Raquia/ Spinal anesthesia

Octubre 11, 2015. No. 2111Octubre, mes de lucha contra cáncer de mama.

Anestesia espinal en altitudes bajas y moderadas. Una comparación de parámetros de anestesia y cambios hemodinámicos Spinal anaesthesia at low and moderately high altitudes: a comparison of anaesthetic parameters and hemodynamic changes. Aksoy M, Ince I, Ahıskalıoglu A, Karaca O, Bayar F, Erdem AF. BMC Anesthesiol. 2015 Sep 10;15(1):123. doi: 10.1186/s12871-015-0104-y. CONCLUSIONS: Hemodynamic variations and more anaesthetic requirements following the spinal anaesthesia may be observed at moderately high altitudes compared to the sea level.  PDF Monitoreo de la function coclear después de anestesia subaracnoidea Cochlear Function Monitoring after Spinal Anesthesia. Janecka-Placek A, Lisowska G, Paradysz A, Misiołek H. Med Sci Monit. 2015 Sep 17;21:2767-73. doi: 10.12659/MSM.893718. Abstract BACKGROUND The aim of the study was to examine the effect of spinal anesthesia on the function of cochlear outer hair cells (OHCs), determined by means of objective distortion product otoacoustic emissions (DPOAE) testing. To the best of our knowledge, our study was the second OAE-based analysis of cochlear function during spinal anesthesia, and the only experiment including such a large group of patients. MATERIAL AND METHODS The study included 20 patients (18 men and 2 women) subjected to a scheduled uretherorenoscopic lithotripsy with routine spinal anesthesia with 10 mg (2 ml) of 0.5% hyperbaric bupivacaine and 50 μg (1 ml) of fentanyl. The levels of DPOAEs and background noise at 1000-6000 Hz were recorded prior to and immediately after the anesthesia, and on the postoperative day 2. RESULTS We did not find significant differences between DPOAEs values recorded prior to and immediately after the anesthesia. The only exception pertained to 5652 Hz, at which a significantly higher level of DPOAEs was observed immediately after the anesthesia. The levels of DPOAEs at 2002 Hz and 2380 Hz collected on the postoperative day 2 were significantly higher than the respective baseline values. Irrespective of the frequency and time of testing, we did not find any significant differences between the recorded levels of background noise. CONCLUSIONS Our findings point to the lack of a detrimental effect of spinal anesthesia on objectively evaluated cochlear function, and thus suggest that this method is safe, even for OHCs, which are extremely susceptible to exogenous and endogenous injuries. PDF

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

Dispsitivos supraglóticos en pediatría/Supraglottic airway in pediatrics

Octubre 6, 2015. No. 2105Octubre, mes de lucha contra cáncer de mama.

