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Desarrollan un método que abre nuevas vías en la lucha contra la malaria |
Un equipo de investigación de la Universidad Complutense de Madrid (UCM) ha desarrollado un procedimiento que permite el cultivo del parásito de la malaria en grandes cantidades y de manera sincronizada. El procedimiento, que se ha publicado en el último número de la revista Nature Protocols, aumenta en gran medida las posibilidades de investigar nuevas vacunas y fármacos contra esta enfermedad. |
FUENTE | Universidad Complutense de Madrid - madri+d | 7/12/2009 |
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Sedación conciente para craniectomía en paciente despierto en un quirófano con resonancia nuclear magnética |
Conscious sedation for awake craniotomy in intraoperative magnetic resona nce imaging operating theater Mohamad Said Maani Takrouri, Firas A Shubbak, Aisha Al Hajjaj, Ronaldo Del Maaestro, Lahbib Soualmi, Mashael H Alkhodair, Abrar M Alduraiby, Najeeb Ghanem Anesthesia Essays Res 2010:4;33-37. doi:10.4103/0259-1162.69306 This case report describes the first case in intraoperative magnetic resonance imaging operating theater (iMRI OT) (BrainSuite;) of awake craniotomy for frontal lobe glioma excision in a 24-year-old man undergoing eloquent cortex language mapping intraoperatively. As he was very motivated to take pictures of him while being operated upon, the authors adapted conscious sedation technique with variable depth according to Ramsey's scale, in order to revert to awake state to perform the intended neurosurgical procedure. The patient tolerated the situation satisfactorily and was cooperative till the finish, without any event. We elicit in this report the special environment of iMRI OT for lengthy operation in pinned fixed patient having craniotomy. |
Craniotomía con paciente despierto, deprimido y agitado |
Awake craniotomy in a depressed and agitated patient Al Shuabi KM Anesthesia Essays Res 2010:4;41-43 Depressed patients with brain tumors are often not referred to awake craniotomy because of concern of uncooperation which may increase the risk of perioperative complications. This report describes an interesting case of awake craniotomy for frontal lobe glioma in a 41-year-old woman undergoing language and motor mapping intraoperatively. As she was fearful and apprehensive and was on antidepressant therapy to control depression, the author adopted general anesthesia with laryngeal mask airway during initial stage of skull pinning and craniotomy procedures. Then, the patient reverted to awake state to continue the intended neurosurgical procedure. The patient tolerated the situation satisfactorily and was cooperative till the finish, without any event. |
Reconociendo y manejando una crisis de hipertermia maligna: Guías del Grupo Europeo de Hipertermia Maligna |
Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group K. P. E. Glahn1,F. R. Ellis, P. J. Halsall, C. R. Müller, M. M. J. Snoeck, A. Urwyler and F. Wappler Danish Malignant Hyperthermia Centre, Department of Anaesthesia, University Hospital Herlev, Copenhagen, Denmark. University of Leeds, Leeds, UK. MH Investigation Unit, St James University Hospital, Leeds, UK . Department of Human Genetics, University of Würzburg, Germany. MH Investigation Unit, Nijmegen, The Netherlands. Department of Anaesthesia and Research, University of Basel, Switzerland. Department of Anaesthesiology and Intensive Care Medicine, Hospital Cologne-Merheim, University Witten-Herdecke, Cologne, Germany British Journal of Anaesthesia 105 (4): 417-20 (2010) Abstract Survival from a malignant hyperthermia (MH) crisis is highly dependent on early recognition and prompt action. MH crises are very rare and an increasing use of total i.v. anaesthesia is likely to make it even rarer, leading to the potential risk of reduced awareness of MH. In addition, dantrolene, the cornerstone of successful MH treatment, is unavailable in large areas around the world thereby increasing the risk of MH fatalities in these areas. The European Malignant Hyperthermia Group collected and reviewed all guidelines available from the various MH centres in order to provide a consensus document. The guidelines consist of two textboxes: Box 1 on recognizing MH and Box 2 on the treatment of an MH crisis. Lea este artículo completo en PDF en el siguiente link: |
Tendencias y resultados de la hipertermia maligna en Estados Unidos, 2000 a 2005. |
Trends and outcomes of malignant hyperthermia in the United States, 2000 to 2005. Rosero EB, Adesanya AO, Timaran CH, Joshi GP. Department of Surgery, Division of Vascular Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9157, USA.eric.rosero@utsouthwestern.edu Anesthesiology. 