Revisiones_bibliográficas TyO_Web: 19/11/17

J Pain Res. 2014 Mar 7;7:117-23. doi: 10.2147/JPR.S58862. eCollection 2014.Abstract

Breakthrough pain in children with cancer is an exacerbation of severe pain that occurs over a background of otherwise controlled pain. There are no randomized controlled trials in the management of breakthrough pain in children with cancer, and limited data and considerable experience indicate that breakthrough pain in this pediatric patient group is common, underassessed, and undertreated. An ideal therapeutic agent would be rapid in onset, have a relatively short duration, and would be easy to administer. A less effective pharmacologic strategy would be increasing a patient's dose of scheduled opioids, because this may increase the risk of oversedation. The most common and effective strategy seems to be multimodal analgesia that includes an immediate-release opioid (eg, morphine, fentanyl, hydromorphone, or diamorphine) administered intravenously by a patient-controlled analgesia pump, ensuring an onset of analgesic action within minutes. Intranasal fentanyl (or hydromorphone) may be an alternative, but no pediatric data have been published yet for commercially available fentanyl transmucosal application systems (ie, sublingual tablets/spray, buccal lozenge/tablet/film, and nasal spray), and these products cannot yet be recommended for use with children with cancer and breakthrough pain. The aim of this paper was to emphasize the dearth of available information on treatment of breakthrough pain in pediatric cancer patients, to describe the treatment protocols we currently recommend based on clinical experience, and to suggest future research on this very important and under-researched topic.

KEYWORDS: adjuvant analgesia; breakthrough pain; cancer; integrative medicine; opioid; pediatric

XIV Congreso Virtual Mexicano de Anestesiología 2017

Octubre 1-Diciembre 31, 2017

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Mérida Yucatán, Noviembre 21-25, 2017

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Anestesiología y Medicina del Dolor

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anestesia-dolor.org

Misatenia gravis y embarazo / Myasthaenia Gravis and pregnancy

Noviembre 19, 2017. No. 2907

Miastenia gravis. Manejo clínico antes, durante y después del embarazo

Myasthaenia Gravis: Clinical management issues before, during and after pregnancy.

Hassan A1, Yasawy ZM1.

Sultan Qaboos Univ Med J. 2017 Aug;17(3):e259-e267. doi: 10.18295/squmj.2017.17.03.002. Epub 2017 Oct 10.

Abstract

Myasthaenia gravis (MG) is an autoimmune neuromuscular disorder which is twice as common among women, often presenting in the second and third decades of life. Typically, the first trimester of pregnancy and first month postpartum are considered high-risk periods for MG exacerbations. During pregnancy, treatment for MG is usually individualised, thus improving its management. Plasma exchange and immunoglobulin therapies can be safely used to treat severe manifestations of the disease or myasthaenic crises. However, thymectomies are not recommended because of the delayed beneficial effects and possible risks associated with the surgery. Assisted vaginal delivery-either vacuum-assisted or with forceps-may be required during labour, although a Caesarean section under epidural anaesthesia should be reserved only for standard obstetric indications. Myasthaenic women should not be discouraged from attempting to conceive, provided that they seek comprehensive counselling and ensure that the disease is under good control before the start of the pregnancy.

KEYWORDS: Disease Management; Myasthenia Gravis; Neonatal Myasthenia Gravis; Postpartum Period; Pregnancy

XIV Congreso Virtual Mexicano de Anestesiología 2017

Octubre 1-Diciembre 31, 2017

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LI Congreso Mexicano de Anestesiología

Mérida Yucatán, Noviembre 21-25, 2017

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Anestesiología y Medicina del Dolor

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Delirio postoperatorio / Postoperative delirium

Noviembre 22, 2017. No. 2910

Salino hipertónico en la prevención del delirio en ancianos operados de la cadera

Hypertonic saline for prevention of delirium in geriatric patients who underwent hip surgery.

Xin X1, Xin F2, Chen X1, Zhang Q1, Li Y1, Huo S1, Chang C1, Wang Q3.

J Neuroinflammation. 2017 Nov 14;14(1):221. doi: 10.1186/s12974-017-0999-y.

Abstract

BACKGROUND: Postoperative delirium (POD) is a common disorder in the elderly patients, and neuroinflammation is the possible underlying mechanism. This study is designed to determine whether or not hypertonic saline (HS) pre-injection can alleviate POD in aged patients. CONCLUSION: HS can alleviate POD in geriatric patients and may inhibit the secretion of inflammatory factors by monocytes.

KEYWORDS: Cytokines; Elderly; Hypertonic saline; Monocytes; Neuroinflammation; Postoperative delirium

Nivel preoperatorio alto de IL-6 es un factor de riesgo de inicio de delirio postoperatorio en viejos

Pre-Operative, High-IL-6 Blood Level is a Risk Factor of Post-Operative Delirium Onset in Old Patients.

