Coma barbitúrico en neurocirugia / Barbiturate-induced coma in neurosurgery

Enero 12, 2016. No. 2204

Uso del coma barbitúrico inducido durante procedimientos neuroquirúrgicos cerebrovasculares. Un revisión de la literatura The use of barbiturate-induced coma during cerebrovascular neurosurgery procedures: A review of the literature. Ellens NR, Figueroa BE, Clark JC. Brain Circ [serial online] 2015 [cited 2015 Dec 31];1:140-5. Available from: http://www.braincirculation.org/text.asp?2015/1/2/140/172887 Barbiturates are indicated for use during vascular neurosurgery procedures such as carotid surgery, arteriovenous malformation (AVM) surgery, cerebral aneurysm surgery, extracranial-intracranial bypass, and following significant bleeding due to AVMs or subarachnoid hemorrhage (SAH). These drugs are commonly used for their neuroprotective effects during focal cerebral ischemia and for their ability to treat intractable intracranial hypertension. Currently, thiopental and pentobarbital are the most frequently used barbiturates for these purposes, although methohexital and phenobarbital have been studied as well. Depending on the drug used and the desired effect, the dose administered may vary. Additionally, barbiturates are known to cause significant, severe side effects including depression of cardiac output, increased liver enzymes, increased risk of cardiac arrhythmia, lowered immune threshold, adversely affected brain temperature, systemic hypotension, and dyskalemia. For these reasons, these drugs should be monitored carefully and only used in circumstances of clear benefit. Finally, in order to evaluate barbiturates use during these procedures, information was gathered via an extensive PubMed literature review in addition to reviewing the resources of previous reviews on this topic or similar, relevant topics. Keywords: Cerebroprotection, focal ischemia, intractable intracranial hypertension, neuroprotection, pentobarbital, thiopental  PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Anafilaxis / Anaphylaxis

Enero 6, 2016. No. 2198

Actualización 2015 basada en evidencias: Guías de anafilaxis de la OrganizaciónMundial de Alergia. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. Simons FE, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, Lockey RF, El-Gamal YM, Brown SG, Park HS, Sheikh A. World Allergy Organ J. 2015 Oct 28;8(1):32. doi: 10.1186/s40413-015-0080-1. eCollection 2015. Abstract The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis provide a unique global perspective on this increasingly common, potentially life-threatening disease. Recommendations made in the original WAO Anaphylaxis Guidelines remain clinically valid and relevant, and are a widely accessed and frequently cited resource. In this 2015 update of the evidence supporting recommendations in the Guidelines, new information based on anaphylaxis publications from January 2014 through mid- 2015 is summarized. Advances in epidemiology, diagnosis, and management in healthcare and community settings are highlighted. Additionally, new information about patient factors that increase the risk of severe and/or fatal anaphylaxis and patient co-factors that amplify anaphylactic episodes is presented and new information about anaphylaxis triggers and confirmation of triggers to facilitate specific trigger avoidance and immunomodulation is reviewed. The update includes tables summarizing important advances in anaphylaxis research. KEYWORDS: Adrenaline; Anaphylaxis; Auto-injector; Drug allergy; Epinephrine; Exercise-induced anaphylaxis; Food allergy; Latex allergy; Stinging insect venom allergy; Systemic allergic reaction PDF Alergia perioperatoria: más allá de los medicamentos y el látex Peri-operative anaphylaxis: beyond drugs and latex. Krishna MT, Huissoon A. Int Arch Allergy Immunol. 2015;167(2):101-2. doi: 10.1159/000436971. Epub 2015 Aug 12. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Vía aérea e inmovilización cervical / Airway and cervical spine immobilization

Enero 11, 2016. No. 2203

Técnicas alternativas de intubación versus laringoscopía con Macintosh en pacientes con inmovilización de la columna cervical Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials. Suppan L, Tramèr MR, Niquille M, Grosgurin O, Marti C. Br J Anaesth. 2016 Jan;116(1):27-36. doi: 10.1093/bja/aev205. Epub 2015 Jun 30. Abstract BACKGROUND: Immobilization of the cervical spine worsens tracheal intubation conditions. Various intubation devices have been tested in this setting. Their relative usefulness remains unclear. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials comparing any intubation device with the Macintosh laryngoscope in human subjects with cervical spine immobilization. The primary outcome was the risk of tracheal intubation failure at the first attempt. Secondary outcomes were quality of glottis visualization, time until successful intubation, and risk of oropharyngeal complications. RESULTS: Twenty-four trials (1866 patients) met inclusion criteria. With alternative intubation devices, the risk of intubation failure was lower compared with Macintosh laryngoscopy [risk ratio (RR) 0.53; 95% confidence interval (CI) 0.35-0.80]. Meta-analyses could be performed for five intubation devices (Airtraq, Airwayscope, C-Mac, Glidescope, and McGrath). The Airtraq was associated with a statistically significant reduction of the risk of intubation failure at the first attempt (RR 0.14; 95% CI 0.06-0.33), a higher rate of Cormack-Lehane grade 1 (RR 2.98; 95% CI 1.94-4.56), a reduction of time until successful intubation (weighted mean difference -10.1 s; 95% CI -3.2 to -17.0), and a reduction of oropharyngeal complications (RR 0.24; 95% CI 0.06-0.93). Other devices were associated with improved glottis visualization but no statistically significant differences in intubation failure or time to intubation compared with conventional laryngoscopy. CONCLUSIONS: In situations where the spine is immobilized, the Airtraq device reduces the risk of intubation failure. There is a lack of evidence for the usefulness of other intubation devices. KEYWORDS: airway; complications, spinal injury; intubation, tracheal tube; trauma PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Cefaleas / Headache

Enero 9, 2016. No. 2201

Tratamiento de la cefalea: abordajes farmacológicos Sinclair AJ, Sturrock A, Davies B, Matharu M. Pract Neurol. 2015 Dec;15(6):411-23. doi: 10.1136/practneurol-2015-001167. Epub 2015 Jul 3. Resumen El dolor de cabeza es una de las condiciones más comunes que se presentan en la clínica de neurología, sin embargo, una proporción significativa de estos pacientes están insatisfechos por su experiencia clínica. El dolor de cabeza puede ser extremadamente incapacitante; el tratamiento eficaz no sólo es esencial para los pacientes, pero es gratificante para el médico. En este primera revisión de dos partes sobre dolor de cabeza, ofrecemos una visión general del manejo de la cefalea, las nuevas estrategias terapéuticas y una interpretación accesible de guías clínicas para ayudar al neurólogo ocupado.   Headache management: pharmacological approaches. Abstract Headache is one of the most common conditions presenting to the neurology clinic, yet a significant proportion of these patients are unsatisfied by their clinic experience. Headache can be extremely disabling; effective treatment is not only essential for patients but is rewarding for the physician. In this first of two parts review of headache, we provide an overview of headache management, emerging therapeutic strategies and an accessible interpretation of clinical guidelines to assist the busy neurologist. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ KEYWORDS: HEADACHE; MIGRAINE PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015