Mostrando entradas con la etiqueta thoracic surgery. Mostrar todas las entradas
Mostrando entradas con la etiqueta thoracic surgery. Mostrar todas las entradas

viernes, 14 de septiembre de 2018

Analgesia regional, ERAS, cirugía de tórax / Regional analgesia, ERAS protocols, thoracic surgery

Septiembre  10, 2018. No. 3182
El papel de las técnicas de anestesia local en los protocolos ERAS para cirugía torácica.
The role of local anaesthetic techniques in ERAS protocols for thoracic surgery.
J Thorac Dis. 2018 Mar;10(3):1998-2004. doi: 10.21037/jtd.2018.02.48.
Abstract
The use of enhanced recovery after surgery (ERAS), as in other surgical specialties, is an emerging concept in cardio-thoracic surgery but there is still a lack of effective protocols to reduce the burden of surgery on the patient, shorten the period of postoperative recovery, and reduce the likelihood of chronic pain developing. The use of local anaesthetic (LA) techniques, such as thoracic epidural analgesia (TEA) and paravertebral blocks (PVB), as an adjunct to anaesthesia are considered key components, though there is little data for direct comparison of the techniques. This review aims to evaluate the role of LA techniques in a thoracic ERAS program through evidence from literature and considering aspects of clinical practice. We discuss how ERAS is adapting and evolving with the increasing use of video-assisted thoracoscopic surgery (VATS) is thoracic surgery. It also examines the advantages of multimodal, opioid-sparing analgesia in the post-operative period to minimise the inflammatory response and improve functional recovery. LA techniques within ERAS protocols have the potential to hasten recovery when managed appropriately and to their full potential.
KEYWORDS: Enhanced recovery; epidural anaesthesia; local anaesthetics (LA); paravertebral block (PVB)
Aumento de las vías de recuperación en cirugía torácica del grupo italiano VATS: protocolos de analgesia perioperatoria.
Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols.
J Thorac Dis. 2018 Mar;10(Suppl 4):S555-S563. doi: 10.21037/jtd.2017.12.86.
Abstract
Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodalanalgesia principles for implementing an ERAS program after VATS lobectomy.
KEYWORDS: Regional analgesia; pain management; video-assisted thoracoscopic surgery (VATS)
Los beneficios de la recuperación mejorada después de los programas de cirugía y su aplicación en la cirugía cardiotorácica.
The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery.
Methodist Debakey Cardiovasc J. 2018 Apr-Jun;14(2):77-88. doi: 10.14797/mdcj-14-2-77.
Abstract
The perioperative care of the surgical patient is undergoing a paradigm shift. Enhanced Recovery After Surgery (ERAS) programs are becoming the standard of care and best practice in many surgical specialties throughout the world. ERAS is a multimodal, multidisciplinary, evidence-based approach to care of the surgical patient that aims to optimize perioperative management and outcomes. Implementation, however, has been slow because it challenges traditional surgical doctrine. The key elements of ERAS Pathways strive to reduce the response to surgical stress, decrease insulin resistance, and maintain anabolic homeostasis to help the patient return to baseline function more quickly. Data suggest that these pathways have produced not only improvements in clinical outcome and quality of care but also significant cost savings. Large trials reveal an increase in 5-year survival and a decrease in immediate complication rates when strict compliance is maintained with all pathway components. Years of success using ERAS in colorectal surgery have helped to establish a body of evidence through a number of randomized controlled trials that encourage application of these pathways in other surgical specialties.
KEYWORDS: ERAS; cardiothoracic surgery; enhanced recovery after surgery; length of stay; lung resection; multimodal analgesia; transcatheter aortic valve replacement
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Curso de Alta Especialidad en Medicina del Dolor y Paliativa 2019
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
Ciudad de México
Congresos Médicos por Especialidades en todo Mundo
Medical Congresses by Specialties around the World
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
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Anestesiología y Medicina del Dolor

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miércoles, 21 de febrero de 2018

Anestesia regional para cirugía de tórax y brazos / Regional anesthesia for thoracic surgery and upper extremities

