https://www.lesionesdeportivas.com.mx/academia/primum-non-nocere-siempre-debe-estar-en-nuestra-mente-y-espiritu-cuando-tenemos-un-ser-humano-en-necesidad-frente-a-nosotros/

“Primum non nocere” siempre debe estar en nuestra mente y espíritu cuando tenemos un ser humano en necesidad frente a nosotros.

julio 25, 2022 por admin

• Adding insult to injury should never be the result of our treatment. Increasing our learning curve of surgeons should never be done at the expense of our inexperience.
• This is a difficult case of a 38 year-old male heavy manual worker. Two years ago he suffered an engaged anterior dislocation which was initially treated by a a traditional healer with no success. After one year after going from here to there, he finally was treated surgically.
• Unfortunately, the result was suboptimal and the open reduction was insufficient, and due to this fact, the surgeons decided to place two transfictive pins damaging the articular surface of humerus and glenoid. Six months postoP the patient developed avascular necrosis. Awaiting the final treatment he suffered a 3 meter fall (he still needs to work) and suffered a 2-part proximal humerus fracture.
• I decided to go with an open reduction of the joint, cerclage of the fracture, hemiarthroplasty due to his work, and ream and run on the glenoid side.
• Could have done better? Not sure about it. What are your thoughts?
• mexicoshoulder #mexicoelbow #mexicoknee #traumatologiadeportivademexico #shoulder #surgery #arthroplasty #fracture #dislocation #learning

• Añadir sal a la herida nunca debe ser el resultado de nuestro tratamiento. El aumento de nuestra curva de aprendizaje de los cirujanos nunca debe hacerse a expensas de nuestra inexperiencia.
• Este es un caso difícil de un trabajador manual pesado de 38 años. Hace dos años sufrió una luxación anterior comprometida que inicialmente fue tratada por un curandero sin éxito. Después de un año de ir de aquí para allá, finalmente fue tratado quirúrgicamente.
• Desafortunadamente, el resultado fue sub-óptimo y la reducción abierta fue insuficiente, por lo que los cirujanos decidieron colocar dos pines transfictivos dañando la superficie articular del húmero y la glenoides.
• Seis meses después de la operación, el paciente desarrolló necrosis avascular. En espera del tratamiento final, sufrió una caída de 3 metros (todavía necesita trabajar) y sufrió una fractura de húmero proximal en dos partes.
• Decidí ir con una reducción abierta de la articulación, cerclaje de la fractura, hemiartroplastia debido a su trabajo, y fresado y corrido en el lado glenoideo.
• ¿Podría haberlo hecho mejor? No estoy seguro de eso. ¿Cuáles son tus pensamientos?
• mexicohombro #mexicocodo #mexicorodilla #traumatologiadeportivademexico #hombro #cirugia #artroplastia #fractura #luxacion #aprendizaje

