Mostrando entradas con la etiqueta anestesiología. Mostrar todas las entradas
Mostrando entradas con la etiqueta anestesiología. Mostrar todas las entradas

miércoles, 8 de agosto de 2012

Talleres de intervencionismo en cadáveres, Conferencias y Curso de Actualización Interactivo dedicado al manejo de opioides.


La Cínica del Dolor del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán ubicado en la Ciudad de México organiza el Curso Anual, del 5 al 8 de Septiembre del 2012, con Talleres de intervencionismo en cadáveres, Conferencias y Curso de  Actualización Interactivo dedicado al manejo de  opioides.
El programa incluye temas de ciencias  básicas, farmacología, intervencionismo y cuidados paliativos impartido por selectos profesores nacionales e internacionales.
Para mayores informes siga este enlace http://www.dolorypaliativos.org/fimdp2012.asp o escriba al correo electrónico azaleap@hotmail.com o llame a los teléfonos (55) 5513 3782 ó (55) 5487 0900 Ext.  5020 y 5021 
Atentamente
Anestesiología y Medicina del Dolor

Más sobre drogas y atletas

Lesión, dolor y uso de opioides de prescripción entre ex futbolistas de la NFL 
Injury, pain, and prescription opioid use among former National Football League (NFL) players.
Cottler LB, Ben Abdallah A, Cummings SM, Barr J, Banks R, Forchheimer R.
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108, USA. cottler@epi.wustl.edu
Drug Alcohol Depend. 2011 Jul 1;116(1-3):188-94. Epub 2011 Jan 28.
Abstract
BACKGROUND: Athletes with injury-related pain, especially National Football League (NFL) players, are at increased risk for opioid use and misuse which may result in medical, psychiatric and social problems. This is the first study to evaluate the intersection of sports pain and opioid use and misuse among former NFL players. METHODS: A telephone survey of 644 retired NFL players from the 2009 Retired Players Association Directory was conducted (53.4% completion rate) from March to August 2010. RESULTS: Over half (52%) used opioids during their NFL career with 71% reporting misuse. Additionally, 15% of NFL misusers currently misused vs. 5% among players who used just as prescribed during their NFL career. Prevalence of current opioid use was 7%-3 times the rate of the general population. Multivariate analyses indicated that significant NFL pain increased the adjusted odds (AOR) of any current opioid use vs. non-use (AOR 6.76, 95%CI 2.88-15.87), as did moderate to severe mental impairment (AOR 1.88, 95%CI 1.19-2.98) and heavy drinking in the past week (AOR 2.15, 95%CI 1.17-3.98). Undiagnosed concussions singly predicted current misuse vs. use just as prescribed (AOR 4.25, 95%CI 1.12-16.22). Three variables predicted current misuse vs. non-use: significant pain (AOR 8.33, 95%CI 1.98-35.04), undiagnosed concussions (AOR 3.51, 95%CI 1.98-35.04) and heavy drinking (AOR 3.48, 95%CI 1.63-7.41). CONCLUSIONS: Players who misused during their NFL career were most likely to misuse currently compared to others. Current misuse was associated with more NFL pain, undiagnosed concussions and heavy drinking. Longitudinal studies are needed to determine the long term effects of opioid misuse among athletes
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095672/pdf/nihms-269860.pdf
 
Abuso de hormona de crecimiento entre levantadores de pesas masculinos 
Human growth hormone abuse in male weightlifters.
Brennan BP, Kanayama G, Hudson JI, Pope HG Jr.
Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02478, USA. bbrennan@partners.org
Am J Addict. 2011 Jan-Feb;20(1):9-13. doi: 10.1111/j.1521-0391.2010.00093.x. Epub 2010 Nov 12.
Abstract
In a study of performance-enhancing substance use among 231 experienced young male weightlifters, we found that 27 (12%) reported illicit use of human growth hormone (HGH) or its bioactive derivative, insulin-like growth factor-1. All of these 27 men also reported use of anabolic-androgenic steroids (AAS) and 22 (81%) met criteria for current or past AAS dependence. Fifteen (56%) also reported current or past dependence on opioids, cocaine, and/or ecstasy. These findings suggest that among young male weightlifters, illicit HGH use has become a common form of substance abuse, frequently associated with both AAS dependence and classical substance dependence.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104052/pdf/nihms243249.pdf
 
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Anestesiología y Medicina del Dolor

