Líquidos en UCI / IV fluids in intensive care

Abril 30, 2016. No. 2312

Meta-análisis de la resucitación hídrica con contenido alto o bajo de cloro en el perioperatorio y en UCI Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation. Krajewski ML1, Raghunathan K, Paluszkiewicz SM, Schermer CR, Shaw AD. Br J Surg. 2015 Jan;102(1):24-36. doi: 10.1002/bjs.9651. Epub 2014 Oct 30. Abstract BACKGROUND: The objective of this systematic review and meta-analysis was to assess the relationship between the chloride content ofintravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting.CONCLUSION: A weak but significant association between higher chloride content fluids and unfavourable outcomes was found, but mortality was unaffected by chloride content. PDF  ¿Qué hay de Nuevo en el manejo de volumen en terapia intensiva? What's new in volume therapy in the intensive care unit? van Haren F1, Zacharowski K2. Best Pract Res Clin Anaesthesiol. 2014 Sep;28(3):275-83. doi: 10.1016/j.bpa.2014.06.004. Epub 2014 Jul 17. Abstract The administration of intravenous fluid to critically ill patients is one of the most common but also one of the most fiercely debated interventions in intensive care medicine. During the past decade, a number of important studies have been published which provide clinicians with improved knowledge regarding the timing, the type and the amount of fluid they should give to their critically ill patients. However, despite the fact that many thousands of patients have been enrolled in these trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Early adequate resuscitation of patients in shock followed by a restrictive strategy may be associated with better outcomes. Colloids such as modern hydroxyethyl starch are more effective than crystalloids in early resuscitation of patients in shock, and are safe when administered during surgery. However, these colloids may not be beneficial later in the course of intensive care treatment and should best be avoided in intensive carepatients who have a high risk of developing acute kidney injury. Albumin has no clear benefit over saline and is associated with increased mortality in neurotrauma patients. Balanced fluids reduce the risk of hyperchloraemic acidosis and possibly kidney injury. The use of hypertonic fluids in patientswith sepsis and acute lung injury warrants further investigation and should be considered experimental at this stage. Fluid therapy impacts relevant patient-related outcomes. Clinicians should adopt an individualized strategy based on the clinical scenario and best available evidence. One size does not fit all. KEYWORDS: albumin; colloid; crystalloid; fluid; hypertonic; intensive care; resuscitation; shock PDF  Uso de líquidos en terapia intensiva de adultos Fluid use in adult intensive care. Wujtewicz M1. Anaesthesiol Intensive Ther. 2012 Aug 8;44(2):92-5. Abstract Methods for the restoration of circulating blood volume, including the use of intravenous fluids, have been widely discussed over many years. There are no clear guidelines regarding the type of solutions, the total volume that should be transfused, or time schedules. Colloid solutions, usually hydroxyethyl starch compositions, are probably the most commonly used volume expanders in resuscitation, despite the lack of convincing trials and possible nephrotoxicity.In 2012, a task force of ESICM published a consensus statement on colloid use in critically ill adult patients. They stressed that infusion of an inappropriate volume may worsen the outcome of critically ill patients. Static parameters of cardiac filling volume, such as CVP or PCWP, commonly used in clinical practice, were found to be useless in the prediction of fluid responsiveness; volumetric or dynamic parameters, like global end diastolic volume (GEDV) or stroke volume variations (SVV), obtained by PICCO meters, seemed be much more appropriate. The dynamic fluid challenge test, which is transfusion of approx. 200 cc (or 3 mL kg-1) of any fluid over 5-10 min resulting in an increase of stroke volume, has also been recommended for the identification of those patients who may benefit from fluid resuscitation. The old passive leg raising test can also be used for this purpose.Despite prolonged discussion about fluid therapy in specific groups of critically ill patients, there is no convincing data to indicate the superiority of colloids over crystalloids. The choice of fluids is usually based on personal preference and hospital policy. Among crystalloid solutions, balanced preparations such as acetates, lactates, malates or citrates are recommended to avoid hyperchloraemia, a common side effect of saline infusion. There is no agreement regarding colloid solutions.The fluid transfusion regimen in criticallyill patients should therefore be based on clinical assessment and patient responses. PDF Committee for European Education in Anaesthesiology (CEEA) Colegio de Anestesiólogos de León AC MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor. Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.   En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016. Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com

