Imagen del mes/Imagen of the month

Ver galeria de Imágenes Ependimomas medulares. Parte 1. Ependimonas intramedulares Spinal ependymomas. Part 1: Intramedullary ependymomas. Klekamp J. Neurosurg Focus. 2015 Aug;39(2):E6. doi: 10.3171/2015.5.FOCUS15161. PDF Ependimomas medulares. Parte 2. Ependimomas del filum terminale Spinal ependymomas. Part 2: Ependymomas of the filum terminale Jörg Klekamp, MD Neurosurgical Focus Aug 2015 / Vol. 39 / No. 2, Page E7 PDF Evolución a largo plazo de la resección quirúrgica con y sin radiación en el tratamiento de ependimomas medulares. Estudio retrospectivo multicéntrico del grupo Korea Spinal OncologyResearch Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group. Lee SH, Chung CK, Kim CH, Yoon SH, Hyun SJ, Kim KJ, Kim ES, Eoh W, Kim HJ. Neuro Oncol. 2013 Jul;15(7):921-9. doi: 10.1093/neuonc/not038. Epub 2013 Apr 10. PDF La diferenciación entre ependimoma espinal intramedular y astrocitoma: análisis de resonancia magnética comparativa. Differentiation between intramedullary spinal ependymoma and astrocytoma: comparative MRI analysis. Kim DH, Kim JH, Choi SH, Sohn CH, Yun TJ, Kim CH, Chang KH. Clin Radiol. 2014 Jan;69(1):29-35. doi: 10.1016/j.crad.2013.07.017. Epub 2013 Sep 10. PDF Resección con microcirugía de ependimoma intramedular Microsurgical resection of intramedullary spinal cord ependymoma. McCormick PC. Neurosurg Focus. 2014 Sep;37 Suppl 2:Video 9. doi: 10.3171/2014.V3.FOCUS14276.Abstract PDF VIDEO https://www.youtube.com/watch?v=lcHhymSvSqU&feature=youtu.be Manejo y evolución de tumores intramedulares en adultos. Experiencia de 20 años Management and outcome in adult intramedullary spinal cord tumours: a 20-year single institution experience. Boström A, Kanther NC, Grote A, Boström J1. BMC Res Notes. 2014 Dec 15;7:908. doi: 10.1186/1756-0500-7-908. PDF Ependimoma lumbar se manifiesta con una raquiaanestesia no usual Lumbar ependymoma presenting with an unusual spinal anaesthetic. Dawson J, Malik A. Anaesthesia. 2012 Jun;67(6):676-7. doi: 10.1111/j.1365-2044.2012.07143.x. PDF Ependimoma lumbar se manifiesta con paraplegia después de un intento de anestesia raquídea Lumbar ependymoma presenting with paraplegia following attempted spinal anaesthesia. Jaeger M, Rickels E, Schmidt A, Samii M, Blömer U. Br J Anaesth. 2002 Mar;88(3):438-40. PDF Manifestación atípica de un tumor medular después de anestesia peridural An unusual presentation of spinal cord tumor after epidural anesthesia. Martin HB, Gibbons JJ, Bucholz RD. Anesth Analg. 1992 Nov;75(5):844-6. PDF Pronóstico por la localización de ependimomas espinales en adultos Prognosis by tumor location in adults with spinal ependymomas. Oh MC, Kim JM, Kaur G, Safaee M, Sun MZ, Singh A, Aranda D, Molinaro AM, Parsa AT. J Neurosurg Spine. 2013 Mar;18(3):226-35. doi: 10.3171/2012.12.SPINE12591. Epub 2013 Jan 11. PDF Ependimomas intramedulares medulocervicales. Manejo operatorio, recuperación funcional y evolución a largo plazo Intramedullary medullocervical ependymoma--surgical treatment, functional recovery, and long-term outcome. Li D, Hao SY, Wu Z, Jia GJ, Zhang LW, Zhang JT. Neurol Med Chir (Tokyo). 2013;53(10):663-75. Epub 2013 Sep 27. PDF

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

Lactarios Institucionales y escolares

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 2 Diciembre 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Lactarios Institucionales y escolares” por el“Dr. Heladio Verver y Vargas”, Pediatra, de la Cd. De México DF La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador http://connectpro60196372.adobeconnect.com/lactados/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia
6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.

Henrys


Dr. Enrique Mendoza López Webmaster: CONAPEME Coordinador Nacional: Seminario Ciberpeds-Conapeme Av La clinica 2520-310 Colonia Sertoma ,Mty N.L. México CP 64710 Tel-Fax 52 81 83482940 y 52 81 81146053 Celular 8183094806 www.conapeme.org www.pediatramendoza.com enrique@pediatramendoza.com emendozal@yahoo.com.mx