Más sobre vía aérea y deportistas

Disfunción de la vía aérea en nadadores 
Airway dysfunction in swimmers.
Bougault V, Boulet LP.
Université Droit et Santé de Lille, Lille, France. valerie.bougault@univ-lille2.fr
Br J Sports Med. 2012 May;46(6):402-6. doi: 10.1136/402 bjsports-2011-090821. Epub 2012 Jan 12
Abstract
Elite competitive swimmers are particularly affected by airway disorders that are probably related to regular and intense training sessions in a chlorinated environment. Upper and lower airway respiratory symptoms, rhinitis, airway hyper-responsiveness, and exercise-induced bronchoconstriction are highly prevalent in these athletes, but their influence on athletic performance is still unclear. The authors reviewed the main upper and lower respiratory ailments observed in competitive swimmers who train in indoor swimming pools, their pathophysiology, clinical significance and possible effects on performance. Issues regarding the screening of these disorders, their management and preventive measures are addressed
La salud respiratoria de los deportistas de élite - la prevención de lesiones las vías respiratorias: una revisión crítica
Respiratory health of elite athletes - preventing airway injury: a critical review.
Kippelen P, Fitch KD, Anderson SD, Bougault V, Boulet LP, Rundell KW, Sue-Chu M, McKenzie DC.
Brunel University, Centre for Sports Medicine & Human Performance, Uxbridge UB8 3PH, UK. pascale.kippelen@brunel.ac.uk
Br J Sports Med. 2012 Jun;46(7):471-6. Epub 2012 Apr 20.
Abstract
Elite athletes, particularly those engaged in endurance sports and those exposed chronically to airborne pollutants/irritants or allergens, are at increased risk for upper and lower airway dysfunction. Airway epithelial injury may be caused by dehydration and physical stress applied to the airways during severe exercise hyperpnoea and/or by inhalation of noxious agents. This is thought to initiate an inflammatory cascade/repair process that, ultimately, could lead to airway hyperresponsiveness (AHR) and asthma in susceptible athletes. The authors review the evidence relating to prevention or reduction of the risk of AHR/asthma development. Appropriate measures should be implemented when athletes exercise strenuously in an attempt to attenuate the dehydration stress and reduce the exposure to noxious airborne agents. Environmental interventions are the most important. Non-pharmacological strategies can assist, but currently, pharmacological measures have not been demonstrated to be effective. Whether early prevention of airway injury in elite athletes can prevent or reduce progression to AHR/asthma remains to be established.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371227/pdf/bjsm-46-7-0471.pdf 
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Anestesiología y Medicina del Dolor

lunes, 6 de agosto de 2012

Update WFSA 2008 y 2007 en Español

La función del Comité de Publicaciones de la WFSA es promover la producción y distribución de materiales educativos de buena calidad a anestesiólogos que trabajan con pocos suministros de libros y revistas actualizados. Update in Anaesthesia es la publicación oficial de la WFSA esta edición presenta algunos cambios importantes con miras a presentar una visión futura más eficaz de anestesia.
Gracias a un grupo de colegas Latinoamericanos que encabeza el Dr. Gustavo Adolfo Elena de Argentina, es que la versión en Inglés de Update in Anaesthesia se ha estado traduciendo al Español y se nos ha autorizado a difundir esta versión a través de nuestro proyecto educativo. A medida que las traducciones estén listas, se le enviaran a su correo electrónico y además estarán enlistadas en nuestro portal para consulta libre.
Si desea ver las ediciones originales en Inglés de esta revista puede ingresar al siguente enlace http://update.anaesthesiologists.org/
Update 2008:24(1) junio
Seguridad quirúrgica de los pacientes OMS
Pentazocina
Hipertermia maligna
Anestesia pediátrica en ONG
Bloqueo del plano abdominal transverso
Manejo de lesiones agudas de la columna cervical
Anestesia para cirugía del pié y tobillo
http://www.anestesia-dolor.org/revistas/Update24_es_WFSA_2008.pdf  
Update 2007;23 
Anestesia en cesárea
Paracetamol
Sepsis
Dispersión de anestésicos locales espinales
Cefalea postpunción dural
Neuroanestesia
Muchos más....
http://www.anestesia-dolor.org/revistas/Update23_es_WFSA_2007.pdf 
 
 

