Anestesia para cirugía de invasión mínima / Anaesthesia for minimally invasive surgery

Septiembre 10, 2017. No. 2807

Anestesia para cirugía de invasión mínima Anaesthesia for minimally invasive surgery. Dec M1, Andruszkiewicz P1. Author information Wideochir Inne Tech Maloinwazyjne. 2016 Jan;10(4):509-14. doi: 10.5114/wiitm.2015.56411. Epub 2015 Dec 15. Abstract Minimally invasive surgery (MIS) is rising in popularity. It offers well-known benefits to the patient. However, restricted access to the surgical site and gas insufflation into the body cavities may result in severe complications. From the anaesthetic point of view MIS poses unique challenges associated with creation of pneumoperitoneum, carbon dioxide absorption, specific positioning and monitoring a patient to whom the anaesthetist has often restricted access, in a poorly lit environment. Moreover, with refinement of surgical procedures and growing experience the anaesthetist is presented with patients from high-risk groups (obese, elderly, with advanced cardiac and respiratory disease) who once were deemed unsuitable for the laparoscopic technique. Anaesthetic management is aimed at getting the patient safely through the procedure, minimizing the specific risks arising from laparoscopy and the patient's coexisting medical problems, ensuring quick recovery and a relatively pain-free postoperative course with early return to normal function. KEYWORDS: general anaesthesia; minimally invasive surgery; perioperative management PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México).  Informes / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

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

Anestesia ambulatoria / Ambulatory anesthesia

Septiembre 11, 2017. No. 2808

Anestesia para cirugía ambulatoriaAnesthesia for ambulatory surgery. Lee JH1. Author information Korean J Anesthesiol. 2017 Aug;70(4):398-406. doi: 10.4097/kjae.2017.70.4.398. Epub 2017 May 19. Abstract Ambulatory anesthesia allows quick recovery from anesthesia, leading to an early discharge and rapid resumption of daily activities, which can be of great benefit to patients, healthcare providers, third-party payers, and hospitals. Recently, with the development of minimallyinvasive surgical techniques and short-acting anesthetics, the use of ambulatory surgery has grown rapidly. Additionally, as the indications for ambulatory surgery have widened, the surgical methods have become more complex and the number of comorbidities has increased. For successful and safe ambulatory anesthesia, the anesthesiologist must consider various factors relating to the patient. Among them, appropriate selection of patients and surgical and anesthetic methods, as well as postoperative management, should be considered simultaneously. Patient selection is a particularly important factor. Appropriate surgical and anesthetic techniques should be used to minimize postoperative complications, especially postoperative pain, nausea, and vomiting. Patients and their caregivers should be fully informed of specific care guidelines and appropriate responses to emergency situations on discharge from the hospital. During this process, close communication between patients and medical staff, as well as postoperative follow-up appointments, should be ensured. In summary, safe and convenient methods to ensure the patient's return to function and recovery are necessary. KEYWORDS: Ambulatory surgical procedures; Anesthesia; Patient safety; Patient selection PDF La seguridad del paciente durante sedación mediante monitorización de capnografía: una revisión sistemática y meta-análisis. Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis. Saunders R1,2, Struys MMRF3,4, Pollock RF2, Mestek M5, Lightdale JR6,7. Author information BMJ Open. 2017 Jun 30;7(6):e013402. doi: 10.1136/bmjopen-2016-013402. Abstract OBJECTIVE: To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery relative to visual assessment and pulse oximetry alone.  CONCLUSIONS: Meta-analysis of 13 RCTs published between 2006 and 2016 showed a reduction in respiratory compromise (from respiratory insufficiency to failure) during PSA with the inclusion of capnography monitoring. In particular, use of capnography was associated with less mild and severe oxygen desaturation, which may have helped to avoid the need for assisted ventilation. KEYWORDS: Ambulatory surgery; Capnography; Meta-analysis; Procedural sedation PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México).  Informes / Information

