Más de obesidad / More on obesity

Octubre 3, 2017. No. 2830

El fenotipo metabólico en obesidad: Masa magra, distribución corporal de grasa, y función del tejido adiposo The Metabolic Phenotype in Obesity: Fat Mass, Body Fat Distribution, and Adipose Tissue Function. Goossens GH Author information Obes Facts. 2017;10(3):207-215. doi: 10.1159/000471488. Epub 2017 Jun 1. Abstract The current obesity epidemic poses a major public health issue since obesity predisposes towards several chronic diseases. BMI and total adiposity are positively correlated with cardiometabolic disease risk at the population level. However, body fat distribution and an impaired adipose tissue function, rather than total fat mass, better predict insulin resistance and related complications at the individual level. Adipose tissue dysfunction is determined by an impaired adipose tissue expandability, adipocyte hypertrophy, altered lipid metabolism, and local inflammation. Recent human studies suggest that adipose tissue oxygenation may be a key factor herein. A subgroup of obese individuals - the 'metabolically healthy obese' (MHO) - have a better adipose tissue function, less ectopic fat storage, and are more insulin sensitive than obese metabolically unhealthy persons, emphasizing the central role of adipose tissue function in metabolic health. However, controversy has surrounded the idea that metabolically healthy obesity may be considered really healthy since MHO individuals are at increased (cardio)metabolic disease risk and may have a lower quality of life than normal weight subjects due to other comorbidities. Detailed metabolic phenotyping of obese persons will be invaluable in understanding the pathophysiology of metabolic disturbances, and is needed to identify high-risk individuals or subgroups, thereby paving the way for optimization of prevention and treatment strategies to combat cardiometabolic diseases. KEYWORDS: Adipose tissue function; Body fat; Metabolic health; Obesity; Oxygen PDF Obesidad: cambios fisiológicos sus implicaciones en el manejo preoperatorio Obesity: physiologic changes and implications for preoperative management. Ortiz VE1, Kwo J2. Author information BMC Anesthesiol. 2015 Jul 4;15:97. doi: 10.1186/s12871-015-0079-8. Abstract The proportion of patients defined as obese continues to grow in many westernized nations, particularly the United States (USA). This trend has shifted the perioperative management of obese patients into the realm of routine care. As obese patients present for all types of procedures, it is crucial for anesthesiologists, surgeons, internists, and perioperative health care providers alike to have a firm understanding of their altered multi-organ physiology in order to safely prepare the obese patient for an operation. A careful preoperative evaluation may also serve to identify risk factors for postoperative adverse events. Subsequently, preoperative measures may be implemented to mitigate these complications. In this manuscript we address the major considerations for the preoperative evaluation of the severely obese patient. PDF Te invitamos a Inscribirte a este Evento Académico en la Red XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion

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

Libro y revistas sobre cuidados paliativos / Book and journals on palliative care

Octubre 8, 2017. No. 2835

Aspectos destacados de varios temas subestimados en cuidados paliativos Highlights on Several Underestimated Topics in Palliative Care Edited by Marco Cascella, ISBN 978-953-51-3566-1, Print ISBN 978-953-51-3565-4, 154 pages, Publisher: InTech, Chapters published October 04, 2017 under CC BY 3.0 license Edited Volume This book focuses on several underestimated topics in palliative care. Seven chapters have been divided into four sections: Ethical Issues, Volunteers in Palliative Care, Special Circumstances, and Prognostic Models in Palliative Care. The underestimated topics concern several ethical themes such as the Balance sheets of suffering, Good Death, Euthanasia, Assisted suicide, and the question of the 'Do not attempt resuscitation'. In addition, the role of volunteers, the approach to non-malignant diseases such as diabetes and Amyotrophic Lateral Sclerosis are also addressed. Finally, the features and utility of different tools in order to facilitate optimal decision making for both physicians and patients, are given in details. This book will aid several figures facing the daily challenges of palliative care. Clinicians, nurses, volunteers, students and resident trainees, and other professionals can find this volume useful in their very difficult but extraordinarily fascinating mission Libro / Book Indian Journal of Palliative Care October-December 2017; Volume 23 | Issue 4  Revista / Journal BMC Palliative Care Volume 17, Issue 1, December 2018 Revista / Journal BMC Palliative Care Revista / Journal Journal of Palliative Care & Medicine 2017¸ Volume 7, Issue 5 Revista / Journal Arch Palliat Care Volume 1, Issue 1 Revista / Journal Palliat Med Hosp Care Open J.  2017 Revista / Journal XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Information

