https://www.eduardocaldelas-artroscopia.mx/blog/2023/01/26/beneficios-de-implementar-un-protocolo-mejorado-de-recuperacion-despues-de-la-cirugia-en-cirugia-ambulatoria/

Beneficios de implementar un protocolo mejorado de recuperación después de la cirugía en cirugía ambulatoria

26 enero 2023 por admin

Los protocolos de recuperación mejorada después de la cirugía con inyección periarticular intraoperatoria para pacientes que se someten a reconstrucción del LCA producen puntajes de dolor más bajos, menor consumo de opioides y menor tiempo de recuperación en la PACU.

https://journals.sagepub.com/doi/10.1177/23259671221133412

• Los protocolos de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) en cirugía ortopédica han obtenido un enfoque significativo debido a su capacidad para controlar el dolor adecuadamente en la ventana posoperatoria inmediata, lo que permite una movilización más temprana, estadías hospitalarias más cortas y menos complicaciones.
  Virginia Commonwealth University creó un enfoque de manejo del dolor multimodal en el que los pacientes reciben un bloqueo preoperatorio del nervio femoral seguido de una inyección local de anestesia periarticular intraoperatoria que consiste en bupivacaína, ketamina y ketorolaco.
• Los hallazgos del estudio sugieren que un protocolo de vías de recuperación mejoradas que incluye una inyección periarticular intraoperatoria estandarizada de bupivacaína, ketamina y ketorolaco mejora las puntuaciones de dolor en la ventana posoperatoria inmediata, disminuye el consumo de opioides y reduce el tiempo de recuperación en la PACU para los pacientes que se someten a una reconstrucción del LCA.

https://pubmed.ncbi.nlm.nih.gov/36452342/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9703544/

https://journals.sagepub.com/doi/10.1177/23259671221133412

Hampton H, Torre M, Satalich J, Pershad P, Gammon L, O’Connell R, Brusilovsky I, Vap A. Benefits of Implementing an Enhanced Recovery After Surgery Protocol in Ambulatory Surgery. Orthop J Sports Med. 2022 Nov 23;10(11):23259671221133412. doi: 10.1177/23259671221133412. PMID: 36452342; PMCID: PMC9703544.

Copyright © The Author(s) 2022

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Anestesia en niños / Pediatric anesthesia

Abril 23, 2018. No. 3060

Anestesia pediátrica para entornos de bajos recursos Paediatric anaesthesia for low-resource settings Ruth Barbour, Papari Deka BJA Education, 17 (11): 351-356 (2017) PDF Genética para el anestesiólogo pediátrico: introducción a las malformaciones congénitas, farmacogenética y proteómica Genetics for the Pediatric Anesthesiologist: A Primer on Congenital Malformations, Pharmacogenetics, and Proteomics Anesth Analg 2010;111:1264-74) PDF La seguridad y la eficacia del bloqueo continuo de nervios periféricos en la analgesia postoperatoria de pacientes pediátricos. The Safety and Efficacy of the Continuous Peripheral Nerve Block in Postoperative Analgesia of Pediatric Patients. Simić D1,2, Stević M1,2, Stanković Z1, Simić I1, Dučić S1,3, Petrov I1, Milenović M2,4. Author information Front Med (Lausanne). 2018 Mar 9;5:57. doi: 10.3389/fmed.2018.00057. eCollection 2018. Abstract Postoperative analgesia is imperative in the youngest patients. Pain, especially if experienced during childhood, has numerous adverse effects-from psychological, through complications of the underlying disease (prolonged treatment, hospital stay, and increased costs of the treatment) to an increase in the incidence of death due to the onset of the systemic inflammatory response. The continuous peripheral block (CPNB) has been increasingly used in recent years for complete and prolonged analgesia of pediatric patients, as well as a part of multidisciplinary treatment of complex regional pain syndrome. It has been shown that outpatient CPNB reduces the need for parenteral administration of opioid analgetics. It has also been proved that this technique can be used in pediatric patients in home conditions. Safety of CPNB is based on the increasing use of ultrasound as well as on the introduction of single enantiomers local anesthetics (ropivacaine and levobupivacaine) in lower concentrations. It is possible to discharge patient home with catheter, but it is necessary to provide adequate education for staff, patients, and parents, as well as to have dedicated anesthesiology team. Postoperative period without major pain raises the morale of the child, parents. and medical staff. KEYWORDS: continuous peripheral nerve block; pain management; pediatric anesthesia; perineural catheters; postoperative analgesia PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World 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