Oxido nitroso / Nitrous oxide

Noviembre 28, 2015. No. 2159

Efectos analgésicos y fisiológicos en sedación consciente con diferentes concentraciones de óxido nitroso Analgesic and physiological effects in conscious sedation with different nitrous oxide concentrations. Bonafé-Monzó N, Rojo-Moreno J, Catalá-Pizarro M. J Clin Exp Dent. 2015 Feb 1;7(1):e63-8. doi: 10.4317/jced.52034. eCollection 2015. Abstract OBJECTIVES: to study the physiological changes, as well as the psychosedative and analgesic effects of nitrous oxide, in experimental conditions. STUDY DESIGN: 101 dental students volunteers participated in a single nitrous oxide sedation session without dental treatment. Signs and symptoms were registered during and after the procedure. Pulse rate and hemoglobin oxygen saturation were monitored at: 100 per cent O2, 30 per cent N2O, 50 per cent N2O and 5 minutes after 100 per cent O2. A Likert scale was used to evaluate pain perception. The analgesic effects of nitrous oxide were evaluated at: 30 per cent N2O, 50 per cent N2O, and five minutes postoperatively. RESULTS: Pulse rate and hemoglobin oxygen saturation decreased significantly through all the procedure and after recovery. However, oxygen saturation recovered after the final oxygenation. Only 8.2% of subjects reported the pain stimulus as being quite annoying when they inhaled 30 per cent N2O, while this percentage was of 15.8 % when inhaling 50 per cent N2O, and of 32.7 % during the recovery period. The most common effects of nitrous oxide sedation were bright eyes (99%), voice change (98%) and smiling (91%). Most of the subjects reported tingling (98%) and relax (91.1%) CONCLUSIONS: nitrous oxide causes a significant decrease in heart rate and oxygen saturation, but always within safety limits. Maintaining an appropriate level of consciousness was confirmed as a feature in 50 per cent dose in this study. The analgesic effect of nitrous oxide was confirmed but a dose dependency could not be established. Key words:Nitrous oxide, conscious sedation, anxiolysis, safety, physiogical parameters, signs, symptoms, analgesia. PDF Técnicas basadas con óxido nitroso versus técnicas sin óxido nitroso en anestesia general Nitrous oxide-based techniques versus nitrous oxide-free techniques for general anaesthesia. Sun R, Jia WQ, Zhang P, Yang K, Tian JH, Ma B, Liu Y, Jia RH, Luo XF, Kuriyama A. Cochrane Database Syst Rev. 2015 Nov 6;11:CD008984. [Epub ahead of print] Abstract BACKGROUND: Nitrous oxide has been used for over 160 years for the induction and maintenance of general anaesthesia. It has been used as a sole agent but is most often employed as part of a technique using other anaesthetic gases, intravenous agents, or both. Its low tissue solubility (and therefore rapid kinetics), low cost, and low rate of cardiorespiratory complications have made nitrous oxide by far the most commonly used general anaesthetic. The accumulating evidence regarding adverse effects of nitrous oxide administration has led many anaesthetists to question its continued routine use in a variety of operating room settings. Adverse events may result from both the biological actions of nitrous oxide and the fact that to deliver an effective dose, nitrous oxide, which is a relatively weak anaesthetic agent, needs to be given in high concentrations that restrict oxygen delivery (for example, a common mixture is 30% oxygen with 70% nitrous oxide). As well as the risk of low blood oxygen levels, concerns have also been raised regarding the risk of compromising the immune system, impaired cognition, postoperative cardiovascular complications, bowel obstruction from distention, and possible respiratory compromise. OBJECTIVES: To determine if nitrous oxide-based anaesthesia results in similar outcomes to nitrous oxide-free anaesthesia in adults undergoing surgery. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014 Issue 10); MEDLINE (1966 to 17 October 2014); EMBASE (1974 to 17 October 2014); and ISI Web of Science (1974 to 17 October 2014). We also searched the reference lists of relevant articles, conference proceedings, and ongoing trials up to 17 October 2014 on specific websites (http://clinicaltrials.gov/, http://controlled-trials.com/, and http://www.centerwatch.com). SELECTION CRITERIA: We included randomized controlled trials (RCTs) comparing general anaesthesia where nitrous oxide was part of the anaesthetic technique used for the induction or maintenance of general anaesthesia (or both) with any general anaesthesia using a volatile anaesthetic or propofol-based maintenance of anaesthesia but no nitrous oxide for adults undergoing surgery. Our primary outcome was inhospital case fatality rate. Secondary outcomes were complications and length of stay. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted the outcome data. We used meta-analysis for data synthesis. Heterogeneity was examined with the Chi² test and by calculating the I² statistic. We used a fixed-effect model if the measure of inconsistency was low for all comparisons (I² statistic < 50%); otherwise we used a random-effects model for measures with high inconsistency. We undertook subgroup analyses to explore inconsistency and sensitivity analyses to evaluate whether the results were robust. We assessed the quality of evidence of the main outcomes using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. MAIN RESULTS: We included 35 trials (13,872 adult participants). Seven included studies were at low risk of bias. We identified eight studies as awaiting classification since we could not obtain the full texts, and had insufficient information to include or exclude them. We included data from 24 trials for quantitative synthesis. The results of meta-analyses showed that nitrous oxide-based techniques increased the incidence of pulmonary atelectasis (odds ratio (OR) 1.57, 95% confidence interval (CI) 1.18 to 2.10, P = 0.002), but had no effects on the inhospital case fatality rate, the incidence of pneumonia, myocardial infarction, stroke, severe nausea and vomiting, venous thromboembolism, wound infection, or the length of hospital stay. The sensitivity analyses suggested that the results of the meta-analyses were all robust except for the outcomes of pneumonia, and severe nausea and vomiting. Two trials reported length of intensive care unit (ICU) stay but the data were skewed so were not pooled. Both trials reported that nitrous oxide-based techniques had no effects on the length of ICU stay. We rated the quality of evidence for two outcomes (pulmonary atelectasis, myocardial infarction) as high, four outcomes (inhospital case fatality rate, stroke, venous thromboembolism, length of hospital stay) as moderate, and three (pneumonia, severe nausea and vomiting, wound infection rate) as low. AUTHORS' CONCLUSIONS: Given the evidence from this Cochrane review, the avoidance of nitrous oxide may be reasonable in participants with pre-existing poor pulmonary function or at high risk of postoperative nausea and vomiting. Since there are eight studies awaiting classification, selection bias may exist in our systematic review. PDF

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

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