Febrero 21, 2018. No. 3001
Analgesia epidural torácica para procedimientos oncológicos de mama: una mejor alternativa a la anestesia general
Thoracic epidural analgesia for breast oncological procedures: A better alternative to general anesthesia
Ravi PR, Jaiswal P.
J Mar Med Soc 2017;19:91-5
Abstract
Objective: The objective of the study was to compare the outcomes of the incidence of nausea/vomiting and other complications along with the time taken for discharged in patients undergoing Thoracic Epidural Analgesia (TEA) and General Anaesthesia (GA) for breast oncological surgeries. Background: GA with or without TEA or other postoperative pain-relieving strategies remains the traditional anesthetic technique used for breast oncological procedures. We initiated the use of high segmental TEA for patients undergoing these procedures in our hospital. Methods: Eighty patients undergoing breast oncological procedures performed by one surgical team were randomly allocated into two groups receiving TEA and GA. The Chi-square test and Fisher's exact test were used for categorical parameters, paired t-test and Student's t-test was used for continuous measurements. Results: In comparison with GA, TEA was associated with lesser incidence of complications of nausea/vomiting. In lumpectomy with axillary node dissection, 1 out of 18 patients (5.55%) in the TEA group had nausea/vomiting, while 11 out of 19 (57.8%) of the GA group had similar symptoms (P < 0.001). The discharge rate for the thoracic epidural group was 12 out of 18 by day 3 (66.6%) while all patients in the GA group required more than 3 days of hospitalization (P< 0.001). Conclusion: Thoracic epidural anesthesia is a safe technique and its use in breast oncological procedures could improve patients' recovery and facilitate their early discharge to home.
Keywords: Bupivacaine, general anesthesia, postoperative nausea and vomiting, regional anesthesia, ropivacaine
El bloqueo retrolaminar guiado por ultrasonido: distribución de inyecciones dependiente del volumen.
The ultrasound-guided retrolaminar block: volume-dependent injectate distribution.
J Pain Res. 2018 Feb 7;11:293-299. doi: 10.2147/JPR.S153660. eCollection 2018.
Abstract
PURPOSE: The ultrasound-guided retrolaminar block is one of the newer and simpler alternatives to the traditional, often technically challenging, paravertebral (PV) block. Its feasibility, safety, and efficacy have already been clinically demonstrated in patients with multiple rib fractures using higher volumes of local anesthetic, when compared with the traditional approach. The primary aim of this observational anatomical study was to assess the spread of local anesthetic from the retrolaminar injection point to the PV space and its volume dependence. Second, we assessed the incidence of epidural and contralateral PV spread in the both groups. METHODS: Ten fresh porcine cadavers were randomized into 2 groups (n=5 each) to receive ultrasound-guided retrolaminar injections at Th4-Th5 level with either 10 mL (low-volume group) or 30 mL (high-volume group) of 2% lidocaine and methylene blue mixture. After the procedure, the cadavers were dissected and frozen. Cross-section cuts (~1 cm thick) were performed to evaluate the injectate spread. RESULTS: In the high-volume group, injectate spread from the retrolaminar to the PV space was observed in all specimens (5 out of 5; 100%), while in the low-volume group, no apparent spread to the PV space was found (0 out of 5; 0%). No epidural or contralateral PV spread was observed in any of the specimens. CONCLUSION: Following ultrasound-guided retrolaminar injections in fresh porcine cadavers, injectate spread from the retrolaminar tissue plane to the PV space is strongly volume dependent, suggesting that, clinically, high local anesthetic volumes maybe critical for achieving regional anesthesia and analgesia consistent with traditional PV blockade.
KEYWORDS: injections; local anesthetic; paravertebral space; vertebral lamina
Bloqueo cervical epidural continuo. Tratamiento del hipo intratable
Continuous cervical epidural block: Treatment for intractable hiccups.
Medicine (Baltimore). 2018 Feb;97(6):e9444. doi: 10.1097/MD.0000000000009444.
Abstract
Intractable hiccups, although rare, may result in severe morbidity, including sleep deprivation, poor food intake, respiratory muscle fatigue, aspiration pneumonia, and death. Despite these potentially fatal complications, the etiology of intractable hiccups and definitive treatment are unknown.......Continuous C3-C5 level cervical epidural block has a successful remission rate. We suggest that continuous cervical epidural block is an effective treatment for intractable hiccups.
Bloqueo cervical epidural para manejo de cirugía de trauma de miembro superior
Dra. Leslian Janet Mejía-Gómez
Rev Mex Anestesiol Volumen 36, Suplemento 1, abril-junio 2013
INTRODUCCIÓN
Según la Organización Mundial de la Salud (OMS), los accidentes de tránsito producen diez millones de heridos y 300,000 muertes por año (1). En los países con mayor población de personas menores de 45 años los accidentes automovilísticos y laborales son la primera causa de cirugía por traumatismo de miembro superior (2). La proporción hombre:mujer es de 3 a 1(1,6). El manejo clínico y las decisiones anestésicas y terapéuticas dependen del tipo y de la gravedad de la fractura (3). Actualmente el trauma de miembro superior ocupa el tercer lugar dentro de los traumatismos en general, después que el trauma abdominal. Grant J (4), refi ere la incidencia del 78% de trauma en el miembro superior. El mecanismo de lesión más frecuente es directo y en segundo lugar por mecanismo indirecto secundario a tracción flexión (4,5). Las más afectadas son personas jóvenes en edad productiva, recibiendo los hombres, más lesiones que las mujeres en una proporción de 3:1.1(1,6).
Bloqueo cervicotorácico en cirugía de mama
World Congress on Regional Anesthesia & Pain Medicine
April 19-21, 2018, New York City, USA
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Anestesiología y Medicina del Dolor

52 664 6848905