sábado, 11 de marzo de 2017

La artritis reumatoide en la columna cervical


Cervical Spine in Rheumatoid Arthritis

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Courtesy: Prof Nabil Ebraheim,
University of Toledo, Ohio, USA
Dr. Ebraheim educational animated video illustrates spine concepts associated the cervical spine – rheumatoid arthritis.
Cervical spine involvement occurs in about 90% of the patients with rheumatoid arthritis.
All rheumatoid arthritis patients should have cervical spine examination.
Start with getting cervical spine x-rays, because this helps to diagnose atlantoaxial instability.
Early aggressive medical treatment can decrease this risk.
C1-C2 instability is common and can occur in up to 80%.
It occurs due to transverse ligament pathology.
So you will need to get flexion extension views in patients with rheumatoid arthritis, especially preoperative x-rays, and if it looks bad, you have to stabilize the spine before doing elective total hip or total knee procedures.
Discover the C1-C2 instability and fix it first before doing elective total hip procedure.
You see in the x-rays the Atlanto Dental Interval: A.D.I., if it was more than 3.5 mm that means instability of the upper cervical spine may be present.
If it is more than 7 mm it means disruption of the alar ligament, these patients can have cervical spine myelopathy.
The A.D.I. is an unreliable predictor of paralysis.
The posterior atlanto dental interval is a better predicting test, it can predict the spinal cord injury better.
If the posterior A.D.I. is less than 14 mm it can predict spinal cord injury, get an MRI.
The surgery is done if the A.D.I. is more than 10mm or if the P.A.D.I. is less than 14mm, the operation is C1-C2 fusion.
Clinically: the C1-C2 instability could give neck pain, headache, and myelopathy with abnormal gait, paresthesia and difficulty in fine motor control.
Basilar Invagination: 
Occur in about 40% of the patients with rheumatoid arthritis, basilar invagination is superior migration of the odontoid so the tip of the odontoid is above the foramen magnum; in this case you do occiput to C2 fusion, plus or minus odontoid resection.
The Subaxial Subluxation:
Occur in about 20% of the patients.
Indication of surgery is neurological compromise.
The space available for the cord is less than 14 mm then do posterior fusion surgery; surgery is usually not successful in severe types of neurological impairment.
When do you do surgery in rheumatoid arthritis?
You do it if there is:
• Severe pain
• Neurological deficit
• X-ray showing that the P.A.D.I. is less than 14mm 
• Superior odontoid migration
• Subaxial subluxation and the sagittal canal diameter is less than 14 mm.
If the posterior atlanto- dental interval (P.A.D.I.) is more than 14 mm, the patient will demonstrate significant motor recovery after surgery.
Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:
https://www.utfoundation.org/foundati…
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ML en niños obesos / LMA in obese children

Marzo 3, 2017. No. 2617






Un ensayo clínico que evalúa la máscara laríngea de la vía aérea-Supreme en niños obesos durante la anestesia general
A clinical trial evaluating the laryngeal mask airway-Supreme in obese children during general anesthesia.
Tian Y1, Wu XY1, Li L1, Ma L1, Li YF1.
Arch Med Sci. 2017 Feb 1;13(1):183-190. doi: 10.5114/aoms.2017.64719. Epub 2016 Dec 19.
Abstract
INTRODUCTION: The laryngeal mask airway (LMA)-Supreme is a disposable double-lumen laryngeal mask airway that is widely used in clinical practice. However, its use in obese children has not been evaluated. The aim of this study was to determine whether the LMA-Supreme could perform equally as well as endotracheal intubation in obese children having a minor surgical procedure. MATERIAL AND METHODS: After ethical board approval, 100 obese male children receiving non-emergent appendectomy for chronic appendicitis or surgery to correct concealed penis were randomly divided into an endotracheal intubation group and an LMA-Supreme group. Endotracheal intubation was performed under direct vision laryngoscopy. In the LMA group, a size-3 LMA-Supreme was placed and a stomach tube inserted via the drainage tube of the mask. Cardiovascular and respiratory parameters, time taken for placement, placement attempts, time to removal of the endotracheal tube/LMA, length of stay in the post-anesthesia care unit (PACU), and complications were recorded. RESULTS: Insertion time was significantly longer (p < 0.001) in the LMA-Supreme group than in the endotracheal intubation group. Peak airway pressure was significantly higher, and pulmonary compliance and PACU stay time lower in the LMA-Supreme group. No significant differences between endotracheal intubation and the LMA-Supreme were seen in other parameters, except for a higher incidence of coughing in the endotracheal intubation group. CONCLUSIONS: The LMA-Supreme can be easily inserted and effectively used for airway management in obese children undergoing minor surgery.
KEYWORDS: airway sealing pressure; laryngeal mask airway; obese children; peripheral oxygen saturation; ventilation


Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

Informes  (477) 716 06 16, kikinhedz@gmail.com
4° Congreso Internacional de Control Total de la Vía Aérea
Asociación Mexicana de Vía  Aérea Difícil, AC
Ciudad de México 21, 22 y 23 de Abril 2017
Informes: 
amvadmexico@gmail.com
Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
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Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015