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

Cirugía bariatrica / Bariatric surgery

Mayo 11, 2016. No. 2323

Implementación mejorada del protocolo de recuperación después de la cirugía bariátrica: un estudio retrospectivo. Implementing enhanced recovery after bariatric surgery protocol: a retrospective study. Proczko M1, Kaska L1, Twardowski P2, Stepaniak P3,4. J Anesth. 2016 Feb;30(1):170-3. doi: 10.1007/s00540-015-2089-6. Epub 2015 Oct 24. Abstract While the demand for bariatric surgery is increasing, hospital capacity remains limited. The ERABS (Enhanced Recovery After Bariatric Surgery) protocol has been implemented in a number of bariatric centers. We retrospectively compared the operating room logistics and postoperative complications between pre-ERABS and ERABS periods in an academic hospital. The primary endpoint was the length of stay in hospital. The secondary endpoints were turnover times-the time required for preparing the operating room for the next case, induction time (from induction ofanesthesia until a patient is ready for surgery), surgical time (duration of surgery), procedure time (duration of stay in the operating room), and the incidence of re-admissions, re-operations and complications during admission and within 30 days after surgery. Of a total of 374 patients, 228 and 146 received surgery following the pre-ERABS and ERABS protocols, respectively. The length of hospital stay was significantly shortened from 3.7 (95 % confidence interval [CI] 3.1-4.7) days to 2.1 (95 % CI 1.6-2.6) days (P < 0.001). Procedure (surgical) times were shortened by 15 (7) min and 12 (5) min for gastric bypass and gastric sleeve surgery, respectively (P < 0.001 for both), by introducing the ERABS protocol. Induction times were reduced from 15.2 (95 % CI 14.3-16.1) min to 12.5 (95 % CI 11.7-13.3) min (P < 0.001).Turnover times were shortened significantly from 38 (95 % CI 44-32) min to 11 (95 % CI 8-14) min. The incidence of re-operations, re-admissions and complications did not change. KEYWORDS: Bariatric surgery; Early recovery after bariatric surgery; Gastric bypass; Sleeve gastrectomy and morbid obesity PDF  VIII Foro Internacional de Medicina del Dolor y Paliativa  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Junio 9-11, Ciudad de México Dra. Argelia Lara Solares Tel. 5513 3782  www.dolorypaliativos.org