Anestesia en el espacio / Anesthesia in space

Abril 17, 2018. No. 3054

Anestesia en ambientes austeros: revisión de literatura y consideraciones para futuras misiones de exploración espacial. Anaesthesia in austere environments: literature review and considerations for future space exploration missions. Komorowski M1,2,3, Fleming S4, Mawkin M1, Hinkelbein J5. Author information NPJ Microgravity. 2018 Feb 23;4:5. doi: 10.1038/s41526-018-0039-y. eCollection 2018. Abstract Future space exploration missions will take humans far beyond low Earth orbit and require complete crew autonomy. The ability to provide anaesthesia will be important given the expected risk of severe medical events requiring surgery. Knowledge and experience of such procedures during space missions is currently extremely limited. Austere and isolated environments (such as polar bases or submarines) have been used extensively as test beds for spaceflight to probe hazards, train crews, develop clinical protocols and countermeasures for prospective space missions. We have conducted a literature review on anaesthesia in austere environments relevant to distant space missions. In each setting, we assessed how the problems related to the provision of anaesthesia (e.g., medical kit and skills) are dealt with or prepared for. We analysed how these factors could be applied to the unique environment of a space exploration mission. The delivery of anaesthesia will be complicated by many factors including space-induced physiological changes and limitations in skills and equipment. The basic principles of a safe anaesthesia in an austere environment (appropriate training, presence of minimal safety and monitoring equipment, etc.) can be extended to the context of a space exploration mission. Skills redundancy is an important safety factor, and basic competency in anaesthesia should be part of the skillset of several crewmembers. The literature suggests that safe and effective anaesthesia could be achieved by a physician during future space exploration missions. In a life-or-limb situation, non-physicians may be able to conduct anaesthetic procedures, including simplified general anaesthesia. PDF Intubación después de la inducción de secuencia rápida realizada por personal no médico durante las misiones de exploración espacial: un estudio piloto de simulación en un entorno analógico de Marte. Intubation after rapid sequence induction performed by non-medical personnel during space exploration missions: a simulation pilot study in a Mars analogue environment. Komorowski M1, Fleming S2. Author information Extrem Physiol Med. 2015 Nov 1;4:19. doi: 10.1186/s13728-015-0038-5. eCollection 2015. Abstract BACKGROUND: The question of the safety of anaesthetic procedures performed by non anaesthetists or even by non physicians has long been debated. We explore here this question in the hypothetical context of an exploration mission to Mars. During future interplanetary spacemissions, the risk of medical conditions requiring surgery and anaesthetic techniques will be significant. On Earth, anaesthesia is generally performed by well accustomed personnel. During exploration missions, onboard medical expertise might be lacking, or the crew doctor could become ill or injured. Telemedical assistance will not be available. In these conditions and as a last resort, personnel with limited medical training may have to perform lifesaving procedures, which could include anaesthesia and surgery. The objective of this pilot study was to test the ability for unassisted personnel with no medical training to perform oro-tracheal intubation after a rapid sequence induction on a simulated deconditioned astronaut in a Mars analogue environment. The experiment made use of a hybrid simulation model, in which the injured astronaut was represented by a torso manikin, whose vital signs and hemodynamic status were emulated using a patient simulator software. Only assisted by an interactive computer tool (PowerPoint(®) presentation), five participants with no previous medical training completed a simplified induction of general anaesthesia with intubation. RESULTS: No major complication occurred during the simulated trials, namely no cardiac arrest, no hypoxia, no cardiovascular collapse and no failure to intubate. The study design was able to reproduce many of the constraints of a space exploration mission. CONCLUSIONS: Unassisted personnel with minimal medical training and familiarization with the equipment may be able to perform advanced medical care in a safe and efficient manner. Further studies integrating this protocol into a complete anaesthetic and surgical scenario will provide valuable input in designing health support systems for space exploration missions. KEYWORDS: Anaesthesia; Medical training; Simulation; Space exploration; Space medicine PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World 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

Seguridad en anestesia / Safe anesthesia

Abril 10, 2018. No. 3049

Reevaluación del riesgo cardíaco perioperatorio (estudio MET REPAIR) Re-evaluation of peri-operative cardiac risk (the MET REPAIR study): Study protocol of a prospective, multicentre cohort study sponsored by the European Society of Anaesthesiology. Mauermann E1, De Hert S, Dell-Kuster S, Filipovic M, Howell S, Ionescu D, Seeberger MD, Szczeklik W, Lurati Buse GAL. Eur J Anaesthesiol. 2017 Nov;34(11):709-712. doi: 10.1097/EJA.0000000000000697. PDF Norma noruega para la práctica segura de la anestesia 2016 Norwegian Standard for the Safe Practice of Anaesthesia 2016 PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World 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

Cirugía, anestesia, inmunposupresión y cáncer / Surgery, anesthesia, immunosuppression and cancer recurrence.

Febrero 9, 2018. No. 2989

Efectos de la cirugía y la elección anestésica en la inmunosupresión y la recurrencia del cáncer. Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence. Kim R1. Author information J Transl Med. 2018 Jan 18;16(1):8. doi: 10.1186/s12967-018-1389-7. Abstract BACKGROUND: The relationship between surgery and anesthetic-induced immunosuppression and cancer recurrence remains unresolved. Surgery and anesthesia stimulate the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) to cause immunosuppression through several tumor-derived soluble factors. The potential impact of surgery and anesthesia on cancer recurrence was reviewed to provide guidance for cancer surgical treatment. METHODS: PubMed was searched up to December 31, 2016 using search terms such as, "anesthetic technique and cancer recurrence," "regional anesthesia and cancer recurrence," "local anesthesia and cancer recurrence," "anesthetic technique and immunosuppression," and "anesthetic technique and oncologic surgery." RESULTS: Surgery-induced stress responses and surgical manipulation enhance tumor metastasis via release of angiogenic factors and suppression of natural killer (NK) cells and cell-mediated immunity. Intravenous agents such as ketamine and thiopental suppress NK cell activity, whereas propofol does not. Ketamine induces T-lymphocyte apoptosis but midazolam does not affect cytotoxic T-lymphocytes. Volatile anesthetics suppress NK cell activity, induce T-lymphocyte apoptosis, and enhance angiogenesis through hypoxia inducible factor-1α (HIF-1α) activity. Opioids suppress NK cell activity and increase regulatory T cells. CONCLUSION: Local anesthetics such as lidocaine increase NK cell activity. Anesthetics such as propofol and locoregional anesthesia, which decrease surgery-induced neuroendocrine responses through HPA-axis and SNS suppression, may cause less immunosuppression and recurrence of certain types of cancer compared to volatile anesthetics and opioids. KEYWORDS: Anesthetic agent; Anesthetic technique; Cancer recurrence; Cancer surgery; Immunosuppression PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

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