Atentamente
Anestesiología y Medicina del Dolor

sábado, 4 de agosto de 2012

Drogas, dopaje y atletas

Uso de anfetaminas y sus factores asociados en fisicoculturistas: un estudio de Terán, Irán. 
Amphetamine use and its associated factors in body builders: a study from Tehran, Iran.
Angoorani H, Narenjiha H, Tayyebi B, Ghassabian A, Ahmadi G, Assari S.
Iranian Research Center for Substance Abuse and Dependence (IRCSAD), University of Social Welfare and Rehabilitation Science, Tehran, Iran.
Arch Med Sci. 2012 May 9;8(2):362-7.
Abstract
INTRODUCTION: Epidemiological studies on all types of illicit drug use among athletes are essential for both the sport community and drug control achievements. Here, we investigated the prevalence and associated factors of amphetamine use in body builders in Tehran, Iran, 2007.MATERIAL AND METHODS: This study is a secondary analysis of a substance use survey done in 103 randomly selected gymnasia in Tehran (capital city of Iran). The survey was conducted from November 2007 to January 2008 and included 843 randomly selected bodybuilders (aged 40 years or less). By interviews via questionnaires the following data were obtained: age, job, marital status, education level, housing status, average monthly family income, number of family members, gymnasium area (m(2)), number of trainers, number of gymnasium members, initiation time (months), weekly duration of the sporting activity (h), monthly cost of the sporting activity, purpose of participating in sporting activity, and history of anabolic steroid and amphetamine use. RESULTS: One hundred twenty (13.3%) body builders reported a history of amphetamine use. According to the results of regression analysis, being married (risk ratio - RR = 0.540), and participating in body building to enhance self-esteem (RR = 0.423) or to enhance sport performance (RR = 0.545) had protective effects on amphetamine use. However, having university qualifications (RR = 1.843), using anabolic steroids (RR = 1.803) and participating in sport to maintain fitness (RR = 2.472) were linked to increased risk of amphetamine use. CONCLUSIONS: Well-educated bodybuilders were more likely to use amphetamines, and why this is so needs to be discovered. If further studies show that they are not aware of the dangers associated with amphetamine use, providing them with information should be considered.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361051/pdf/AMS-8-18565.pdf 
¿Existe un peligro para la miopía en la educación contra el dopaje? Análisis comparativo del uso y abuso de sustancias en los deportes de raqueta Olímpicos requiere un enfoque más amplio. 
Is there a danger for myopia in anti-doping education? Comparative analysis of substance use and misuse in Olympic racket sports calls for a broader approach.
Kondric M, Sekulic D, Petroczi A, Ostojic L, Rodek J, Ostojic Z.
Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
Subst Abuse Treat Prev Policy. 2011 Oct 11;6:27.
Abstract
BACKGROUND: Racket sports are typically not associated with doping. Despite the common characteristics of being non-contact and mostly individual, racket sports differ in their physiological demands, which might be reflected in substance use and misuse (SUM). The aim of this study was to investigate SUM among Slovenian Olympic racket sport players in the context of educational, sociodemographic and sport-specific factors. METHODS: Elite athletes (N=187; mean age=22±2.3; 64% male) representing one of the three racket sports, table tennis, badminton, and tennis, completed a paper-and-pencil questionnaire on substance use habits. Athletes in this sample had participated in at least one of the two most recent competitions at the highest national level and had no significant difference in competitive achievement or status within their sport. RESULTS: A significant proportion of athletes (46% for both sexes) reported using nutritional supplements. Between 10% and 24% of the studied males would use doping if the practice would help them achieve better results in competition and if it had no negative health consequences; a further 5% to 10% indicated potential doping behaviour regardless of potential health hazards. Females were generally less oriented toward SUM than their male counterparts with no significant differences between sports, except for badminton players. Substances that have no direct effect on sport performance (if timed carefully to avoid detrimental effects) are more commonly consumed (20% binge drink at least once a week and 18% report using opioids), whereas athletes avoid substances that can impair and threaten athletic achievement by decreasing physical capacities (e.g. cigarettes), violating anti-doping codes or potentially transgressing substance control laws (e.g. opiates and cannabinoids). Regarding doping issues, athletes' trust in their coaches and physicians is low. CONCLUSION: SUM in sports spreads beyond doping-prone sports and drugs that enhance athletic performance. Current anti-doping education, focusing exclusively on rules and fair play, creates an increasingly widening gap between sports and the athletes' lives outside of sports. To avoid myopia, anti-doping programmes should adopt a holistic approach to prevent substance use in sports for the sake of the athletes' health as much as for the integrity of sports.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204239/pdf/1747-597X-6-27.pdf
 
Ejercicio y usos de drogas entre jóvenes Estadounidenses, 1991-2009. 
Exercise and substance use among American youth, 1991-2009.
Terry-McElrath YM, O'Malley PM, Johnston LD.
Institute for Social Research, University of Michigan, Ann Arbor, USA.yterry@umich.edu
Am J Prev Med. 2011 May;40(5):530-40.

Abstract
BACKGROUND:
The National Institute on Drug Abuse has called for increased research into the use of physical activity in substance abuse prevention, specifically research into physical activity type and context. PURPOSE: This paper examines the relationships between (1) secondary school student substance use and (2) exercise in general and school athletic team participation, and examines such relationships over time. METHODS: Nationally representative cross-sectional samples of 8th-, 10th-, and 12th-grade students were surveyed each year from 1991 to 2009. Substance use measures included past 2-week binge drinking and past 30-day alcohol, cigarette, smokeless tobacco, marijuana, and steroid use. Analyses were conducted during 2009-2010. RESULTS: Across grades, higher levels of exercise were associated with lower levels of alcohol, cigarette, and marijuana use. Higher levels of athletic team participation were associated with higher levels of smokeless tobacco use and lower levels of cigarette and marijuana use across grades and to higher levels of high school alcohol and steroid use. Exercise helped suppress the undesired relationship between team participation and alcohol use; exercise and athletic team participation worked synergistically in lowering cigarette and marijuana use. Observed relationships were generally stable across time. CONCLUSIONS: There appear to be substantive differences between exercise and team sport participation in relation to adolescent substance use. These findings from cross-sectional data suggest that interventions to improve levels of general physical activity should be evaluated to determine if they help delay or reduce substance use among youth in general as well as among student athletes.
Atentamente
Anestesiología y Medicina del Dolor