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

Feliz Día de las Madres/Happy Mother's Day

No.2322                                                                                   Mayo 10, 2016 La decisión que toma la mujer para estudiar medicina y posteriormente tener una triple actividad como madre, esposa y doctora las convierte en supermujeres para cada día de su vida: cuando tiene hijos es la supermamá que vela con amor minuto a minuto por el cuidado de sus hijos en un quehacer de alta demanda que inicia muy temprano cada día. Luego se convierte en superdoctora para cuidar de cada paciente por largas horas de cada día, para después cambiar su papel al de superesposa y atender las múltiples actividades de su supercasa, sin dejar de estudiar temas de Familia y Medicina que son parte de esta rutina de entrega personal muy propia de cada mujer profesionista, en especial de las superdoctoras. Anestesiología y Medicina del Dolor se complace en FELICITAR a todas esas MAMÁS que hoy celebran su día y les deseamos lo mejor para hoy y cada día de su vida en compañía de su Familia, amigos y compañeros de trabajo.      ¿Es seguro para las profesionales de la salud embarazadas manejar los fármacos citotóxicos? Una revisión de la literatura y recomendaciones. Is it safe for pregnant health-care professionals to handle cytotoxic drugs? A review of the literature and recommendations. Gilani S1, Giridharan S1. Ecancermedicalscience. 2014 Apr 10;8:418. doi: 10.3332/ecancer.2014.418. eCollection 2014. Abstract The information related to health risks to foetuses due to the handling of chemotherapeutic agents by nurses during pregnancy is limited. The risks involved can be reduced significantly if nurses adhere to standard safety precautions while handling cytotoxic drugs. Nurses in patient areas where chemotherapy is administered are at constant low-level risk of exposure. The authors tried to gather evidence in this article from the recent literature to help to formalise policies for pregnant mothers working in these settings. KEYWORDS: chemotherapy; health-care professional; nurse; pregnant PDF Esclerosis multiple y embarazo Multiple sclerosis and pregnancy: current considerations. Buraga I1, Popovici RE2. ScientificWorldJournal. 2014;2014:513160. doi: 10.1155/2014/513160. Epub 2014 Apr 7. Abstract Multiple sclerosis is the most common neurological disease of young adults that causes major disability. In Romania, it is estimated that this disease has a prevalence of 35-40 per 100,000 inhabitants. It is a disease that begins at the age of 20-40 years and is 2-3 times more common in women than in men. More than half of patients with MS develop the disease in their fertile period of life; therefore, MS patients use contraceptive methods while being under our treatment. Since several therapeutic options have been implemented with good efficiency in the disease stabilization, increasingly more patients begin to wonder about the possibility of having a child and about the possible risks of pregnancy. The evolution during pregnancy and the lactation period has been favorable, with lower relapses and side effects comparable to those in the general population. In addition, babies born to mothers with MS have not had a significantly different mean gestational age or birth weight compared to babies born to healthy mothers PDF La cardiomiopatía periparto: Un rompecabezas más cerca de la solución. Peripartum cardiomyopathy: A puzzle closer to solution. Fett JD1. World J Cardiol. 2014 Mar 26;6(3):87-99. doi: 10.4330/wjc.v6.i3.87. Abstract Peripartum cardiomyopathy (PPCM) represents new heart failure in a previously heart-healthy peripartum patient. It is necessary to rule out all other known causes of heart failure before accepting a diagnosis of PPCM. The modern era for PPCM in the United States and beyond began with the report of the National Institutes of Health PPCM Workshop in 2000, clarifying all then-currently known aspects of the disease. Since then, hundreds of publications have appeared, an indication of how devastating this disease can be to young mothers and their families and the urgent desire to find solutions for its cause and better treatment. The purpose of this review is to highlight the important advances that have brought us nearer to the solution of this puzzle, focusing on what we have learned about PPCM since 2000; and what still remains unanswered. Despite many improvements in outcome, we still do not know the actual triggers that initiate the pathological process; but realize that cardiac angiogenic imbalances resulting from complex pregnancy-related immune system and hormonal changes play a key role. KEYWORDS: Heart failure; Peripartum cardiomyopathy; Pregnancy PDF  Vasopresores en anestesia obstétrica Vasopressors in obstetric anesthesia: A current perspective. Nag DS1, Samaddar DP1, Chatterjee A1, Kumar H1, Dembla A1. World J Clin Cases. 2015 Jan 16;3(1):58-64. doi: 10.12998/wjcc.v3.i1.58. Abstract Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetal acid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today. KEYWORDS: Cesarean section; Hypotension; Obstetrics; Spinal anesthesia; Vasopressor agents PDF Evaluación de la altura del bloqueo para cesárea en las últimas tres décadas: las tendencias de la literatura. Assessing the height of block for caesarean section over the past three decades: trends from the literature. Hoyle J1, Yentis SM. Anaesthesia. 2015 Apr;70(4):421-8. doi: 10.1111/anae.12927. Epub 2014 Nov 10.Abstract There are multiple methods of assessing the height of block before caesarean section under regional anaesthesia, and surveys of practice suggest considerable variation in practice. So far, little emphasis has been placed on the guidance to be gained from published research literature or textbooks. We therefore set out to investigate the methods of block assessment documented in published articles and textbooks over the past 30 years. We performed two searches of PubMed for randomised clinical trials with caesarean section and either spinal anaesthesia or epiduralanaesthesia as major Medical Subject Headings. A total of 284 papers, from 1984 to 2013, were analysed for methods of assessment of sensory and motor block, and the height of block deemed adequate for surgery. We also examined 45 editions of seven anaesthetic textbooks spanning 1950-2014 for recommended methods of assessment and height of block required for caesarean section. Analysis of published papers demonstrated a wide variation in techniques, though there has been a trend towards the increased use of touch, and an increased use of a block height of T5 over the study period. Only 115/284 (40.5%) papers described the method of assessing motor block, with most of those that did (102/115; 88.7%) describing it as the 'Bromage scale', although only five of these (4.9%) matched the original description by Bromage. The required height of block recommended by textbooks has risen over the last 30 years to T4, although only four textbooks made any recommendation about the preferred sensory modality. The variation in methods suggested by surveys of practice is reflected in variation in published trials, and there is little consensus or guidance in anaesthetic textbooks. PDF  VIII Foro Internacional de Medicina del Dolor y Paliativa  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Junio 9-11, Ciudad de México Dra. Argelia Lara Solares Tel. 5513 3782  www.dolorypaliativos.org  Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org