ML en pediatría / LMA in pediatrics

Marzo 4, 2017. No. 2618






Estudio piloto en maniquí mostró que un dispositivo de vía aérea supraglótica mejoró la ventilación neonatal simulada en un entorno de bajos recursos.
Pilot manikin study showed that a supraglottic airway device improved simulated neonatal ventilation in a low-resource setting.
Acta Paediatr. 2016 Dec;105(12):1440-1443. doi: 10.1111/apa.13565.
Abstract
AIM: We compared the performance of personnel in a low-resource setting when they used the I-gel cuffless neonatal laryngeal mask or a face mask on a neonatal airway management manikin. METHODS: At Mulago Hospital, Uganda, 25 doctors, nurses and midwives involved in neonatal resuscitation were given brief training with the I-gel and face mask. Then, every participant was observed positioning both devices on three consecutive occasions. The success rate and insertion times leading to effective positive pressure ventilation (PPV) were recorded. Participants rated the perceived efficiency of the devices using a five-point Likert scale. RESULTS: The I-gel achieved a 100% success rate on all three occasions, but the face mask was significantly less effective in achieving effective PPV and the failure rates at the first, second and third attempts were 28%, 8% and 20%, respectively. The perceived efficiency of the devices was significantly superior for the I-gel (4.7 ± 0.4) than the face mask (3.3 ± 0.8). CONCLUSION: The I-gel was more effective than the face mask in establishing PPV in the manikin, and user satisfaction was higher. These encouraging manikin data could be a stepping stone for clinical research on the use of the I-gel for neonatal resuscitation in low-resource settings.
KEYWORDS: Face mask; I-gel; Laryngeal mask; Low-resource country; Neonatal resuscitation

Uso de ML durante ecocardiografía transesofágica en pacientes pediátricos
The use of laryngeal mask airway during transesophageal echocardiography in pediatric patients.
Saudi J Anaesth. 2014 Oct;8(4):489-92. doi: 10.4103/1658-354X.140858.
Abstract
BACKGROUND: Transesophageal echocardiography (TEE) in the cardiac lab is usually performed in pediatric patients under general anesthesia with an endotracheal intubation (ET). This study was performed to investigate the safety and efficacy of using the laryngeal mask airway (LMA) as an alternative to ET to maintain pediatric airway during the general anesthesia for TEE. MATERIALS AND METHODS: A total of 50 pediatric patients undergoing TEE in the cardiac lab were randomized to have their airway maintained during the procedure with either LMA (LMA group) or ET (ET group). Hemodynamic, respiratory parameters, time to extubation, recovery time, the incidence of complication and operator satisfaction were compared between the two groups. RESULTS: There were no differences between both groups in hemodynamic and respiratory parameters. Laryngeal spasm was reported in one patient in the LMA group and two patients in the ET group. TEE operators were equally satisfied with the procedure in groups. The time to extubation was shorter in the LMA group (P < 0.01). The mean recovery time was also significantly shorter in the LMA than in the ET group (44 ± 8 min and 59 ± 11 min, respectively; P < 0.001). CONCLUSION: The LMA is safe and effective in securing the airway of children undergoing diagnostic TEE.
KEYWORDS: Laryngeal mask airway; randomized clinical trial; transesophageal echocardiography
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ML para resucitación neonatal en un país en desarrollo
Laryngeal Mask Airway for neonatal resuscitation in a developing country: evaluation of an educational intervention. Neonatal LMA: an educational intervention in DRC.
BMC Health Serv Res. 2010 Aug 31;10:254. doi: 10.1186/1472-6963-10-254.
Abstract
BACKGROUND: Studies carried out in developing countries have indicated that training courses in newborn resuscitation are efficacious in teaching local birth attendants how to properly utilize simple resuscitation devices. The aim of this study was to assess the knowledge and expertise gained by physicians and midwifes who participated in a Neonatal Resuscitation Course and workshop organized in a Third World Country on the use of Laryngeal Mask Airway (LMA). METHODS: A 28-item questionnaire, derived from the standard test contained in the American Heart Association and the American Academy of Pediatrics Neonatal Resuscitation Manual, was administered to 21 physicians and 7 midwifes before and after a course, which included a practical, hands-on workshop focusing on LMA positioning and bag-ventilation in a neonatal manikin. RESULTS: The knowledge gained by the physicians was superior to that demonstrated by the midwifes. The physicians, in fact, demonstrated a significant improvement with respect to their pre-course knowledge. Both the physicians and the midwives showed a good level of expertise in manipulating the manipulating the manikin during the practical trial session. The midwifes and physicians almost unanimously manifested a high degree of approval of neonatal resuscitation by LMA, as they defined it a sustainable and cost-effective method requiring minimal expertise. CONCLUSIONS: Further studies are warranted to test the advantages and limits of the neonatal LMA training courses in developing countries.


Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

Informes  (477) 716 06 16, kikinhedz@gmail.com
4° Congreso Internacional de Control Total de la Vía Aérea
Asociación Mexicana de Vía  Aérea Difícil, AC
Ciudad de México 21, 22 y 23 de Abril 2017
Informes: 
amvadmexico@gmail.com
Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015