Capri M1, Yani SL2, Chattat R3, Fortuna D4, Bucci L5, Lanzarini C5, Morsiani C6, Catena F7, Ansaloni L8, Adversi M9, Melotti MR10, Di Nino G10, Franceschi C1.

Front Endocrinol (Lausanne). 2014 Oct 17;5:173. doi: 10.3389/fendo.2014.00173. eCollection 2014.

Abstract

BACKGROUND: Post-operative delirium (POD) is a common complication in elderly patients undergoing surgery, but the underpinning causes are not clear. We hypothesized that inflammaging, the subclinical low and chronic grade inflammation characteristic of old people, can contribute to POD onset. Accordingly, we investigated the association of pre-operative and circulating cytokines in elderly patients, admitted for elective and emergency surgery. CONCLUSION: Pre-operative, high-plasma level of IL-6 was significantly associated with POD onset. We propose IL-6 as an additional risk factor of POD onset together with the previously identified factors. Discovery of all risk factors contributing to POD onset will permit to improve hospitalized patient management and the decrease of healthcare cost.

KEYWORDS: IL-6; aging; inflammaging; inflammatory cytokines; post-operative delirium

DELIRIUM POST OPERATORIO EN PACIENTES ANCIANOS: UNA REVISIÓN DEL TEMA

Nicolás García S. y Ricardo Fuentes H

Rev Chil Anest, 2013; 42: 162-166

INTRODUCCIÓN Y CONTEXTO

Los cambios demográficos a nivel nacional, dados principalmente por la disminución de la fecundidad y el aumento de la esperanza de vida, han producido un aumento dramático de la población quirúrgica mayor de 65 años. Datos del Instituto Nacional de Estadística (INE) muestran que entre 1907 y 1952 el ritmo de crecimiento medio anual de la población del país entre los distintos grupos de edad era prácticamente el mismo, situación que cambió entre 1952 y el 2002, en que el ritmo de crecimiento de los adultos mayores casi triplicó al de los menores de 15 años. Así, entre los años 2001 y 2011 en el Hospital Clínico de la Pontificia Universidad Católica de Chile se realizaron un total de 110.820 cirugías, de las cuales 28.055 fueron pacientes mayores de 65 años, correspondiente al 25,3% del total, con un promedio de edad de 77 años.

XIV Congreso Virtual Mexicano de Anestesiología 2017

Octubre 1-Diciembre 31, 2017

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LI Congreso Mexicano de Anestesiología

Mérida Yucatán, Noviembre 21-25, 2017

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Anestesiología y Medicina del Dolor

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martes, 21 de noviembre de 2017

Enfermedades graves y embarazo

Revisión clínica. Poblaciones especiales. Enfermedades graves y embarazo.

Clinical review: Special populations--critical illness and pregnancy.

Neligan PJ1, Laffey JG.

Crit Care. 2011 Aug 12;15(4):227. doi: 10.1186/cc10256.

Abstract

Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia. Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients.

Maternal critical care: what can we learn from patient experience? A qualitative study

Atención crítica materna: ¿qué podemos aprender de la experiencia del paciente? Un estudio cualitativo

Lisa Hinton, Louise Locock, Marian Knight

BMJ Open. 2015; 5(4): e006676. Published online 2015 Apr 27. doi: 10.1136/bmjopen-2014-006676

Objective

For every maternal death, nine women develop severe maternal morbidity. Many of those women will need care in an intensive care unit (ICU) or high dependency unit (HDU). Critical care in the context of pregnancy poses distinct issues for staff and patients, for example, with breastfeeding support and separation from the newborn. This study aimed to understand the experiences of women who experience a maternal near miss and require critical care after childbirth. Setting: Women and some partners from across the UK were interviewed as part of a study of experiences of near-miss maternal morbidity. Design: A qualitative study, using semistructured interviews. Participants; A maximum variation sample was recruited of 35 women and 11 partners of women who had experienced a severe maternal illness, which without urgent medical attention would have led to her death. 18 of the women were admitted to ICU or HDU. Results; The findings are presented in three themes: being in critical care; being a new mother in critical care; transfer and follow-up after critical care. The study highlights the shock of requiring critical care for new mothers and the gulf between their expectations of birth and what actually happened; the devastation of being separated from their baby, how valuable access to their newborn was, if possible, and the importance of breast feeding; the difficulties of transfer and the need for more support; the value of follow-up and outreach to this population of critical care patients. Conclusions: While uncommon, critical illness in pregnancy can be devastating for new mothers and presents a challenge for critical care and maternity staff. This study provides insights into these challenges and recommendations for overcoming them drawn from patient experiences.

Keywords: QUALITATIVE RESEARCH

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Octubre 1-Diciembre 31, 2017

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