Infusión de isoproterenol y microcirculación en shock séptico

Infusión de isoproterenol y microcirculación en shock séptico  Isoproterenol infusion and microcirculation in septic shock. Wiramus S, Textoris J, Bardin R, Vigne C, Kelway C, Martin C, Leone M. Heart Lung Vessel. 2014;6(4):274-9. Abstract INTRODUCTION: Our study primarily aimed at investigating the effect of isoproterenol infusion on tissue oxygen saturation in patients with septic shock. The secondary aim was to assess the relation between cardiac index, central venous oxygen saturation and tissue oxygen saturation. METHODS: This retrospective study was conducted from December 2010 to March 2012. We included 14 consecutive patients with septic shocktreated with isoproterenol. All patients were monitored by cardiac index and tissue oxygen saturation. From medical charts, routine hemodynamic data were extracted one hour before and six hours after the onset of isoproterenol infusion. RESULTS: From baseline to H6, tissue oxygen saturation levels rise from 78 [72-82]% to 85 [78-88]% (p = 0.03). Isoproterenol infusion was associated with an increase of central venous oxygen saturation (from 67 [65-74]% to 84 [77-86]%, p = 0.02) and cardiac index (from 2.9 [2.7-3.1] L/min/m² to 3.9 [3.0-4.4] L/min/m², p = 0.006). Tissue oxygen saturation was correlated neither to cardiac index (p = 0.14, R(2) = 0.08) nor to central venous oxygen saturation (p = 0.19, R(2) = 0.10). CONCLUSIONS: Use of isoproterenol was associated with an increase of tissue oxygen saturation. This increase was not correlated to cardiac index, suggesting a decoupling between macrocirculation and microcirculation. KEYWORDS: isoproterenol; microcirculation; oxygen saturation; septic shock Artí­culo/Article

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Líquidos perioperatorios/Perioperative fluids

Fluidoterapia perioperatoria: Declaración del grupo internacional de optimización de fluidos Perioperative fluid therapy: a statement from the international Fluid Optimization Group. Navarro LH, Bloomstone JA, Auler JO Jr, Cannesson M, Rocca GD, Gan TJ, Kinsky M7, Magder S, Miller TE, Mythen M, Perel A, Reuter DA,Pinsky MR, Kramer GC. Perioper Med (Lond). 2015 Apr 10;4:3. doi: 10.1186/s13741-015-0014-z. eCollection 2015. Abstract BACKGROUND:Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Maintaining effective circulating blood volume and pressure are key components of assuring adequate organ perfusion while avoiding the risks associated with either organ hypo- or hyperperfusion. Relative to perioperative fluid therapy, three inescapable conclusions exist: overhydration is bad, underhydration is bad, and what we assume about the fluid status of our patients may be incorrect. There is wide variability of practice, both between individuals and institutions. The aims of this paper are to clearly define the risks and benefits of fluid choices within the perioperative space, to describe current evidence-based methodologies for their administration, and ultimately to reduce the variability with which perioperative fluids are administered.METHODS: Based on the abovementioned acknowledgements, a group of 72 researchers, well known within the field of fluid resuscitation, were invited, via email, to attend a meeting that was held in Chicago in 2011 to discuss perioperative fluid therapy. From the 72 invitees, 14 researchers representing 7 countries attended, and thus, the international Fluid Optimization Group (FOG) came into existence. These researches, working collaboratively, have reviewed the data from 162 different fluid resuscitation papers including both operative and intensive care unit populations. This manuscript is the result of 3 years of evidence-based, discussions, analysis, and synthesis of the currently known risks and benefits of individual fluids and the best methods for administering them. RESULTS: The results of this review paper provide an overview of the components of an effective perioperative fluid administration plan and address both the physiologic principles and outcomes of fluid administration. CONCLUSIONS: We recommend that both perioperative fluid choice and therapy be individualized. Patients should receive fluid therapy guided by predefined physiologic targets. Specifically, fluids should be administered when patients require augmentation of their perfusion and are also volume responsive. This paper provides a general approach to fluid therapy and practical recommendations. KEYWORDS: Fluid responsiveness; Fluid resuscitation; Goal-directed fluid therapy; Perioperative fluids PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Apnea obstructiva del sueño/Obstructive sleep apnea