Drogas, dopaje y atletas

Uso de anfetaminas y sus factores asociados en fisicoculturistas: un estudio de Terán, Irán. 
Amphetamine use and its associated factors in body builders: a study from Tehran, Iran.
Angoorani H, Narenjiha H, Tayyebi B, Ghassabian A, Ahmadi G, Assari S.
Iranian Research Center for Substance Abuse and Dependence (IRCSAD), University of Social Welfare and Rehabilitation Science, Tehran, Iran.
Arch Med Sci. 2012 May 9;8(2):362-7.
Abstract
INTRODUCTION: Epidemiological studies on all types of illicit drug use among athletes are essential for both the sport community and drug control achievements. Here, we investigated the prevalence and associated factors of amphetamine use in body builders in Tehran, Iran, 2007.MATERIAL AND METHODS: This study is a secondary analysis of a substance use survey done in 103 randomly selected gymnasia in Tehran (capital city of Iran). The survey was conducted from November 2007 to January 2008 and included 843 randomly selected bodybuilders (aged 40 years or less). By interviews via questionnaires the following data were obtained: age, job, marital status, education level, housing status, average monthly family income, number of family members, gymnasium area (m(2)), number of trainers, number of gymnasium members, initiation time (months), weekly duration of the sporting activity (h), monthly cost of the sporting activity, purpose of participating in sporting activity, and history of anabolic steroid and amphetamine use. RESULTS: One hundred twenty (13.3%) body builders reported a history of amphetamine use. According to the results of regression analysis, being married (risk ratio - RR = 0.540), and participating in body building to enhance self-esteem (RR = 0.423) or to enhance sport performance (RR = 0.545) had protective effects on amphetamine use. However, having university qualifications (RR = 1.843), using anabolic steroids (RR = 1.803) and participating in sport to maintain fitness (RR = 2.472) were linked to increased risk of amphetamine use. CONCLUSIONS: Well-educated bodybuilders were more likely to use amphetamines, and why this is so needs to be discovered. If further studies show that they are not aware of the dangers associated with amphetamine use, providing them with information should be considered.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361051/pdf/AMS-8-18565.pdf 
¿Existe un peligro para la miopía en la educación contra el dopaje? Análisis comparativo del uso y abuso de sustancias en los deportes de raqueta Olímpicos requiere un enfoque más amplio. 
Is there a danger for myopia in anti-doping education? Comparative analysis of substance use and misuse in Olympic racket sports calls for a broader approach.
Kondric M, Sekulic D, Petroczi A, Ostojic L, Rodek J, Ostojic Z.
Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
Subst Abuse Treat Prev Policy. 2011 Oct 11;6:27.
Abstract
BACKGROUND: Racket sports are typically not associated with doping. Despite the common characteristics of being non-contact and mostly individual, racket sports differ in their physiological demands, which might be reflected in substance use and misuse (SUM). The aim of this study was to investigate SUM among Slovenian Olympic racket sport players in the context of educational, sociodemographic and sport-specific factors. METHODS: Elite athletes (N=187; mean age=22±2.3; 64% male) representing one of the three racket sports, table tennis, badminton, and tennis, completed a paper-and-pencil questionnaire on substance use habits. Athletes in this sample had participated in at least one of the two most recent competitions at the highest national level and had no significant difference in competitive achievement or status within their sport. RESULTS: A significant proportion of athletes (46% for both sexes) reported using nutritional supplements. Between 10% and 24% of the studied males would use doping if the practice would help them achieve better results in competition and if it had no negative health consequences; a further 5% to 10% indicated potential doping behaviour regardless of potential health hazards. Females were generally less oriented toward SUM than their male counterparts with no significant differences between sports, except for badminton players. Substances that have no direct effect on sport performance (if timed carefully to avoid detrimental effects) are more commonly consumed (20% binge drink at least once a week and 18% report using opioids), whereas athletes avoid substances that can impair and threaten athletic achievement by decreasing physical capacities (e.g. cigarettes), violating anti-doping codes or potentially transgressing substance control laws (e.g. opiates and cannabinoids). Regarding doping issues, athletes' trust in their coaches and physicians is low. CONCLUSION: SUM in sports spreads beyond doping-prone sports and drugs that enhance athletic performance. Current anti-doping education, focusing exclusively on rules and fair play, creates an increasingly widening gap between sports and the athletes' lives outside of sports. To avoid myopia, anti-doping programmes should adopt a holistic approach to prevent substance use in sports for the sake of the athletes' health as much as for the integrity of sports.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204239/pdf/1747-597X-6-27.pdf
 
Ejercicio y usos de drogas entre jóvenes Estadounidenses, 1991-2009. 
Exercise and substance use among American youth, 1991-2009.
Terry-McElrath YM, O'Malley PM, Johnston LD.
Institute for Social Research, University of Michigan, Ann Arbor, USA.yterry@umich.edu
Am J Prev Med. 2011 May;40(5):530-40.

