Más de obstetricia / More on obstetrics

Mayo 18, 2018. No. 3084

Comparando el efecto de agregar fentanilo, sufentanilo y placebo con bupivacaína intratecal en la duración de la analgesia y las complicaciones de la anestesia espinal en pacientes programados para cesárea Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section. Farzi F1, Mirmansouri A2, Naderi Nabi B3, Atrkar Roushan Z4, Ghazanfar Tehran S5, Nematollahi Sani M6, Makhlooghi Azad S6, Nemati M6. Author information Anesth Pain Med. 2017 Aug 27;7(5):e12738. doi: 10.5812/aapm.12738. eCollection 2017 Oct. Abstract BACKGROUND: Spinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics. METHODS: This was a double-blind clinical trial performed on 99 patients. Women were divided into 3 groups of fentanyl, sufentanil, and placebo. For fentanyl group, 12.5 mg of bupivacaine and 25 micrograms of fentanyl; for sufentanil group, 12.5 mg of bupivacaine and 2.5 micrograms of sufentanil; and for placebo group, 12.5 mg of bupivacaine and a half mL of normal saline were injected in subarachnoid space. The sensory and motor block, hemodynamic status (mean blood pressure and heart rate), and probable complications were assessed. RESULTS: There was no significant difference between the groups in demographic characteristics. Durations of analgesia were, respectively, 314 ± 42.95, 312.5 ± 34.44, and 116.1 ± 42.24 minutes in the fentanyl, sufentanil, and placebo groups (P = 0.0001). Duration of sensory and motor block was higher in fentanyl and sufentanil groups compared with the placebo group. The highest duration of sensory and motor block was noted in sufentanil group (P = 0.0001). No significant difference was found between the groups in the hemodynamic parameters (P > 0.05). The frequency of itching in the fentanyl group was higher than sufentanil and placebo groups (P = 0.003). Also, shivering was higher in the placebo group compared with other groups (P = 0.036). CONCLUSIONS: According to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesareansection surgery. KEYWORDS: Bupivacaine; Cesarean Sections; Fentanyl; Spinal Anesthesia; Sulfentanil PDF Anestesia espinal continua para anestesia y analgesia obstétrica Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia. Veličković I1, Pujic B2, Baysinger CW3, Baysinger CL4. Author information Front Med (Lausanne). 2017 Aug 15;4:133. doi: 10.3389/fmed.2017.00133. eCollection 2017. Abstract The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used. Small doses of drug can be administered and extension of labor analgesia for emergency cesarean delivery may occur more rapidly compared to continuous epidural techniques. KEYWORDS: intrathecal catheters; labor analgesia; neuraxial blockade; obstetric anesthesia; post-dural puncture headache; spinal catheters PDF El enfoque de control óptimo del dolor para el trabajo de parto: una revisión de la literatura actual. The Optimal Pain Management Approach for a Laboring Patient: A Review of Current Literature. Kelly A1, Tran Q1. Author information Abstract Cureus. 2017 May 10;9(5):e1240. doi: 10.7759/cureus.1240. There is a general agreement that a patient in labor should be given the option to have an epidural block for pain management. Despite this consensus, there are differences in practice patterns as to when to initiate an epidural and how to minimize its impact on the duration and outcome of a patient's labor. A review of the literature suggests epidural analgesia does prolong stages one and two of labor, but not significantly. Cesarean delivery rates are not affected by the early initiation of epidural analgesia. The use of various adjuvants such as opioids, clonidine, and neostigmine in conjunction with local anesthetics solution can significantly reduce the severity of motor blockade and the need for assisted vaginal delivery. KEYWORDS: labor analgesia; labor epidural; regional anesthesia PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information X Foro Internacional de Medicina del Dolor y Paliativa Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información / Information V Congreso Internacional de Vía Aérea, EVALa, México Junio 7-9, 2018. Guadalajara. México Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Compartir el gusto por seguir en la enseñanza de la cirugía ortopédica..Rodilla y Cadera

http://www.ortotrauma.xyz/academia/compartir-el-gusto-por-seguir-en-la-ensenanza-de-la-cirugia-ortopedica-rodilla-y-cadera/