Manejo perioperatorio y complicaciones en pacientes con apnea obstructiva del sueño sometidos a cirugía trans espenoidal Perioperative management and complications in patients with obstructive sleep apnea undergoing transsphenoidal surgery: Our institutional experience. Rahimi E, Mariappan R, Tharmaradinam S, Manninen P, Venkatraghavan L. J Anaesthesiol Clin Pharmacol. 2014 Jul;30(3):351-4. doi: 10.4103/0970-9185.137266. Abstract BACKGROUND AND AIMS: Patients with endocrine diseases such as acromegaly and Cushing's disease have a high prevalence of obstructivesleep apnea (OSA). There is controversy regarding the use of continuous positive airway pressure (CPAP) following transsphenoidal surgery. The aim of this study was to compare the perioperative management and complications, in patients with or without OSA undergoing transsphenoidal surgery. MATERIALS AND METHODS: After Research Ethics Board approval, we retrospectively reviewed the charts of all patients who underwent transsphenoidal surgery in our institution from 2006 to 2011. Information collected included patients' demographics, pathology of lesion, history of OSA, anesthetic and perioperative management and incidence of perioperative complications. Patients with sleep study proven OSA were compared with a control group, matched for age, sex and pathology of patients without OSA. Statistical analysis was performed using t-test and Chi-square test and the P < 0.05 was considered to be significant. RESULTS: Out of a total 469 patients undergoing transsphenoidal surgery, 105 patients were found to be at risk for OSA by a positive STOP-BANG scoring assessment. Preoperative sleep study testing was positive for OSA in 38 patients. Post-operative hypoxemia (SpO2 < 90) occurred in 10 (26%) patients with OSA and was treated with high-flow oxygen through face mask (n = 7) and by CPAP mask (n = 3). In the OSA-negative group, 2 patients had hypoxemia and were treated with low-flow oxygen using face mask. There were no differences between the groups with respect to post-operative opioid use, destination, hospital stay or other complications. CONCLUSIONS: Post-operative hypoxemia in patients with OSA following transsphenoidal surgery can be treated in most but not all patients with high flow oxygen using the face mask. We were able to safely use CPAP in a very small number of patients but caution is needed to prevent complications. Further prospective studies are needed to determine the safe use of CPAP in patients after transsphenoidal surgery. KEYWORDS: Continuous positive airway pressure; obstructive sleep apnea; transsphenoidal surgery PDF Actualización en la definición, consecuencias y manejo de la apnea obstructiva del sueño Updates on definition, consequences, and management of obstructive sleep apnea. Park JG1, Ramar K, Olson EJ. Mayo Clin Proc. 2011 Jun;86(6):549-54; quiz 554-5. doi: 10.4065/mcp.2010.0810. Abstract Obstructive sleep apnea (OSA) is a breathing disorder during sleep that has implications beyond disrupted sleep. It is increasingly recognized as an independent risk factor for cardiac, neurologic, and perioperative morbidities. Yet this disorder remains undiagnosed in a substantial portion of our population. It is imperative for all physicians to remain vigilant in identifying patients with signs and symptoms consistent with OSA. This review focuses on updates in the areas of terminology and testing, complications of untreated OSA, perioperative considerations, treatment options, and new developments in this field. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Actualización en el manejo perioperatorio y en urgencias de anticoagulantes orales no antagonistas de la vitamina K

Actualización en el manejo perioperatorio y en urgencias de anticoagulantes orales no antagonistas de la vitamina K Updates in the perioperative and emergency management of non-vitamin K antagonist oral anticoagulants. Faraoni D, Levy JH, Albaladejo P, Samama CM; Groupe d'Intérêt en Hémostase Périopératoire. Crit Care. 2015 Apr 29;19(1):203. doi: 10.1186/s13054-015-0930-9. Abstract Perioperative management of patients treated with the non-vitamin K antagonist oral anticoagulants is an ongoing challenge. Due to the lack of good clinical studies involving adequate monitoring and reversal therapies, management requires knowledge and understanding of pharmacokinetics, renal function, drug interactions, and evaluation of the surgical bleeding risk. Consideration of the benefit of reversal of anticoagulation is important and, for some low risk bleeding procedures, it may be in the patient's interest to continue anticoagulation. In case of major intra-operative bleeding in patients likely to have therapeutic or supra-therapeutic levels of anticoagulation, specific reversal agents/antidotes would be of value but are currently lacking. As a consequence, a multimodal approach should be taken which includes the administration of 25 to 50 U/kg 4-factor prothrombin complex concentrates or 30 to 50 U/kg activated prothrombin complex concentrate (FEIBA®) in some life-threatening situations. Finally, further studies are needed to clarify the ideal therapeutic intervention. PDF