Abstract
BACKGROUND:
The National Institute on Drug Abuse has called for increased research into the use of physical activity in substance abuse prevention, specifically research into physical activity type and context. PURPOSE: This paper examines the relationships between (1) secondary school student substance use and (2) exercise in general and school athletic team participation, and examines such relationships over time. METHODS: Nationally representative cross-sectional samples of 8th-, 10th-, and 12th-grade students were surveyed each year from 1991 to 2009. Substance use measures included past 2-week binge drinking and past 30-day alcohol, cigarette, smokeless tobacco, marijuana, and steroid use. Analyses were conducted during 2009-2010. RESULTS: Across grades, higher levels of exercise were associated with lower levels of alcohol, cigarette, and marijuana use. Higher levels of athletic team participation were associated with higher levels of smokeless tobacco use and lower levels of cigarette and marijuana use across grades and to higher levels of high school alcohol and steroid use. Exercise helped suppress the undesired relationship between team participation and alcohol use; exercise and athletic team participation worked synergistically in lowering cigarette and marijuana use. Observed relationships were generally stable across time. CONCLUSIONS: There appear to be substantive differences between exercise and team sport participation in relation to adolescent substance use. These findings from cross-sectional data suggest that interventions to improve levels of general physical activity should be evaluated to determine if they help delay or reduce substance use among youth in general as well as among student athletes.
Atentamente
Anestesiología y Medicina del Dolor

sábado, 28 de julio de 2012

Endotelio-papel en la regulación de la coagulación y la inflamación


Endotelio-papel en la regulación de la coagulación y la inflamación 
Endothelium--role in regulation of coagulation and inflammation.
van Hinsbergh VW.
Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands. v.vanhinsbergh@vumc.nl
Semin Immunopathol. 2012 Jan;34(1):93-106. Epub 2011 Aug 4

Abstract
By its strategic position at the interface between blood and tissues, endothelial cells control blood fluidity and continued tissue perfusion while simultaneously they direct inflammatory cells to areas in need of defense or repair. The endothelial response depends on specific tissue needs and adapts to local stresses. Endothelial cells counteract coagulation by providing tissue factor and thrombin inhibitors and receptors for protein C activation. The receptor PAR-1 is differentially activated by thrombin and the activated protein C/EPCR complex, resulting in antithrombotic and anti-inflammatory effects. Thrombin and vasoactive agents release von Willebrand factor as ultra-large platelet-binding multimers, which are cleaved by ADAMTS13. Platelets can also facilitate leukocyte-endothelium interaction. Platelet activation is prevented by nitric oxide, prostacyclin, and exonucleotidases. Thrombin-cleaved ADAMTS18 induces disintegration of platelet aggregates while tissue-type plasminogen activator initiates fibrinolysis. Fibrin and products of platelets and inflammatory cells modulate the angiogenic response of endothelial cells and contribute to tissue repair.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233666/?tool=pubmed


 
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Anestesiología y Medicina del Dolor

Apnea obstructiva del sueño


Apnea obstructiva del sueño 
Obstructive sleep apnea.
Ho ML, Brass SD.
UC Davis Department of Neurology, Davis Medical Center, University of California, California, USA.
Neurol Int. 2011 Nov 29;3(3):e15. Epub 2011 Dec 2.
Abstract
Obstructive sleep apnea (OSA) affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual's risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286155/pdf/ni-2011-3-e15.pdf


 
 

Atentamente
Anestesiología y Medicina del Dolor

domingo, 22 de julio de 2012

Vía aérea en el embarazo


Inducción anestésica de secuencia rápida en obstetricia: ¿Que tan segura es? 
Rapid-sequence induction of anesthesia in obstetric women: how safe is it?
Asai T.
Department of Anesthesiology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan, asait@takii.kmu.ac.jp
J Anesth. 2012 Jun;26(3):321-3. Epub 2012 May 19
A 35-year-old woman, 154 cm, 86 kg, with placenta previa and preeclampsia, had massive bleeding after consuming a lunch. She was immediately transferred to the operating room, where an anesthesiologist was called in. She was morbidly obese, having large breasts and a low-pitched voice (indicative of laryngeal edema), and the view of the oropharynx was obscured (Mallampati score 4). Awake tracheal intubation was attempted, but the patient refused to open her mouth. General anesthesia was induced as a rapid sequence, and tracheal intubation was attempted, but failed twice. A senior anesthesiologist was called in and accomplished intubation. Cesarean section was started. Soon after this, it was found that the tube was wrongly inserted into the esophagus. The tube was taken out and mask ventilation was attempted, but this was difficult. Arterial hemoglobin oxygen saturation rapidly decreased to 70 % with cardiac arrhythmia. Nevertheless, the baby was successfully taken out and the mother started to breathe. As the operation would continue, the laryngeal mask airway was inserted. The mother vomited and aspirated.
http://www.springerlink.com/content/7g6ut4877qv12400/fulltext.pdf