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

Guías para sedación paliativa / Guidelines for palliative sedation

Octubre 10, 2017. No. 2837

Variaciones internacionales en las guías de práctica clínica para la sedación paliativa: una revisión sistemática. International variations in clinical practice guidelines for palliative sedation: a systematic review. Abarshi E, Rietjens J, Robijn L, Caraceni A, Payne S, Deliens L, Van den Block L; EURO IMPACT. Author information BMJ Support Palliat Care. 2017 Sep;7(3):223-229. doi: 10.1136/bmjspcare-2016-001159. Epub 2017 Apr 20. Abstract OBJECTIVES: Palliative sedation is a highly debated medical practice, particularly regarding its proper use in end-of-life care. Worldwide, guidelines are used to standardise care and regulate this practice. In this review, we identify and compare  national/regional clinical practiceguidelines on palliative sedation against the European Association for Palliative Care (EAPC) palliative sedation Framework and assess the developmental quality of these guidelines using the Appraisal Guideline Research and Evaluation (AGREE II) instrument. METHODS: Using the PRISMA criteria, we searched multiple databases (PubMed, CancerLit, CINAHL, Cochrane Library, NHS Evidence and Google Scholar) for relevant guidelines, and selected those written in English, Dutch and Italian; published between January 2000 and March 2016. RESULTS: Of 264 hits, 13 guidelines-Belgium, Canada (3), Ireland, Italy, Japan, the Netherlands, Norway, Spain, Europe, and USA (2) were selected. 8 contained at least 9/10 recommendations published in the EAPC Framework; 9 recommended 'pre-emptive discussion of the potential role of sedation in end-of-life care'; 9 recommended 'nutrition/hydration while performing sedation' and 8 acknowledged the need to 'care for the medical team'. There were striking differences in terminologies used and in life expectancy preceding the practice. Selected guidelines were conceptually similar, comparing closely to the EAPC Framework recommendations, albeit with notable variations. CONCLUSIONS: Based on AGREE II, 3 guidelines achieved top scores and could therefore be recommended for use in this context. Also, domains 'scope and purpose' and 'editorial independence' ranked highest and lowest, respectively-underscoring the importance of good reportage at the developmental stage. KEYWORDS: Clinical Practice Guideline; EAPC; Palliative Medicine; Sedation; Systematic Review; Terminal care PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information

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

Paro cardiaco y embarazo / Cardiac arrest and pregnancy

Octubre 12, 2017. No. 2839

Fundamentos en el paro cardíaco durante la cesárea Essentials in cardiac arrest during cesarean section. van Liempt SW, Stoecklein K, Tjiong MY, Schwarte LA, de Groot CJ, Teunissen PW. Author information Clin Pract. 2015 Feb 17;5(1):668. doi: 10.4081/cp.2015.668. eCollection 2015 Jan 28. Abstract Cardiac arrest during cesarean section is very rare. Obstetrical teams have low exposure to these critical situations necessitating frequent rehearsal and knowledge of its differential diagnosis and treatment. A 40-year-old woman pregnant with triplets underwent cesarean sections because of vaginal bleeding due to a placenta previa at 35.2 weeks of gestation. Spinal anesthesia was performed. Asystole occurred during uterotomy. Immediate resuscitation and delivery of the neonates eventually resulted in good maternal and neonatal outcomes. The differential diagnosis is essential and should include obstetric and non-obstetric causes. We describe the consideration of Bezold Jarisch reflex and amniotic fluid embolism as most appropriate in this case. KEYWORDS: Bezold Jarisch reflex; cardiac arrest; cesarean section PDF Colapso materno: Desafiando la regla de cuatro minutos. Maternal collapse: Challenging the four-minute rule. Benson MD1, Padovano A2, Bourjeily G3, Zhou Y4. Author information EBioMedicine. 2016 Apr;6:253-257. doi: 10.1016/j.ebiom.2016.02.042. Epub 2016 Mar 2. Abstract INTRODUCTION: The current approach to, cardiopulmonary resuscitation of pregnant women in the third trimester has been to adhere to the "four-minute rule": If pulses have not returned within 4min of the start of resuscitation, perform a cesarean birth so that birth occurs in the next minute. This investigation sought to re-examine the evidence for the four-minute rule. METHODS: A literature review focused on perimortem cesarean birth was performed using the same key words that were used in formulating the "four-minute rule." Maternal and neonatal injury free survival rates as a function of arrest to birth intervals were determined, as well as actual incision to birth intervals. RESULTS: Both maternal and neonatal injury free survival rates diminished steadily as the time interval from maternal arrest to birth increased. There was no evidence for any specific survival threshold at 4min. Skin incision to birth intervals of 1min occurred in only 10% of women. CONCLUSION: Once a decision to deliver is made, care providers should proceed directly to Cesarean birth during maternal cardiac arrest in the third trimester rather than waiting for 4min for restoration of the maternal pulse. Birth within 1min from the start of the incision is uncommon in these circumstances. KEYWORDS: Cardiopulmonary resuscitation in pregnancy; Maternal cardiac arrest; Maternal mortality; Perimortem cesarean section; Postmortem cesarean section PDF Paro Cardíaco en el embarazo Dr. Manuel Eduardo Sáenz Madrigal, Dr. Carlos Adrián Vindas Morera Rev. Costarr. Cardiol. 2013 Julio-Diciembre, Volumen 15, N.º 2 Resumen El paro cardíaco en el embarazo presenta un escenario único en el que están incluidos dos pacientes: la madre y el feto. El manejo de este escenario requiere de un equipo multidisciplinario incluyendo especialistas en anestesia, obstetricia, neonatología, cardiología y en ocasiones cirugía cardíaca. Los protocolos de soporte vital básico y soporte cardíaco avanzado deben ser implementados, sin embargo, dados los cambios anatómicos y fisiológicos que ocurren en el embarazo, algunas modificaciones en los algoritmos son fundamentales. La evidencia existente acerca del manejo del paro cardíaco en el embarazo es relativamente insuficiente, sin estudios randomizados, por lo tanto las recomendaciones son basadas en pequeños estudios de cohorte y reportes de casos, además de la opinión de los expertos. En esta revisión hablaremos del paro cardíaco en el embarazo, sus implicaciones y el manejo adecuado por parte del equipo multidisciplinario, además del tiempo en el que se debe realizar la cesárea en caso de no retorno de circulación espontánea. Palabras clave: paro, cardíaco, reanimación, cardiopulmonar y embarazo. PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Information

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