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

Patologia tiroidea y anestesia / Thyroid disorders and anesthesia

Julio 19, 2017. No. 2754

CONSIDERACIONES PERIOPERATORIAS DEL PACIENTE HIPERTIROIDEO Patricia Zamora Porras REVISTA MEDICA DE COSTA RICA Y CENTROAMERICA LXX (606) 313-318, 2013 PDF Manejo perioperatorio de pacientes con patología tiroidea y tratamiento crónico con corticoides Claudio Nazar J, Javier Bastidas E, Maximiliano Zamora H,  Roberto Coloma D, Ricardo Fuentes H Rev Chil Cir. Vol 68 - Nº 1, Febrero 2016; pág. 87-93 PDF Espectro y prevalencia de trastornos tiroideos en pacientes ingresados en la clínica de anestesiología para cirugía ambulatoria Spectrum and Prevalence of Thyroid Disorders in Patients Admitted to the Anaesthesiology Outpatient Clinic for Surgery. Sarıtas A1, Sarıtas PU1, Kurnaz MM1, Çelik A2. Abstract Turk J Anaesthesiol Reanim. 2015 Aug;43(4):240-5. doi: 10.5152/TJAR.2015.03206. Epub 2015 Mar 3. OBJECTIVE: An anaesthetic approach and surgery are important treatment strategies in patients with thyroid dysfunction due to potential complications. We investigated the prevalence of thyroid disorders, the significance of thyroid function tests (TFTs) with respect to anaesthesia in the preoperative period and the need for routine examinations. METHODS: A total of 10,600 patients who were admitted to the anaesthesiology outpatient clinic for surgery were retrospectively screened and enrolled between 2011 and 2013. Evident hypothyroidism was defined as free tetra-iodothyronine (fT4) <0.7 ng dL(-1) and thyroid-stimulating hormone (TSH) >4 mIU mL(-1), and subclinical hypothyroidism was defined as TSH >4 mIU mL(-1) with normal free hormone levels. Evident hyperthyroidism was defined as fT4 >1.7 ng dL(-1) and TSH <0.1 mIU mL(-1), and subclinical hyperthyroidism was defined as TSH <0.1 mIU mL(-1) with normal free hormone levels. Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 17.0. Independent samples t-test and one-way analysis of variance were used to compare the difference between groups. RESULTS: Of the participants, 8.5% were found to have hypothyroidism, 2.5% had hyperthyroidism, 3.5% received treatment and 2.5% had their treatment postponed. The likelihood of hypothyroidism was greater among females, and no difference was found between genders with respect to hyperthyroidism. CONCLUSION: We believe that TFTs are important because of regional factors. However, given the high cost of TFTs and because thyroid dysfunction risk increases with age, we concluded that routine TFTs in young patients with normal physical examination findings are not mandatory. KEYWORDS: Thyroid function tests; hyperthyroidism; hypothyroidism; iodine PDF Efecto de las acciones no genómicas de las hormonas tiroideas sobre el efecto anestésico del propofol. Effect of non-genomic actions of thyroid hormones on the anaesthetic effect of propofol. Wang Y1, Ma K2, Li LI2, Liu Y2, Si J3, Wan YU4. Exp Ther Med. 2015 Sep;10(3):959-965. Epub 2015 Jul 7. Abstract Hyperthyroidism is a common disease of the endocrine system and it is known that additional propofol anaesthesia is required during surgery for patients with hyperthyroidism compared with those with normal thyroid function. The aim of the present study was to determine the mechanism through which thyroid hormones (THs) inhibit the effect of propofol anaesthesia. Immunofluorescence techniques were used to verify the difference between the expression quantities of γ-aminobutyric acid type A (GABAA) receptor subunits α2 and β2 in the dorsal root ganglions (DRGs) of rats with hyperthyroidism and those in normal rats. Perforated patch clamp recordings in the whole-cell mode were performed to detect the GABA-activated current in acutely isolated rat DRG neurons from rats with hyperthyroidism and normal rats. This method was also used to evaluate the change in the GABA-activated currents following the pre-perfusion of propofol with and without 3,3',5-L-triiodothyronine (T3). Compared with normal rats, rats with hyperthyroidism expressed same quantities of GABAA receptor α2 and β2 subunits in DRGs. In addition, no difference in GABA-activated currents in the acutely isolated DRG neurons from the two types of rat was observed (P>0.05). T3 inhibits or minimises the augmentation effect of propofol on the GABA-activated currents (P<0.05). The inhibitory effect of T3 on propofol was minimised by increasing the propofol concentration (P<0.05). The inhibitory effect of T3 on the anaesthetic effect of propofol is achieved through the inhibition of the function of GABAA receptors through the non-genomic actions of the THs, rather than by changing the number of GABAA receptors. This inhibitory effect can be mitigated by increasing the propofol concentration. In conclusion, rats with hyperthyroidism require a larger dose of propofol to induce anaesthesia since the non-genomic actions of THs suppress GABA receptors, which in turn inhibits the anaesthetic action of propofol. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information

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