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

Espacio epidural en niños / Pediatric epidural space

Abril 26, 2017. No. 2671

Estimación de la profundidad del espacio epidural torácico en niños utilizando RNM Estimation of the depth of the thoracic epidural space in children using magnetic resonance imaging. Wani TM1, Rafiq M2, Nazir A2, Azzam HA2, Al Zuraigi U2, Tobias JD3. J Pain Res. 2017 Mar 28;10:757-762. doi: 10.2147/JPR.S124123. eCollection 2017. Abstract BACKGROUND: The estimation of the distance from the skin to the thoracic epidural space or skin to epidural depth (SED) may increase the success rate and decrease the incidence of complications during placement of a thoracic epidural catheter. Magnetic resonance imaging (MRI) is the most comprehensive imaging modality of the spine, allowing for the accurate determination of tissue spaces and distances. The present study uses MRI-derived measurements to measure the SED and define the ratio between the straight and inclined SEDs at two thoracic levels (T6-7 and T9-10) in children. METHODS: The T2-weighed sagittal MRI images of 109 children, ranging in age from 1 month to 8 years, undergoing radiological evaluation unrelated to spine pathology were assessed. The SEDs (inclined and straight) were determined, and a comparison between the SEDs at two thoracic levels (T6-7 and T9-10) was made. Univariate and multivariate linear regression models were used to assess the relationship of the inclined thoracic T6-7 and T9-10 SED measurements with age, height, and weight. RESULTS: Body weight demonstrated a stronger association with the SED than did the age or height with R2 values of 0.6 for T6-7 and 0.5 for T9-10. The formulae describing the relationship between the weight and the inclined SED were T6-7 inclined (mm) = 7 + 0.9 × kg and T9-10 inclined (mm) = 7 + 0.8 × kg. CONCLUSION: The depth of the pediatric thoracic epidural space shows a stronger correlation with weight than with age or height. Based on the MRI data, the predictive weight-based formulas can serve as guide to clinicians for placement of thoracic epidural catheters. KEYWORDS: magnetic resonance imaging; measurement techniques; thoracic epidural space PDF Vacante para Anestesiología Pediátrica El Hospital de Especialidades Pediátricas de León, Guanajuato México  ofrece un contrato laboral en el departamento de anestesiología  Informes con la Dra Angélica García Álvarez  angy.coachanestped@gmail.com o al teléfono 477 101 8700 Ext 1028

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