Laringoespasmo / Laryngospasm

Mayo 16, 2018. No. 3082

Actualización en el manejo del laringoespasmo Update on the management of laryngospasm. Hernández-Cortez E. J Anesth Crit Care Open Access. 2018;8(2):1-6. DOI: 10.15406/jaccoa.2018.08.00327 Introduction Laryngospasm is defined as the sustained closure of the vocal cords. It is a primitive protective airway reflex, which happens to safeguard the integrity of the airway by protecting it from tracheobronchial aspiration.1 Laryngospasm is also defined as an exaggerated response of the closure reflex or glottic muscle spasm. Essentially is a protective reflex, which acts to prevent the entry of any foreign material into the tracheobronchial tree. The presence of this reflex results in an impediment to adequate breathing, under these conditions it becomes a sudden obstruction of upper airway. A feature of laryngospasm is that the airway closure is maintained even after the initial causal stimulus disappears. In any of the situations mentioned above, we face a partial or total loss of the airway, and therefore an anesthetic urgency. Forty % of the airway obstructions are secondary to laryngospasm, and this may result in a life-threatening complication, and is a major cause of cardiac arrest in the pediatric patient. PDF Eficacia de lidocaína para prevenir laringoespasmo en niños: Revisión sistemática y meta-análisis The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis. Mihara T1, Uchimoto K, Morita S, Goto T. Author information Anaesthesia. 2014 Dec;69(12):1388-96. doi: 10.1111/anae.12788. Epub 2014 Jul 3. Abstract The purpose of this meta-analysis was to determine the efficacy of lidocaine in preventing laryngospasm during general anaesthesia in children. An electronic search of six databases was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to. We included randomised controlled trials reporting the effects of intravenous and/or topical lidocaine on the incidence of laryngospasm during general anaesthesia. Nine studies including 787 patients were analysed. The combined results demonstrated that lidocaine is effective in preventing laryngospasm (risk ratio (RR) 0.39, 95% CI 0.24-0.66; I(2)  = 0). Subgroup analysis revealed that both intravenous lidocaine (RR 0.34, 95% CI 0.14-0.82) and topical lidocaine (RR 0.42, 95% CI 0.22-0.80) lidocaine are effective in preventing laryngospasm. The results were not affected by studies with a high risk of bias. We conclude that, both topical and intravenous lidocaine are effective for preventing laryngospasm in children. PDF Espasmo en la vía aérea pediátrica: ¿Qué hacer? Dra. Liliana Ramírez-Aldana, Dr. David Ángel Pablo García-Arreola, Dra. Deoselina Hernández-Gutiérrez Rev Mex Anestesiol Vol. 35. Supl. 1 Abril-Junio 2012 pp S159-S163 RESUMEN Los niños poseen características anatómicas y funcionales de la vía aérea que los difi eren de los adultos. Estas diferencias son sufi cientes para provocar que al presentarse un espasmo de la vía aérea superior o inferior, si no se resuelve adecuadamente, el acto anestésico puede terminar en una catástrofe. Por lo que en el presente artículo revisaremos en forma breve las diferencias anatómicas y funcionales de la vía aérea pediátrica en relación con el adulto y dos entidades: el laringoespasmo y el broncoespasmo haciendo énfasis en la defi nición, fi siopatología, etiología, formas de prevención y sugerencias de tratamiento. Palabras clave: Vía aérea pediátrica, espasmo, extubación, laringoespasmo, broncoespasmo. PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Congreso Nacional de Residentes de Anestesiología 7 al 9 de junio, 2018. Lima, Perú  Informes / Information  Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

El uso de plasma rico en plaquetas (PRP) para ayudar en la cicatrización de la reparación del manguito rotador

www.clinicadeartroscopia.com.mx/academia/el-uso-de-plasma-rico-en-plaquetas-prp-para-ayudar-en-la-cicatrizacion-de-la-reparacion-del-manguito-rotador/

El uso de plasma rico en plaquetas (PRP) para ayudar en la cicatrización de la reparación del manguito rotador durante el período perioperatorio sigue siendo controvertido. Si bien los resultados de los metanálisis y las revisiones sistemáticas no respaldan el uso común de PRP en el tratamiento del manguito rotador, sus conclusiones se ven obstaculizadas por la heterogeneidad en los protocolos de preparación, el momento de colocación, el método y la cantidad de administración, los procedimientos quirúrgicos y la intervención postoperatoria. protocolos de rehabilitación etc etc . Sin embargo, hay algunas pruebas que apoyan un efecto positivo de la curación en la interfaz tendón-hueso en las roturas del manguito rotador de pequeño a mediano tamaño. Este caso destaca los diferentes pasos en el diagnóstico y tratamiento de una reparación del manguito rotador con PRP. Rutinariamente incluimos la inyección de PRP con la reparación de nuestro manguito rotador, ya que creemos que brinda el mejor ambiente posible para la curación del manguito rotador y es relativamente rápido y seguro. Se incluye una evaluación exhaustiva de la literatura actual para ayudar al médico tratante a comprender el mecanismo del PRP y guiar su uso en la reparación del manguito rotador.

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