 
Intubación difícil no anticipada en obstetricia 
The unanticipated difficult intubation in obstetrics.
Mhyre JM, Healy D.
Department of Anesthesiology, The University of Michigan Health System, L3622 Women's Hospital, 1500 E. Medical Center Dr., SPC 5278, Ann Arbor, MI 48109-5278, USA. jmmhyre@umich.ed
Anesth Analg. 2011 Mar;112(3):648-52.
Abstract
In this focused review, we discuss an algorithm specifically for the unanticipated difficult intubation in obstetrics. This generic algorithm emphasizes a standardized and prespecified sequence of interventions to provide safe, efficient, and effective airway management for the emergency obstetric surgical patient. Individual institutions and anesthesia providers are encouraged to use this framework to select specific pieces of equipment for each step, and to create regular opportunities for all obstetric anesthesia providers to become facile with each airway device and to integrate the algorithm under simulated conditions.
http://www.anesthesia-analgesia.org/content/112/3/648.full.pdf 
Parturienta obesa morbida: Retos para el anestesiólogo incluyendo el manejo de la vía aérea difícil en obstetricia. ¿Que hay de nuevo? 
Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new?
Rao DP, Rao VA.
Department of Anaesthesiology, Siddhartha Medical College, Government General Hospital, Government of Andhra Pradesh, Vijayawada, India.
Indian J Anaesth. 2010 Nov;54(6):508-21.
Abstract
The purpose of this article is to review the fundamental aspects of obesity, pregnancy and a combination of both. The scientific aim is to understand the physiological changes, pathological clinical presentations and application of technical skills and pharmacological knowledge on this unique clinical condition. The goal of this presentation is to define the difficult airway, highlight the main reasons for difficult or failed intubation and propose a practical approach to management Throughout the review, an important component is the necessity for team work between the anaesthesiologist and the obstetrician. Certain protocols are recommended to meet the anaesthetic challenges and finally concluding with "what is new?" in obstetric anaesthesia.
Cambios en la clasificación de Mallampati durante el embarazo, parto y después del embarazo: ¿Pueden ser previstos? 
Mallampati class changes during pregnancy, labour, and after delivery: can these be predicted?
Boutonnet M, Faitot V, Katz A, Salomon L, Keita H.
Service d'Anesthésie, Hôpital Louis Mourier, 178 rue des Renouillers, F-92701 Colombes, France.
Br J Anaesth. 2010 Jan;104(1):67-70.
Abstract
BACKGROUND: An increase in Mallampati class is associated with difficult laryngoscopy in obstetrics. The goal of our study was to determine the changes in Mallampati class before, during, and after labour, and to identify predictive factors of the changes. METHODS: Mallampati class was evaluated at four time intervals in 87 pregnant patients: during the 8th month of pregnancy (T(1)), placement of epidural catheter (T(2)), 20 min after delivery (T(3)), and 48 h after delivery (T(4)). Factors such as gestational weight gain, duration of first and second stages of labour, and i.v. fluids administered during labour were evaluated for their predictive value. Mallampati classes 3 and 4 were compared for each time interval. Logistic regression was used to test the association between each factor and Mallampati class evolution. RESULTS: Mallampati class did not change for 37% of patients. The proportion of patients falling into Mallampati classes 3 and 4 at the various times of assessment were: T(1), 10.3%; T(2), 36.8%; T(3), 51.7%; and T(4), 20.7%. The differences in percentages were all significant (P<0.01). None of the evaluated factors was predictive. CONCLUSIONS: The incidence of Mallampati classes 3 and 4 increases during labour compared with the pre-labour period, and these changes are not fully reversed by 48 h after delivery. This work confirms the absolute necessity of examining the airway before anaesthetic management in obstetric patients.
http://bja.oxfordjournals.org/content/104/1/67.full.pdf
Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor

Anestesia general, sueño y orexinas


Un vínculo emergente entre la anestesia general y el sueño.
An emerging link between general anesthesia and sleep.
Allada R.
Department of Neurobiology and Physiology, Center for Sleep and Circadian Biology, Northwestern University, 2205 Tech Drive, 2-160, Evanston, IL 60208, USA.
Proc Natl Acad Sci U S A. 2008 Feb 19;105(7):2257-8. Epub 2008 Feb 12.

Two of the most enigmatic and challenging problems in neuroscience are the search for the function of sleep and understanding the mechanism by which volatile chemicals can induce general anesthesia. Despite the apparent similarity of sleep and anesthesia to the neophyte, it is widely argued that these brain states are actually apples and oranges, sleep being readily reversible (thankfully), whereas anesthesia is irreversible. In a recent issue of PNAS, Kelz et al. (1) demonstrate that disruption of a specific neural locus involved in normal sleep-wake regulation selectively affects emergence from, but not induction of, general anesthesia. That article demonstrates that waking up from anesthesia uses neural circuits distinct from those necessary to become anesthetized. It also further solidifies the connection between anesthesia and sleep, implicating wake-promoting neural circuitry in selectively contributing to emergence from anesthesia.
http://www.pnas.org/content/105/7/2257.full.pdf+html 

