.
Hurricanes and earthquakes have hit México in a crude way. Devastation, death and a thousand misfortunes are the current theme, and we Mexicans have united in great support for those who have been affected by Mother Nature.
Furacões e terremotos atingiram o México de uma maneira grosseira. A devastação, a morte e mil desgraças são o tema atual, e nós, os mexicanos, nos unimos em grande apoio para aqueles que foram afetados pela Mãe Natureza.
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Provisión de anestesia en desastres y conflictos armados.
Anesthesia Provision in Disasters and Armed Conflicts.
Abstract
Local, spinal and general intravenous (mainly with Ketamine) anesthetics seem to be the most widely accepted. Inhalation anesthesia has constraints; regional is underused and epidural is not recommended. Standard operative procedures should be in place, and an informed consent from the patient must be granted.
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Anestesia regional para lesiones dolorosas después de desastres (RAPID): protocolo de estudio para un ensayo controlado aleatorio.
Regional Anesthesia for Painful Injuries after Disasters (RAPID): study protocol for a randomized controlled trial.
Abstract
BACKGROUND: Lower extremity trauma during earthquakes accounts for the largest burden of disaster-related injuries. Insufficient pain management is common in resource-limited disaster settings, and regional anesthesia (RA) may reduce pain in injured patients beyond current standards of care. To date, no controlled trials have been conducted to evaluate the use of RA for pain management in a disaster setting. METHODS/DESIGN: The Regional Anesthesia for Painful Injuries after Disasters (RAPID) study aims to evaluate whether regional anesthesia (RA), either with or without ultrasound (US) guidance, can reduce pain from earthquake-related lower limb injuries in a disaster setting. The proposed study is a blinded, randomized controlled equivalence trial among earthquake victims with serious lower extremity injuries in a resource-limited setting. After obtaining informed consent, study participants will be randomized in a 1:1:1 allocation to either: standard care (parenteral morphine at 0.1 mg/kg); standard care plus a landmark-guided fascia iliaca compartment block (FICB); or standard care plus an US-guided femoral nerve block. General practice humanitarian response providers who have undergone a focused training in RA will perform nerve blocks with 20 ml 0.5 % levobupivacaine. US sham activities will be used in the standard care and FICB arms and a normal saline injection will be given to the control group to blind both participants and nonresearch team providers. The primary outcome measure will be the summed pain intensity difference calculated using a standard 11-point Numerical Rating Scale reported by patients over 24 h of follow-up. Secondary outcome measures will include overall analgesic requirements, adverse events, and participant satisfaction. DISCUSSION: Given the high burden of lower extremity injuries in the aftermath of earthquakes and the currently limited treatment options, research into adjuvant interventions for pain management of these injuries is necessary. While anecdotal reports on the use of RA for patients injured during earthquakes exist, no controlled studies have been undertaken. If demonstrated to be effective in a disaster setting, RA has the potential to significantly assist in reducing both acute suffering and long-term complications for survivors of earthquake trauma.
TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02698228 ), registered on 16 February 2016.
KEYWORDS: Earthquake; Humanitarian response; Natural disaster; Pain management; Randomized controlled trial; Regional anesthesia
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¿Una cuestión de vida o de miembro? Una revisión de los patrones de lesiones traumáticas y técnicas de anestesia para el alivio de desastres después de terremotos de gran magnitud.
A matter of life or limb? A review of traumatic injury patterns and anesthesia techniques for disaster relief after major earthquakes.
Anesth Analg. 2013 Oct;117(4):934-41. doi: 10.1213/ANE.0b013e3182a0d7a7. Epub 2013 Aug 19.
Abstract
BACKGROUND: All modalities of anesthetic care, including conscious sedation, general, and regional anesthesia, have been used to manage earthquake survivors who require urgent surgical intervention during the acute phase of medical relief. Consequently, we felt that a review of epidemiologic data from major earthquakes in the context of urgent intraoperative management was warranted to optimize anesthesia disaster preparedness for future medical relief operations. The primary outcome measure of this study was to identify the predominant preoperative injury pattern (anatomic location and pathology) of survivors presenting for surgical care immediately after major earthquakes during the acute phase of medical relief (0-15 days after disaster). The injury pattern is of significant relevance because it closely relates to the anesthetic techniques available for patient management. We discuss our findings in the context of evidence-based strategies for anesthetic management during the acute phase of medical relief after major earthquakes and the associated obstacles of devastated medical infrastructure. METHODS: To identify reports on acute medical care in the aftermath of natural disasters, a query was conducted using MEDLINE/PubMed, Embase, CINAHL, as well as an online search engine (Google Scholar). The search terms were "disaster" and "earthquake" in combination with "injury," "trauma," "surgery," "anesthesia," and "wounds." Our investigation focused only on studies of acute traumatic injury that specified surgical intervention among survivors in the acute phase of medical relief. RESULTS: A total of 31 articles reporting on 15 major earthquakes (between 1980 and 2010) and the treatment of more than 33,410 patients met our specific inclusion criteria. The mean incidence of traumatic limb injury per major earthquake was 68.0%. The global incidence of traumatic limb injury was 54.3% (18,144/33,410 patients). The pooled estimate of the proportion of limb injuries was calculated to be 67.95%, with a 95% confidence interval of 62.32% to 73.58%. CONCLUSIONS: Based on this analysis, early disaster surgical intervention will focus on surviving patients with limb injury. All anesthetic techniques have been safely used for medical relief. While regional anesthesia may be an intuitive choice based on these findings, in the context of collapsed medical infrastructure, provider experience may dictate the available anesthetic techniques for earthquake survivors requiring urgent surgery.
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