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Paciente despierto/Awake patient

Endarterectomía con pacientes despiertos. Seguridad, tolerabilidad y resultados Carotid endarterectomy in awake patients: safety, tolerability and results. Mendonça CT, Fortunato JA Jr, Carvalho CA, Weingartner J, Filho OR, Rezende FF, Bertinato LP. Rev Bras Cir Cardiovasc. 2014 Oct-Dec;29(4):574-80. doi: 10.5935/1678-9741.20140053. Abstract OBJECTIVE: To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. METHODS: One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%). RESULTS: A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%). CONCLUSION: Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates. PDF Efectos hemodinámicos de dexmedetomidina durante electrocorticografía intraoperatoria para cirugía de epilepsia Hemodynamic effects of dexmedetomidine during intra-operative electrocorticography for epilepsy surgery. Chaitanya G, Arivazhagan A, Sinha S, Madhusudan Reddy KR, Thennarasu K, Bharath RD, Rao MB2, Chandramouli BA, Satishchandra P. J Neurosci Rural Pract. 2014 Nov;5(Suppl 1):S17-21. doi: 10.4103/0976-3147.145195. Abstract BACKGROUND: Dexmedetomidine, a predominant alpha-2-adrenergic agonist has been used in anesthetic practice to provide good sedation. The drug is being recently used in neuroanesthesia during awake surgery for brain tumors and in functional neurosurgery. MATERIALS AND METHODS: This prospective study analyzed the hemodynamic effects of dexmedetomidine infusion during electrocorticography in patients undergoing surgery for mesial temporal sclerosis. Dexmedetomidine infusion was administered during intra-operative electrocorticography recording, 15 minutes after the end tidal MAC of N2O and isoflurane were decreased to zero. Anesthesia was maintained with O2 : air mixture = 50:50, vecuronium and fentanyl. Heart rate (HR), mean arterial pressure (MAP) and end tidal carbon dioxide (ETCO2) were recorded across at induction, 2 min prior to dexmedetomidine (PreDEX), 5 min during dexmedetomidine infusion (DEX; 1 μg/kg), 5 min after stopping dexmedetomidine and 10 minutes after stopping dexmedetomidine. RESULTS: Forty patients with mesial temporal sclerosis (M: F = 27:13, mean age = 28.15 ± 10.9 years; duration of epilepsy = 12.0 ± 7.9 years) underwent anterior temporal lobe resection with amygdalohippocampectomy for drug-resistant epilepsy. Infusion of dexmedetomidine caused a transient fall in HR in 87.5% of patients and an increase in MAP in 62.5% of patients, which showed a tendency to revert back towards PreDEX values within 10 min after stopping the infusion. Sixty-five percent of the patients showed ≤25% reduction and 10% of them showed >25% reduction in HR. 47.5% of the patients showed ≤25% increase and 15% of them showed >25% increase in MAP. These changes were over a narrow range and within physiological limits. CONCLUSION: The infusion of dexmedetomidine for a short period causes reduction of HR and increase in MAP in patients, however the variations are within acceptable range. KEYWORDS: Dexmedetomidine; heart rate; hemodynamic changes; mean arterial pressure PDF

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Bibliotecas populares. Alerta

bibliotecas populares
Notificaciones semanales ⋅ 20 de mayo de 2015
NOTICIAS

Bibliotecas Populares reciben asistencia financiera de Vicegobernación por cuarto año consecutivo
Noticiasdel6.com
En la Vía Cultural “La Estación”, se entregaron aportes destinados a la compra de material bibliográfico, de artículos de librería y para mejoras de ...




nuevazona

Viale. Para todos los gustos: La Biblioteca Popular adquirió más de cien nuevos libros
nuevazona
Como ya es tradición todos los años, en la Feria del Libro de Buenos Aires la Biblioteca Popular “Dr. Julio Vitor”, de Viale adquirió más de cien ...