2009 Jan;110(1):89-94 Abstract BACKGROUND: Malignant hyperthermia (MH) is a potentially fatal pharmacogenetic disorder with an estimated mortality of less than 5%. The purpose of this study was to evaluate the current incidence of MH and the predictors associated with in-hospital mortality in the United States. METHODS: The Nationwide Inpatient Sample, which is the largest all-payer inpatient database in the United States, was used to identify patients discharged with a diagnosis of MH during the years 2000-2005. The weighted exact Cochrane-Armitage test and multivariate logistic regression analyses were used to assess trends in the incidence and risk-adjusted mortality from MH, taking into account the complex survey design. RESULTS: From 2000 to 2005, the number of cases of MH increased from 372 to 521 per year. The occurrence of MH increased from 10.2 to 13.3 patients per million hospital discharges (P = 0.001). Mortality rates from MH ranged from 6.5% in 2005 to 16.9% in 2001 (P < 0.0001). The median age of patients with MH was 39 (interquartile range, 23-54 yr). Only 17.8% of the patients were children, who had lower mortality than adults (0.7% vs. 14.1%, P < 0.0001). Logistic regression analyses revealed that risk-adjusted in-hospital mortality was associated with increasing age, female sex, comorbidity burden, source of admission to hospital, and geographic region of the United States. CONCLUSIONS: The incidence of MH in the United States has increased in recent years. The in-hospital mortality from MH remains elevated and higher than previously reported. The results of this study should enable the identification of areas requiring increased focus in MH-related education. |
Consideraciones perioperatorias para la seguridad de los pacientes durante cirugía cosmética- Previniendo complicaciones |
Perioperative considerations for patient safety during cosmetic surgery - preventing complications. Ellsworth WA, Basu CB, Iverson RE. Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas; Can J Plast Surg. 2009 Spring;17(1):9-16. Abstract Maintaining patient safety in the operating room is a major concern of surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential, and pressure to avoid these complications in cosmetic surgery is increasing. Traditionally, nursing and anesthesia staff have managed patient positioning and safety issues in the operating room. As the number of office-based procedures in the plastic surgeon's practice increases, understanding and implementing patient safety guidelines by the plastic surgeon is of increasing importance.A review of the Joint Commission's Universal Protocol highlights requirements set forth to prevent perioperative complications. In the present paper, the importance of implementing these guidelines into the cosmetic surgery practice is reviewed. Key aspects of patient safety in the operating room are outlined, including patient positioning, ocular protection and other issues essential for minimization of postoperative morbidity. Additionally, as the demand for body contouring surgery in the cosmetic practice continues to increase, special attention to safety considerations specific to the obese and massive weight loss patients is mandatory.After review of the present paper, the reader should be able to introduce the Joint Commission's Universal Protocol into their daily practice. The reader will understand key aspects of patient positioning, airway management and ocular protection in cosmetic surgery. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese, massive weight loss patients and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patient's experience and surgical outcome |
Mezcla de clonidina y fentanyl a la ropivacaína en anestesia epidural para cirugía de abdomen inferior |
Admixture of clonidine and fentanyl to ropivacaine in epidural anesthesia for lower abdominal surgery Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa, Jasbir Kaur, Amarjit Singh, Geetika Bakshi, Kanwalpreet Singh, Aparajita Panda Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India Anesth Essays Res 2010:4:9-14. doi:10.4103/0259-1162.69299 Context and Background: Dose sparing action of one adjuvant for another in regional anesthesia. Aims and Objectives: To evaluate and compare the clonidine-ropivacaine combination with fentanyl-ropivacaine in epidural anesthesia and also to find out whether addition of clonidine can reduce the dose of fentanyl in epidural anesthesia. Materials and Methods: 60 patients of ASA grade I and II between the ages of 21 and 55 years, who underwent lower abdominal surgeries, were included randomly into three clinically controlled study groups comprising 20 patients in each. They were administered epidural anesthesia with ropivacaine-clonidine (RC), ropivacaine-fentanyl (RF) or ropivacaine-fentanyl-clonidine (RCF). Per-op and post-op block characteristics as well as hemodynamic parameters were observed and recorded. Statistical data were compiled and analyzed using non-parametric tests and P<0.05 was considered as significant value. Results: The demographic profile of the patients in all the three groups was similar as were the various block characteristics. The reduction of clonidine and fentanyl in the RCF group did not make any significant difference (P>0.05) in the analgesic properties of drug combination and hemodynamic parameters as compared to RC and RF groups. However, there was significant reduction of incidence of side effects in the RCF group (P<0.05) and it resulted in increased patient comfort. Conclusions: The analgesic properties of the clonidine and fentanyl when used as adjuvant to ropivacaine in epidural anesthesia are almost comparable and both can be used in combination at lower dosages without impairing the pharmacodynamic profile of the drugs as well as with a significant reduction in side effects |