 
Un papel esencial de las orexinas en la emergencia de anestesia general 
 An essential role for orexins in emergence from general anesthesia.
Kelz MB, Sun Y, Chen J, Cheng Meng Q, Moore JT, Veasey SC, Dixon S, Thornton M, Funato H, Yanagisawa M.
Department of Anesthesiology and Critical Care, Mahoney Institute for Neurological Sciences, Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, PA 19104, USA.kelzma@uphs.upenn.edu
Proc Natl Acad Sci U S A. 2008 Jan 29;105(4):1309-14. Epub 2008 Jan 14.
Abstract
The neural mechanisms through which the state of anesthesia arises and dissipates remain unknown. One common belief is that emergence from anesthesia is the inverse process of induction, brought about by elimination of anesthetic drugs from their CNS site(s) of action. Anesthetic-induced unconsciousness may result from specific interactions of anesthetics with the neural circuits regulating sleep and wakefulness. Orexinergic agonists and antagonists have the potential to alter the stability of the anesthetized state. In this report, we refine the role of the endogenous orexin system in impacting emergence from, but not entry into the anesthetized state, and in doing so, we distinguish mechanisms of induction from those of emergence. We demonstrate that isoflurane and sevoflurane, two commonly used general anesthetics, inhibit c-Fos expression in orexinergic but not adjacent melanin-concentrating hormone (MCH) neurons; suggesting that wake-active orexinergic neurons are inhibited by these anesthetics. Genetic ablation of orexinergic neurons, which causes acquired murine narcolepsy, delays emergence from anesthesia, without changing anesthetic induction. Pharmacologic studies with a selective orexin-1 receptor antagonist confirm a specific orexin effect on anesthetic emergence without an associated change in induction. We conclude that there are important differences in the neural substrates mediating induction and emergence. These findings support the concept that emergence depends, in part, on recruitment and stabilization of wake-active regions of brain
http://www.pnas.org/content/105/4/1309.full.pdf+html
 
Receptores de orexina: oportunidades farmacológicas y terapéuticas 
Orexin receptors: pharmacology and therapeutic opportunities.
Scammell TE, Winrow CJ.
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.tscammel@bidmc.harvard.edu
Annu Rev Pharmacol Toxicol. 2011 Feb 10;51:243-66.
Abstract
Orexin-A and -B (also known as hypocretin-1 and -2) are neuropeptides produced in the lateral hypothalamus that promote many aspects of arousal through the OX1 and OX2 receptors. In fact, they are necessary for normal wakefulness, as loss of the orexin-producing neurons causes narcolepsy in humans and rodents. This has generated considerable interest in developing small-molecule orexin receptor antagonists as a novel therapy for the treatment of insomnia. Orexin antagonists, especially those that block OX2 or both OX1 and OX2 receptors, clearly promote sleep in animals, and clinical results are encouraging: Several compounds are in Phase III trials. As the orexin system mainly promotes arousal, these new compounds will likely improve insomnia without incurring many of the side effects encountered with current medications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058259/pdf/nihms277744.pdf

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Anestesiología y Medicina del Dolor

sábado, 21 de julio de 2012

fibrilación auricular postoperatoria


Tratamiento de la fibrilación auricular postoperatoria 
Management of postoperative atrial fibrillation.
Omae T, Kanmura Y.
Department of Anesthesiology, Fujimoto Hayasuzu Hospital, 17-1 Hayasuzu, Miyakonojo, Miyazaki, 885-0055, Japan, omae@za2.so-net.ne.jp.
Anesth. 2012 Jun;26(3):429-37. Epub 2012 Jan 25.
Abstract
The impact of postoperative atrial fibrillation (PAF) on patient outcomes has prompted intense investigation into the optimal methods for prevention and treatment of this complication. In the prevention of PAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. However, their use requires caution due to the possibility of drug-related adverse effects. Aside from these risks, perioperative prophylactic treatment with statins seems to be effective for preventing PAF and is associated with a low incidence of adverse effects. PAF can be treated by rhythm control, heart-rate control, and antithrombotic therapy. For the purpose of heart rate control, β-blockers, calcium-channel antagonists, and amiodarone are used. In patients with unstable hemodynamics, cardioversion may be performed for rhythm control. Antithrombotic therapy is used in addition to heart-rate maintenance therapy in cases of PAF >48-h duration or in cases with a history of cerebrovascular thromboembolism. Anticoagulation is the first choice for antithrombotic therapy, and anticoagulation management should focus on maintaining international normalized ratio (INRs) in the 2.0-3.0 range in patients <75 years of age, whereas prothrombin-time INR should be controlled to the 1.6-2.6 range in patients ≥75 years of age. In the future, dabigatran could be used for perioperative management of PAF, because it does not require regular monitoring and has a quick onset of action with short serum half-life. Preventing PAF is an important goal and requires specific perioperative management as well as other approaches. PAF is also associated with lifestyle-related diseases, which emphasizes the ongoing need for appropriate lifestyle management in individual patients.
http://www.springerlink.com/content/d7g7281135705452/fulltext.pdf