Diario Uno

“Calambres en el Alma” en la Biblioteca Alberdi de Luján
Diario Uno
Este viernes 15 de mayo, a partir de las 21, se presentará en la Biblioteca Popular Municipal J. B. Alberdi (República del Líbano 418), la muestra de ...




ADN Río Negro (Sátira) (Comunicado de prensa) (Registro) (blog)

Chicos del barrio Ferri rodaron un cortometraje
ADN Río Negro (Sátira) (Comunicado de prensa) (Registro) (blog)
... la Comisión Nacional Protectora de Bibliotecas Populares del Ministerio de Cultura de la Nación (CONABIP) y su “Bibliomóvil”, la municipalidad de ...




El Diario del Sur de Córdoba

Permitirá continuar acercando el servicio a escuelas rurales
El Diario del Sur de Córdoba
Cabe destacar que la Biblioteca tuvo durante un año y medio un bibliomóvil cedido por la Comisión Nacional de Bibliotecas Populares (Conabip) y ...



Arranca la Feria del Libro
Otro Día
Es una iniciativa conjunta entre municipio, bibliotecas y libreros. ... 19:00. Lectura de textos a cargo de las bibliotecas populares de nuestra ciudad.




El Digital de Castilla la Mancha

Bienio de la lectura y de las bibliotecas públicas (2015-2016)
El Digital de Castilla la Mancha
Estos años de crisis y recortes han afectado mucho a las bibliotecas ... de la Red de Bibliotecas Populares de la Mancomunidad de Cataluña.

Bloqueos nerviosos con ultrasonido/Ultrasound guided nerve blocks

Bloqueos guiados con ultrasonido Ultrasound-guided nerve blocks--is documentation and education feasible using only text and pictures? Worm BS, Krag M, Jensen K. PLoS One. 2014 Feb 12;9(2):e86966. doi: 10.1371/journal.pone.0086966. eCollection 2014. PDF Ultrasonido guiado vs neuroestimulación en bloqueo ciático. Un meta-analisis Ultrasound-guided technology versus neurostimulation for sciatic nerver block: a meta-analysis. Cao X, Zhao X, Xu J, Liu Z, Li Q. Int J Clin Exp Med. 2015 Jan 15;8(1):273-80. eCollection 2015. Abstract BACKGROUND: Sciatic nerve block is widely used for anesthesia and analgesia in lower limb surgery, traditional method used for sciatic nerve block is nerve stimulation guidance. Whether the use of ultrasound-guided technology can increases the success rate of sciatic nerve block and provide other benefits are not defined. This meta-analysis was aimed to clarify this issue. METHOD: We searched Pubmed, the Cochrane library and Google Scholar. A total of 10 RCTs met our inclusion criteria. The patients included underwent ultrasound-guided or nerve stimulation guidance for sciatic nerve block. We compared the success rate, vascular puncture, the time of procedure and Success rate of catheter placement. RESULTS: Ultrasound-guided technology, compared with nerve stimulation for sciatic nerve block, provided higher success rate. [RR = 1.22 95% CI: 1.04-1.42, P = 0.01], Ultrasound guidance also reduce the risk of vascular puncture. [RR = 0.13 95% CI: 0.02-0.97, P = 0.05]. However, the success rate of catheter placement [RR = 1.1095% CI: 0.93-1.29, P = 0.27] and the time of performing sciatica never block [RR = -0.17 95% CI: -1.61-1.27, P = 0.82] did not differ significantly. CONCLUSIONS: Compared to traditional nerve stimulation guidance, ultrasound guidance for sciatic nerve may improve the success rate of blockand reduce the risk of vascular puncture. KEYWORDS: Sciatic never block; meta-analysis; ultrasound-guided technology PDF