Cirugia trans nasal-transesfenoidal / Transnasal transsphenoidal surgery

Julio 26, 2017. No. 2761

Cambios en los resultados funcionales en la cirugía de adenomas hipofisarios después de la ocurrencia intraoperatoria del reflejo trigeminocárdico: primera descripción en un estudio observacional retrospectivo. Functional Outcome Changes in Surgery for Pituitary Adenomas After Intraoperative Occurrence of the Trigeminocardiac Reflex: First Description in a Retrospective Observational Study. Chowdhury T1, Nöthen C, Filis A, Sandu N, Buchfelder M, Schaller B. Medicine (Baltimore). 2015 Sep;94(37):e1463. doi: 10.1097/MD.0000000000001463. Abstract Trigeminocardiac reflex (TCR) represents now a nearly ubiquitary phenomenon in skull base surgery. Functional relevance of the intrainterventional TCR occurrence is hitherto only proven for vestibular schwannoma.  It is presented, for the first time, an impact of TCR on the functional hormonal outcome after pituitary surgery and strongly underline again the importance of the TCR in clinical daily practice. As a consequence, TCR should be considered as a negative prognostic factor of hormonal normalization after surgery for pituitary adenomas that should be included into routine practice. PDF Efectos de la dexmedetomidina y el sulfato de magnesio en adultos sometidos a endoscópica transnasal transsfenoidal para resección de adenoma hipofisario: Un estudio aleatorizado doble ciego. The effects of dexmedetomidine and magnesium sulphate in adult patients undergoing endoscopic transnasal transsphenoidal resection of pituitary adenoma: A double-blind randomised study. Soliman R1, Fouad E1. Indian J Anaesth. 2017 May;61(5):410-417. doi: 10.4103/ija.IJA_581_16. Abstract BACKGROUND AND AIM: Transnasal transsphenoidal resection of pituitary tumours is associated with blood loss and wide fluctuations in haemodynamic parameters. The aim of the present study was to compare the effect of dexmedetomidine and magnesium sulphate during the transsphenoidal resection of pituitary tumours. METHODS: The study was a double-blind, randomised study and included 152 patients classified randomly into two groups: Group D: Dexmedetomidine was given as a loading dose 1 μg/kg over 10 min before induction followed by an infusion at 0.5 μg/kg/h during the surgery. Group M: Magnesium sulphate was given as loading dose of 50 mg/kg over 10 min followed by an infusion at 15 mg/kg/h during the surgery. The systolic, diastolic and mean arterial blood pressures, in addition to the amount of blood loss were measured at specific timepoints. Data were described in terms of mean ± standard deviation, median, frequencies, 95% confidence of interval of mean and percentages. RESULTS: Mean bleeding score was lower in Group D than Group M (1.36 ± 0.48 vs. 3.05 ± 0.65, respectively; P = 0.002). Mean blood loss was lower in Group D (157.43 ± 48.79 ml vs.299.47 ± 77.28 ml in Group M; P < 0.001)Heart rate, mean arterial pressure, fentanyl requirements, end-tidal sevoflurane concentration, and extubation and emergence times were lower, while incidence of bradycardia and hypotension were higher in Group D. CONCLUSIONS: During transsphenoidal pituitary resection, dexmedetomidine, compared to magnesium, is associated with lower blood loss and better operating conditions but with more hypotension and bradycardia. KEYWORDS: Dexmedetomidine; magnesium sulphate; pituitary adenoma; transsphenoidal resection PDF Efecto de la infiltración intramucosa de diferentes concentraciones de adrenalina en la hemodinámica durante la cirugía transesfenoidal. Effect of intramucosal infiltration of different concentrations of adrenaline on hemodynamics during transsphenoidal surgery. Bhatia N1, Ghai B1, Mangal K1, Wig J1, Mukherjee KK2. J Anaesthesiol Clin Pharmacol. 2014 Oct;30(4):520-5. doi: 10.4103/0970-9185.142848. Abstract BACKGROUND AND AIMS: Neurosurgeons routinely instill vasopressors, with or without local anesthetics, to prepare nasal passages prior to transsphenoidal surgeries. As there is a paucity of data comparing the effect of intramucosal nasal infiltration of different concentrations of adrenaline that is, 1:200,000 and 1:400,000 in patients undergoing transsphenoidal surgery, we conducted this study to evaluate the effect of these two concentrations of adrenaline with 2% lignocaine on hemodynamics as well as bleeding. MATERIALS AND METHODS: Fifty-two American Society of Anesthesiologists I/II patients, aged 15-70 years, undergoing transsphenoidalsurgery for pituitary or sellar masses were enrolled. Prior to surgical incision, nasal septal mucosa was infiltrated with lignocaine-adrenaline solution, after randomly allocating them to one of the two groups, with patients in Group A receiving intramucosal infiltration using 2% lignocaine with 1:200,000 adrenaline and those in Group B receiving 2% lignocaine with 1:400,000 adrenaline. Following infiltration, hemodynamic parameters were recorded every 1 min for 5 min and thereafter at every 5 min interval. RESULTS: Fewer patients (3/24 [12.5%]) in Group B had a rise of >50% in systolic blood pressure, from baseline values, after nasal mucosa infiltration as compared with patients in Group A (9/24 [37.5%]). In addition, mean rise in systolic, diastolic and mean arterial pressure was also significantly lower in Group B as compared with Group A. CONCLUSION: Adrenaline in a concentration of 1:400,000 added to 2% lignocaine for nasal mucosa infiltration produces less hemodynamic response as compared with adrenaline 1:200,000 added to 2% lignocaine while at the same time providing similar operating conditions. KEYWORDS: Hemodynamic effects; intramucosal infiltration; lignocaine-adrenaline infiltration; transsphenoidal surgery PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

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