 
Fibrilación auricular postoperatoria: un laberinto de mecanismos
Post-operative atrial fibrillation: a maze of mechanisms.
Maesen B, Nijs J, Maessen J, Allessie M, Schotten U.
Department of Cardiothoracic Surgery, University Hospital of Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Europace. 2012 Feb;14(2):159-74. Epub 2011 Aug 6.
Abstract
Post-operative atrial fibrillation (POAF) is one of the most frequent complications of cardiac surgery and an important predictor of patient morbidity as well as of prolonged hospitalization. It significantly increases costs for hospitalization. Insights into the pathophysiological factors causing POAF have been provided by both experimental and clinical investigations and show that POAF is 'multi-factorial'. Facilitating factors in the mechanism of the arrhythmia can be classified as acute factors caused by the surgical intervention and chronic factors related to structural heart disease and ageing of the heart. Furthermore, some proarrhythmic mechanisms specifically occur in the setting of POAF. For example, inflammation and beta-adrenergic activation have been shown to play a prominent role in POAF, while these mechanisms are less important in non-surgical AF. More recently, it has been shown that atrial fibrosis and the presence of an electrophysiological substrate capable of maintaining AF also promote the arrhythmia, indicating that POAF has some proarrhythmic mechanisms in common with other forms of AF. The clinical setting of POAF offers numerous opportunities to study its mechanisms. During cardiac surgery, biopsies can be taken and detailed electrophysiological measurements can be performed. Furthermore, the specific time course of POAF, with the delayed onset and the transient character of the arrhythmia, also provides important insight into its mechanisms. This review discusses the mechanistic interaction between predisposing factors and the electrophysiological mechanisms resulting in POAF and their therapeutic implications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262403/pdf/eur208.pdf
 
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Anestesiología y Medicina del Dolor

anestesia en oftalmología


Comparación entre levobupivacaína 0.5% o bupivacaína 0.5%, ambas mezcladas con lidocaína 2% para bloqueo superficial extraconal
Comparison of levobupivacaine 0.5% or bupivacaine 0.5% both in a mixture with lidocaine 2% for superficial extraconal blockade.
Ahmad N, Zahoor A, Al Assiri A, Al Jastaneiah S, Riad W.
Middle East Afr J Ophthalmol [serial online] 2012 [cited 2012 Jul 3];19:330-3.
Abstract
Purpose: To evaluate the quality and efficacy of Peribulbar blockade for superficial extraconal anesthesia with levobupivacaine 0.5% versus bupivacaine 0.5%, both combined with lidocaine 2% for patients undergoing phacoemulsification. Materials and Methods: In this prospective, double blind study, 150 patients were randomly divided into two groups: group-1 received a Peribulbar block (PB) with a mixture of evobupivacaine 0.5% and lidocaine 2% while group-2 received a PB with a mixture of bupivacaine 0.5% and lidocaine 2%. The block was performed by insertion of a short needle (15 mm) in infra-temporal space just above inferior orbital notch. An initial volume of 6 9 ml of either mixture was injected until total upper eyelid drop. Akinesia score was assessed at 2, 5, and 10 min after the block. The degree of pain was assessed by a verbal rating scale immediately after block, at the end of surgery and 4 h postoperatively. The patients and surgeons were asked to rate their satisfaction level of the quality of block postoperatively. Data were analyzed with the unpaired, two-tailed t-test and the Chi-square test as appropriate. P < 0.05 was considered statistically significant. Results: There were no significant differences between groups with respect to the akinesia score (P = 0.2) at 2, 5, and 10 min, the number of supplementary injections (P = 0.84) and initial and total required volume of local anesthetics (P = 0.80 and 0.81, respectively). There was no significant difference between the groups regarding surgeon and patient satisfaction (P = 0.53 and P = 0.74, respectively). Similarly the verbal rating scales assessed at three different occasions were not significantly different between the groups (P > 0.05 all cases). The need for additional intra-operative topical anesthetic was also similar between the groups. (P = 0.69). Conclusions: Superficial extra-conal block with a mixture of levobupivicaine 0.5% and lidocaine 2% or bupivicaine 0.5% and lidocaine 2% provides similar block quality and efficacy.
Keywords: Levobupivacaine vs. Bupivacaine, Local Anesthesia, Superficial Extraconal Block
http://www.meajo.org/text.asp?2012/19/3/330/97945 

Anestesia locorregional en oftalmología: una puesta al día
J. Benatar-Haserfaty, J. A. Puig Flores
Servicio de Anestesiología, Reanimación y Terapia del Dolor. Hospital Universitario Ramón y Cajal. Madrid.
Rev. Esp. Anestesiol. Reanim. 2003; 50: 284-294
Resumen
La anestesia regional oftálmica ha cambiado significativamente en los últimos diez años. El uso de la facoemulsificación para la cirugía de cataratas a través de mínimas incisiones corneales, las lentes plegables y la anestesia tópica simplifican la cirugía de tal forma que la mayoría de los casos se realizan en régimen ambulante. Algunos bloqueos anestésicos son efectuados tanto por anestesiólogos como por oftalmólogos, quienes deben conocer los beneficios y perjuicios que ocasionan en cada paciente. En esta revisión se analizan los aspectos anatómicos de interés para el anestesiólogo, las principales técnicas e innovaciones anestésicas de la especialidad, las complicaciones asociadas y algunos puntos controvertidos como el manejo del paciente que recibe medicaciones que alteran la hemostasia, la retirada de la hialuronidasa en algunos países y la solicitud sistemática de pruebas complementarias antes de la intervención.
Palabras clave:Cirugía: Oftálmica. Técnicas anestésicas: anestesia regional, anestesia retrobulbar, anestesia peribulbar, anestesia tópica, anestesia sub-Tenoniana. Complicaciones: hemorragia orbitaria, perforación ocular, estrabismo, epistaxis.
http://www.sedar.es/vieja/restringido/2003/n6_2003/formacion.pdf

 
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Anestesiología y Medicina del Dolor