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Imagen del mes/Month imagen

Herpes Zoster en niño. Ver galería See gallery

El Herpes zoster es causado por la reactivación del virus de la varicela-zoster latente que reside en un ganglio de la raíz dorsal, o del trigémino. Se puede desarrollar en cualquier momento después de una infección primaria o después de recibir la vacuna contra la varicela viva atenuada. La enfermedad se manifiesta como erupciones cutáneas dolorosas de uno, dos o más dermatomas contiguos; son invariablemente unilaterales y no cruzan la línea media. En los niños pequeños el herpes zoster tiene predilección por las zonas suministrados por los dermatomas cervicales y sacros, aunque puede afectar a cualquier nervio periférico. Las complicaciones más frecuentes son infecciones bacterianas secundarias, despigmentación, y la cicatrización. El aciclovir es el tratamiento de elección para la infección aguda del herpes zoster. La incidencia de herpes zoster pediátrico aumenta con la edad; de 20 casos por 100.000 personas-año en los menores de cinco años de edad a 63 casos por 100.000 personas-año en los 15 a 19 años. La incidencia de zoster en la infancia en pacientes con leucemia linfocítica aguda es mayor que en los niños sin una neoplasia subyacente. La varicela en el primer año de vida es un factor de riesgo para zoster pediátrico, con un riesgo relativo entre 2,8 y 20,9. Ni la varicela en el segundo año de vida, ni vacunaciones recientes son factores de riesgo de zoster infantil. La imagen que hoy se envía es de un niño de 6 años de edad, bien nutrido, inmunocompetente que desarrolló un cuadro clínico típico de herpes zoster localizado en los dermatomas T3-T5 izquierdos. Se trató con aciclovir y tuvo una evolución satisfactoria. Herpes zoster is caused by reactivation of latent varicella-zoster virus that resides in a dorsal root ganglion, or in the trigeminal ganglia. It can develop any time after a primary infection or after receiving live attenuated varicella vaccine. The disease manifests as painful cutaneous eruptions over a single, two or more contiguous dermatomes; they are invariably unilateral and do not cross the midline. In young children, herpes zoster has predilection for areas supplied by the cervical and sacral dermatomes, although can affect any peripheral nerve. The most common complications are secondary bacterial infection, depigmentation, and scarring. Acyclovir is the treatment of choice for acute herpes zoster infection. The incidence of pediatric herpes zoster increased with age from 20 cases per 100,000 person-years in those less than five years of age to 63 cases per 100,000 person-years in those aged 15 to 19. The incidence of childhood zoster in patients with acute lymphocytic leukemia is higher than in children without an underlying malignancy. Chickenpox in the first year of life is a risk factor for childhood zoster, with a relative risk between 2.8 and 20.9. Neither chickenpox in the second year of life nor recent vaccinations are risk factors for childhood zoster. Today´s picture is a 6 year old boy, well-nourished, immunocompetent that developed a typical clinical picture of herpes zoster located in the left T3-T5 dermatome He was treated with acyclovir and had a satisfactory evolution. Paciente pediátrico con rash Pediatric patient with a rash. Sutton J, Walsh R, Franklin J. West J Emerg Med. 2014 Jul;15(4):372-4. doi: 10.5811/westjem.2014.1.19356. PDF Herpes zoster oftálmico diseminado en un niño de 8 años inmunocompetente Disseminated herpes zoster ophthalmicus in an immunocompetent 8-year old boy. Oladokun RE, Olomukoro CN Owa AB1. Clin Pract. 2013 May 20;3(2):e16. doi: 10.4081/cp.2013.e16. eCollection 2013. PDF Herpes zoster bilateral simétrico en un adolescende de 15 años inmunocompetente Bilateral symmetrical herpes zoster in an immunocompetent 15-year-old adolescent boy. Leung AK, Barankin B. Case Rep Pediatr. 2015;2015:121549. doi: 10.1155/2015/121549. Epub 2015 Jan 27. PDF Herpes zoster oftálmico en un niño sano Herpes zoster ophthalmicus in a healthy child. Teran CG1, Medows M. BMJ Case Rep. 2013 May 21;2013. pii: bcr2013009702. doi: 10.1136/bcr-2013-009702. PDF Herpes zoster en la infancia Herpes Zoster in Childhood Alexander K. C. Leung, Benjamin Barankin Open Journal of Pediatrics, 2015, 5, 39-44 PDF Riesgo elevado de herpes zoster en niños con asma. Estudio de casos y controles de base poblacional. Increased risk of herpes zoster in children with asthma: a population-based case-control study. Kim BS1, Mehra S, Yawn B, Grose C, Tarrell R, Lahr B, Juhn YJ. J Pediatr. 2013 Sep;163(3):816-21. doi: 10.1016/j.jpeds.2013.03.010. Epub 2013 Apr 13. PDF