Comparación del i-gel y ML-ProSeal en pacientes pediátricos con ventilación controlada Comparison of i-gel supraglottic airway and LMA-ProSeal™ in pediatric patients under controlled ventilation. Saran S, Mishra SK, Badhe AS, Vasudevan A, Elakkumanan LB, Mishra G. J Anaesthesiol Clin Pharmacol. 2014 Apr;30(2):195-8. doi: 10.4103/0970-9185.130013. Abstract BACKGROUND: i-gel™ and the ProSeal™ laryngeal mask airway (PLMA) are two supraglottic airway devices with gastric channel used for airway maintenance in anesthesia. This study was designed to evaluate the efficacy of i-gel compared with PLMA for airway maintenance in pediatric patients under general anesthesia with controlled ventilation. MATERIALS AND METHODS: A total of 60 American Society of Anesthesiologists physical status 1 and 2 patients were included in the study and randomized to either i-gel or PLMA group. After induction of anesthesia using a standardized protocol for all the patients, one of supraglottic airway devices was inserted. Insertion parameters, ease of gastric tube insertion and fiber-optic scoring of the glottis were noted. Airway parameters such as end-tidal carbon dioxide (EtCO2), peak airway pressures and leak airway pressures were noted. Patients were observed for any complications in the first 12 h of the post-operative period. RESULTS: Both groups were comparable in terms of ease of insertion, number of attempts and other insertion parameters. Ease of gastric tube insertion, EtCO2, airway pressures (peak and leak airway pressure) and fiber-optic view of the glottis were comparable in both groups. There were no clinically significant complications in the first 12 h of the post-operative period. CONCLUSION: i-gel is as effective as PLMA in pediatric patients under controlled ventilation. KEYWORDS: Controlled ventilation; ProSeal™ laryngeal mask; fiber-optic view of glottis; leak airway pressure; peak airway pressure; pediatric i-gel airway PDF  Comparación de tres dispositivos supraglóticos en niños anestesiados y relajados para cirugía electiva Comparison of three supraglottic devices in anesthetised paralyzed children undergoing elective surgery. Das B, Mitra S, Jamil SN, Varshney RK. Saudi J Anaesth. 2012 Jul;6(3):224-8. doi: 10.4103/1658-354X.101212.Abstract CONTEXT: The newest variation of the i-gel supraglottic airway is a pediatric version. AIMS: This study was designed to investigate the usefulness of the size 2 i-gel compared with the ProSeal laryngeal mask airway (PLMA) and classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children. SETTINGS AND DESIGN: A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital. METHODS: Ninety ASA grade I-II patients undergoing lower abdominal, inguinal and orthopedic surgery were included in this prospective study. The patients were randomly assigned to the i-gel, PLMA and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure and postoperative complications. RESULTS: There were no differences in the demographic and hemodynamic data among the three groups. The airway leak pressure of the i-gel group (27.1±2.6 cmH(2)O) was significantly higher than that of the PLMA group (22.73±1.2 cmH(2)O) and the cLMA group (23.63±2.3 cmH(2)O). The success rates for first attempt of insertion were similar among the three devices. There were no differences in the incidence of postoperative airway trauma, sore throat or hoarse cry in the three groups. CONCLUSIONS: Hemodynamic parameters, ease of insertion and postoperative complications were comparable among the i-gel, PLMA and cLMA groups, but airway sealing pressure was significantly higher in the i-gel group. KEYWORDS: Classic laryngeal mask airway; ProSeal laryngeal mask airway; i-gel; pediatric patients PDF Crítica de los dispositivos supraglóticos electivos en pediatría A critique of elective pediatric supraglottic airway devices. White MC, Cook TM, Stoddart PA. Paediatr Anaesth. 2009 Jul;19 Suppl 1:55-65. doi: 10.1111/j.1460-9592.2009.02997.x. Abstract          In 1988, when the Laryngeal Mask Airway-Classic (Intavent Orthofix, Maidenhead, UK), was introduced there were only two choices of airway management: tracheal tube or facemask. The supraglottic airway, as we now understand the term, did not exist. Yet, 20 years later, we are faced with an ever increasing choice of supraglottic airway devices (SAD). For many SADs, with the exception of the LMA-Classic and LMA-Proseal (Intavent Orthofix, Maidenhead, UK), there is a lack of high quality data of efficacy. The best evidence requires a randomized controlled trial comparing a new device against an established alternative, properly powered to detect clinically relevant differences in clinically important outcomes. Such studies in children are very rare. Safety data is even harder to establish particularly for rare events such as aspiration. Therefore, most safety data comes from extended use rather than high quality evidence which inevitably biases against newer devices. For reason of these factors, claims of efficacy and particularly safety must be interpreted cautiously. This narrative review aims to present the evidence surrounding the use of currently available pediatric SADs in routine anesthetic practice.    PDF

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

TEP y nuevos anticoagulates orales/Venous thromboembolic and novel oral anticoagulants

Octubre 8, 2015. No. 2108Octubre, mes de lucha contra cáncer de mama.

Enfermedad tromboembólica perioperatoria y el papel emergente de nuevos anticoagulantes orales. Análisis de las implicaciones en el manejo perioperatorio Perioperative venous thromboembolic disease and the emerging role of the novel oral anticoagulants: An analysis of the implications for perioperative management Mookadam M, Shamoun FE, Ramakrishna H, Obeid H, Rife RL, Mookadam F. Ann Card Anaesth [serial online] 2015 [cited 2015 Oct 6];18:517-27. Abstract Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current accepted standard therapy with good efficacy. However, this therapeutic strategy has many limitations including the significant risk of bleeding and drug, food and disease interactions that require frequent monitoring. Dabigatran, rivaroxaban, apixaban, and edoxaban are the novel oral anticoagulants that are available for use in stroke prevention in atrial fibrillation and for the treatment and prevention of venous thromboembolism (HYPERLINK\l "1). Recent prospective randomized trials comparing the NOACs with warfarin have shown similar efficacy between the treatment strategies but fewer bleeding episodes with the NOACs. This paper presents an evidence-based review describing the efficacy and safety of the new anticoagulants compared to warfarin. Keywords: Apixaban; Dabigatran; Edoxaban; Novel oral anticoagulants; Rivaroxaban; Venous thromboembolism; Warfarin PDF

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

Premio Nobel de química 2015

Octubre 8, 2015. No. 2108-AOctubre, mes de lucha contra cáncer de mama.

Premio Nobel de química Cellular secrets of DNA repair win Nobel Prize for chemistry Tomas Lindahl, Paul Modrich, and Aziz Sancar  HTML Control de calidad de la reparación del ADN. Quality control by DNA repair. Lindahl T, Wood RD. Science. 1999 Dec 3;286(5446):1897-905. Abstract Faithful maintenance of the genome is crucial to the individual and to species. DNA damage arises from both endogenous sources such as water and oxygen and exogenous sources such as sunlight and tobacco smoke. In human cells, base alterations are generally removed by excision repair pathways that counteract the mutagenic effects of DNA lesions. This serves to maintain the integrity of the genetic information, although not all of the pathways are absolutely error-free. In some cases, DNA damage is not repaired but is instead bypassed by specialized DNA polymerases.  PDF

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