Revisiones sistemáticas en anestesia /Systematic reviews in anesthesia

Octubre 30, 2017. No. 2897

Heterogeneidad de los estudios en revisiones sistemáticas de anestesiología: revisión metaepidemiológica y propuesta de mapeo de evidencia. Heterogeneity of studies in anesthesiology systematic reviews: a meta-epidemiological reviewand proposal for evidence mapping. Umberham B1, Hedin R1, Detweiler B1, Kollmorgen L1, Hicks C1, Vassar M1. Author information Br J Anaesth. 2017 Nov 1;119(5):874-884. doi: 10.1093/bja/aex251. Abstract Heterogeneity among the primary studies included in a systematic review (SR) is one of the most challenging considerations for systematic reviewers. Current practices in anaesthesiology SRs have not been evaluated, but traditional methods may not provide sufficient information to evaluate the true nature of these differences. We address these issues by examining the practices for evaluating heterogeneity in anesthesiology reviews. Also, we propose a mapping method for presenting heterogeneous aspects of the primary studies in SRs.We evaluated heterogeneity practices reported in SRs published in highly ranked anesthesiology journals and Cochrane reviews. Elements extracted from the SRs included heterogeneity tests, models used, analyses conducted, plots used, and I2 values. Additionally, we selected a SR to develop an evidence map in order to display clinical heterogeneity.Our statistical analysis showed 150/207 SRs reporting a test for statistical heterogeneity. Plots were used in 138 reviews to display heterogeneity. Subgroup analyses were the most commonly reported analysis (54%). Meta-regression and sensitivity analyses were used sparingly (25%; 23% respectively). A random effects model was most commonly reported (33%). Heterogeneity statistics across meta-analyses suggested that, in our sample, the majority (55%) did not present sufficient heterogeneity to be of great concern. Cochrane reviews (n=58) were also analysed. Plots were used in 88% of Cochrane reviews. Subgroup analysis was used in 59% Cochrane reviews, while sensitivity analysis was used in 62%.Many reviews did not provide sufficient detail regarding heterogeneity. We are calling for improvement to reporting practices. PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information

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

Alergia y anestesia / Allergy and anesthesia

Octubre 25, 2017. No. 2892

Alergia a las benzodiazepinas con administración de anestesia: revisión de la literatura actual. Benzodiazepine Allergy With Anesthesia Administration: A Review of Current Literature. Haybarger E1, Young AS2, Giovannitti JA Jr3. Author information Anesth Prog. Fall 2016;63(3):160-7. doi: 10.2344/16-00019.1. Abstract The incidence of anaphylactic/anaphylactoid reactions has been reported to vary between 1:3500 and 1:20,000 cases with a mortality rate ranging from 3 to 9%. Clinical signs present as skin rash, urticaria, angioedema, bronchospasm, tachycardia, bradycardia, and hypotension. Rapid identification and treatment are crucial to overall patient prognosis, as delayed intervention is associated with increased mortality. Diagnosis may be confirmed with clinical presentation, serum tryptase levels, and skin test results. While the main causative agents in anesthetic practice are typically neuromuscular blocking agents (NMBs), latex, and antibiotics, this review aims to discuss recognition, management, and preventive measures in perioperative anaphylactic/anaphylactoid reactions from benzodiazepine administration. KEYWORDS: Anaphylactoid reactions; Anaphylaxis; Benzodiazepine allergy; Diagnosis of anaphylaxis; Management of anaphylaxis PDF Hipersensibilidad a los anestésicos locales Hypersensitivity to local anesthetics. Grzanka A, Wasilewska I, Śliwczyńska M, Misiołek H1. Author information Anaesthesiol Intensive Ther. 2016;48(2):128-34. doi: 10.5603/AIT.a2016.0017. Epub 2016 Mar 15. Abstract Using local anaesthetics in daily practice, particularly by anaesthetists and dentists, is connected with the risk of side effects. Therefore, the observation of side effects, carrying out detailed research (according to the chart proposed in this study) and conducting specialist examinations is of the highest importance. There is a variety of side effects that could occur during local anaesthesia procedures, with the intensity ranging from clinically unimportant to life threatening. Clinicians' major concerns are the appearance of various hypersensitivity reactions, including anaphylaxis. Healthcare providers responsible for the administration of local anaesthetics should be able to detect hypersensitivity reactions to implement appropriate treatment and then choose highly selected diagnostic procedures. The final diagnosis should be based on specific medical history; documentation, including a description of the case and measurement of tryptase activity; skin tests; and provocation trials. Screening tests are not recommended in populations without hypersensitivity to local anaesthestics in their medical history. KEYWORDS: hypersensitivity; local anestehtics; local anesthesia; skin tests PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion