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Medwave Mayo 2015

Tenemos el agrado de informarle que existen cupos disponibles para curso Prevención y control de infecciones asociadas a la atención de salud que se inicia el 03 de junio. Para información más detallada: http://www.medwave.cl/link.cgi/eCampus/IAAS

También comunicamos que hemos completado la edición correspondiente al mes de Mayo 2015, los artículos incluidos son los siguientes.

ESTUDIOS PRIMARIOS

Hepatotoxicidad medicamentosa y tuberculosis en un hospital del noreste argentino: estudio transversal
Alfredo Sebastián Golemba, Francisco Gastón Emmanuel Ferreyra, Ricardo Enrique Martearena, Fernando Ramón Achinelli, Gloria Beatriz Rovai (Argentina)

Medwave 2015 May;15(4):e6135
http://dx.doi.org/10.5867/medwave.2015.04.6135


Conocimientos, prácticas y actitudes hacia el voluntariado ante una influenza pandémica: estudio transversal con estudiantes de medicina en Perú
Julio A. Huapaya, Julio Maquera-Afaray, Patricia J. García, César Cárcamo, Javier A. Cieza (Perú)

Medwave 2015 May;15(4):e6136
http://dx.doi.org/10.5867/medwave.2015.04.6136


Imagen corporal en personas con disforia de género
María Frenzi Rabito Alcón, José Miguel Rodríguez Molina (España)

Medwave 2015 May;15(4):e6138
http://dx.doi.org/10.5867/medwave.2015.04.6138


REPORTE DE CASO

Teratoma sacrococcígeo: presentación de un caso
Ricardo Molina Vital, José Martín De Santiago Valenzuela, Roberto Carlos De Lira Barraza (México)

Medwave 2015 May;15(4):e6137
http://dx.doi.org/10.5867/medwave.2015.04.6137


ARTÍCULO DE REVISIÓN

Aborto: tomando el debate en serio
Miguel Hugo Kottow Lang (Chile)

Medwave 2015 May;15(4):e6139
http://dx.doi.org/10.5867/medwave.2015.04.6139


RESUMEN EPISTEMONIKOS

¿Son beneficiosas las estatinas en la insuficiencia cardíaca crónica?
Carmen Rain, Gabriel Rada (Chile)

Medwave 2015 May;15(4):e6140
http://dx.doi.org/10.5867/medwave.2015.04.6140


NOTA TÉCNICA

Parto pretérmino e intimidad durante el embarazo: interacciones entre los microbiomas bucal, vaginal e intestinal
Demian Arturo Herrera Morban (República Dominicana)

Medwave 2015 May;15(4):e6144
http://dx.doi.org/10.5867/medwave.2015.04.6144


CARTA A LA EDITORA
Cambios en la investigación médica en pregrado
David Gutiérrez España, Constanza Cid Bassaletti (Chile)

Medwave 2015 May;15(4):e6142
http://dx.doi.org/10.5867/medwave.2015.04.6142


Además se encuentran abiertas las inscripciones para próximos cursos a realizarse:

Planificación estratégica en salud: http://www.medwave.cl/link.cgi/eCampus/PES/
Gestión de calidad en la atención abierta de salud: http://www.medwave.cl/link.cgi/eCampus/APIA/
Centros de responsabilidad en el ámbito de la salud: http://www.medwave.cl/link.cgi/eCampus/ges05/


PORTADA MEDWAVE
http://www.medwave.cl

PORTADA eCAMPUS
http://www.medwave.cl/link.cgi/eCampus/Capacitacion

Ondanstron y prurito/Ondansetron and pruritus

Estudio comparativo con ondansetron i.v. versus dosis subhipnóticas de propofol en el manejo de prurito inducido por sufentanil intratecal en cesárea The comparative study of intravenous Ondansetron and sub-hypnotic Propofol dose in control and treatment of intrathecal Sufentanil-induced pruritus in elective caesarean surgery. Hirmanpour A, Safavi M, Honarmand A, Hosseini AZ, Sepehrian M. J Res Pharm Pract. 2015 Apr-Jun;4(2):57-63. doi: 10.4103/2279-042X.155751. Abstract OBJECTIVE: Pruritus is a common and disturbing side effect of neuraxial opioids after cesarean section. The purpose of this study was to compare the efficacy of intravenous ondansetron and sub-hypnotic dose of propofol in control and treatment of intrathecal sufentanil induced pruritus in cesarean surgery. METHODS: Totally, 90 parturient with American Society of Anesthesiology physical status grade I-II, undergoing spinal anesthesia with 2.5 μg sufentanil and 10 mg bupivacaine 0.5% were enrolled to this randomized, prospective, double-blind study. The women were randomly assigned to two groups who received 8 mg ondansetron or 10 mg propofol to treat pruritus grade ≥3. The patient was evaluated after 5 min and in the lack of successful treatment, the doses of two drugs repeated and if the pruritus is on-going, the exact treatment with naloxone was done. FINDINGS: The incidence of pruritus was 69.3%. Both groups were well-matched. The peak time pruritus was 30-75 min after injection. The percentage of individuals consumed naloxone were 6.8% and 15.9% in ondansetron and propofol groups, respectively (P = 0.18). The mean score of satisfaction (according to visual analog scale criteria) was 9.09 ± 1.1 in ondansetron group and 9.3 ± 1.07 in the propofol group (P = 0.39). CONCLUSION: Ondansetrone and sub-hypnotic dose of propofol are both safe and well-tolerated. Due to their same efficacy in the treatment of intrathecal sufentanil-induced pruritus, they can be widely used in clinical practice. KEYWORDS: Caesarean surgery; Ondansetron; Propofol; intrathecal opioid; pruritus PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Monitoreo y seguridad en anestesia/Monitoring and safety in anesthesia

Un intento de aumentar la seguridad de los anestésicos por los avances en el monitoreo de anestesia: Análisis cienciométrico. A quest to increase safety of anesthetics by advancements in anesthesia monitoring: scientometric analysis. Vlassakov KV, Kissin I. Drug Des Devel Ther. 2015 May 11;9:2599-608. doi: 10.2147/DDDT.S81013. eCollection 2015. Abstract The aim of this study was to assess progress in the field of anesthesia monitoring over the past 40 years using scientometric analysis. The following scientometric indexes were used: popularity indexes (general and specific), representing the proportion of articles on either a topic relative to all articles in the field of anesthetics (general popularity index, GPI) or the subfield of anesthesia monitoring (specific popularity index, SPI); index of change (IC), representing the degree of growth in publications on a topic from one period to the next; and index of expectations (IE), representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000) biomedical journals covered by PubMed. Publications on 33 anesthesia-monitoring topics were assessed. Our analysis showed that over the past 40 years, the rate of rise in the number of articles on anesthesia monitoring was exponential, with an increase of more than eleven-fold, from 296 articles over the 5-year period 1974-1978 to 3,394 articles for 2009-2013. This rise profoundly exceeded the rate of rise of the number of articles on general anesthetics. The difference was especially evident with the comparison of the related GPIs: stable growth of the GPI for anesthesia monitoring vs constant decline in the GPI for general anesthetics. By the 2009-2013 period, among specific monitoring topics introduced after 1980, the SPI index had a meaningful magnitude (≥1.5) in 9 of 24 topics: Bispectral Index (7.8), Transesophageal Echocardiography (4.2), Electromyography (2.8), Pulse Oximetry (2.4), Entropy (2.3), Train-of-four (2.3), Capnography (1.9), Pulse Contour (1.9), and Electrical Nerve Stimulation for neuromuscular monitoring (1.6). Only one of these topics (Pulse Contour) demonstrated (in 2009-2013) high values for both IC and IE indexes (76 and 16.9, respectively), indicating significant recent progress. We suggest that rapid growth in the field of anesthetic monitoring was one of the most important developments to compensate for the intrinsically low margins of safety of anesthetic agents. KEYWORDS: anesthesia-related morbidity; anesthesia-related mortality; anesthetics; general anesthesia; regional anesthesia PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org