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

Anestesia en cirugía laparoscópica / Anesthesia in laparoscopic surgery

Septiembre 27, 2017. No. 2824

Complicaciones relacionadas con la anestesia, en cirugía laparoscópica Anaesthesia-related complications in laparoscopic surgery Dr. Juan Bautista Olivé González Revista Cubana de Anestesiología y Reanimación . 2013;12(1):57-69 PDF Anestesia en la cirugía laparoscópica abdominal Anesthesia in abdominal laparoscopic surgery Jorge Enciso Nano An Fac med. 2013;74(1):63-70 PDF Anestesia en Cirugía Laparoscópica: implicancias Anesthesia in Laparoscopic Surgery: Implications Jorge Enciso Nano PDF Anestesia en cirugía laparoscópica Gerardo Murga Velázquez, Pedro Casanovas Catot Actas Peru Anestesiología PDF Consideraciones anestésicas en cirugía laparoscópica en el paciente pediátrico Dr. David Ángel P García-Arreola, Dra. Liliana Ramírez-Aldana, Dra. Deoselina Hernández-Gutiérrez Rev Mex Anestesiología Vol. 35. Supl. 1 Abril-Junio 2012 pp S164-S167 PDF Anestesia en cirugia laparoscópica Dr. Diosdado Pelegrí Grau Hospital Universitari de Tarragona Joan XXIII PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion

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

Anestesia en cirugía cardiaca / Cardiac anaesthesia

Septiembre 13, 2017. No. 2810

Ensayo clínico aleatorizado que compara las respuestas hemodinámicas a ketamina-propofol ón (Ketofol) versus etomidato durante la inducción de la anestesia en pacientes con disfunción ventricular izquierda sometidos a cirugía de bypass coronario. A randomized clinical trial comparing hemodynamic responses to ketamine-propofol combination (ketofol) versus etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery. Baradari AG1, Alipour A2, Habibi MR1, Rashidaei S3, Emami Zeydi A4,5. Author information Arch Med Sci. 2017 Aug;13(5):1102-1110. doi: 10.5114/aoms.2016.63193. Epub 2016 Oct 25. Abstract INTRODUCTION: Anesthesia induction is often accompanied by a period of hemodynamic instability, which could be a significant problem in patients with compromised ventricular function. The aim of this study is to compare the hemodynamic responses to etomidate versus a combination of ketamine and propofol (ketofol) for anesthetic induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS: In a double-blind randomized clinical study, a total of 84 patients with ischemic left ventricular dysfunction (EF < 40%) were randomly assigned to two groups (A and B). Patients in group A received etomidate 0.2 mg/kg and a placebo (normal saline); group B received a combination of ketamine (1 mg/kg) and propofol (1.5 mg/kg) at the induction of anesthesia. Two minutes after induction, hemodynamic variables, including systolic, diastolic, mean arterial pressure (SAP, DAP, MAP) and heart rate (HR), were measured immediately before and after the laryngoscopy, and before intubation and post-intubation at 1, 2, and 3 min. RESULTS: The decrease in all hemodynamic parameters (SBP, DBP, MAP and HR) from induction time to laryngoscopy was greater in the ketofol group (group B) than in the etomidate group (group A) (p < 0.05). The ephedrine prescription rate due to hemodynamic changes was 24.4% (10 patients) and 5% (2 patients) in group B and group A, respectively (p = 0.03). CONCLUSIONS: We found that etomidate provides superior hemodynamic stability as compared to ketofol in patients with left ventricular dysfunction undergoing CABG surgery under general anesthesia. KEYWORDS: etomidate; hemodynamics; ketamine; ketofol; propofol; ventricular dysfunction PDF Leucocitosis asintomática preoperatoria y evolución postoperatoria en pacientes con cirugía cardíaca. Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients. Mahmood E1,2, Knio ZO3, Mahmood F1, Amir R1, Shahul S1, Mahmood B1,4, Baribeau Y1, Mueller A1, Matyal R1. Author information PLoS One. 2017 Sep 5;12(9):e0182118. doi: 10.1371/journal.pone.0182118. eCollection 2017. Abstract BACKGROUND: Despite showing a prognostic value in general surgical patients, preoperative asymptomatic elevated white blood cell (WBC) count is not considered a risk factor for cardiac surgery. Whereas there is sporadic evidence of its value as a preoperative risk marker, it has not been looked at methodically as a specific index of outcome during cardiac surgery. Using a national database we sought to determine the relationship between preoperative WBC count and postoperative outcome in cardiac surgical patients. METHODS: Cardiac surgeries were extracted from the 2007-2013 American College of Surgeons National Surgical Quality Improvement Program database. Leukocytosis was defined by a preoperative WBC count greater than 11,000 cells/μL. A univariate analysis compared the incidence of adverse outcomes for patients with and without leukocytosis. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality. RESULTS: Out of a total of 10,979 cardiac surgery patients 863 (7.8%) had preoperative leukocytosis. On univariate analysis, patients with leukocytosis experienced greater incidences of 30-day mortality, wound complications, and medical complications. Wound complications included surgical site infection as well as wound dehiscence. The medical complications included all other non-surgical causes of increased morbidity and infection leading to urinary tract infection, pneumonia, ventilator dependence, sepsis and septic shock. After stepwise model adjustment, leukocytosis was a strong predictor of medical complications (OR 1.22, 95% CI: 1.09-1.36, p = 0.002) with c-statistic of 0.667. However, after stepwise model adjustment leukocytosis was not a significant predictor of 30-day mortality and wound complications. CONCLUSION: Preoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications. 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