lunes, 12 de marzo de 2018

Sedación en niños / Pediatirc sedation

Marzo 10, 2018. No. 3018

Protocolo de sedación durante la inyección intravítrea de bevacizumab en recién nacidos prematuros con retinopatía de la prematuridad.

Sedation Protocol During Bevacizumab Intravitreal Injection in Preterm Infants With Retinopathy of Prematurity.

Miller JL, Johnson PN, Harkey K, Siatkowski RM.

J Pediatr Pharmacol Ther. 2018 Jan-Feb;23(1):34-40. doi: 10.5863/1551-6776-23.1.3

4Abstract

OBJECTIVES: This study describes outcomes of intravenous (IV) analgesics and sedatives for bedside intravitreal bevacizumab injections for retinopathy of prematurity. METHODS: This retrospective study included infants receiving intravitreal bevacizumab injections between January 2012 and May 2016. Infants were excluded if bevacizumab was administered under general anesthesia or for incomplete records. Data collection included demographics, sedation and analgesia regimen, and cardiopulmonary adverse events (AEs). The primary objective was to identify the median doses of the IV analgesics and sedatives. The secondary objectives included the number of patients with cardiopulmonary AEs and those with procedure success, defined as procedure completion without interruption and absence of interventions. RESULTS: Fifteen infants were included. Fourteen (93.3%) were initiated on a fentanyl infusion at a median of 2 mcg/kg/hr (IQR, 2-3.6), and 12 (80%) received midazolam infusions at a median of 0.06 mg/kg/hr. All patients received at least 1 IV neuromuscular blocker dose just prior to the procedure. Only 2 patients (13.3%) required an increase in their fentanyl or midazolam infusions. Procedure success was achieved in 13 patients (86.7%). Five patients (33.3%) experienced 1 cardiopulmonary AE. One patient (6.7%) had a delay in the procedure, and 1 patient (6.7%) required naloxone. Despite this, the procedure was completed in all patients. CONCLUSIONS: Most received fentanyl and midazolam infusions with a dose of vecuronium just prior to the procedure. Thirteen (86.7%) met the criteria for procedure success. One-third experienced a cardiopulmonary AE. Future studies are needed to identify the optimal agents and route of administration for this procedure.

KEYWORDS: bevacizumab; fentanyl; midazolam; neonatal intensive care unit; retinopathy of prematurity

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Resultados del tratamiento del uso de sedación por inhalación para la atención dental integral.

Treatment outcomes of using inhalation sedation for comprehensive dental care.

Madouh M1, BaniHani A2, Tahmassebi JF2.

Author information

Eur Arch Paediatr Dent. 2018 Feb;19(1):33-37. doi: 10.1007/s40368-017-0318-4. Epub 2018 Jan 11.

Abstract

AIM: To assess the outcomes of dental treatment under inhalation sedation within a UK specialist hospital setting. METHODS: This was a retrospective cohort study of the case notes of patients under 17 years of age who received dental treatment using inhalation sedation at a UK specialist setting during the period 2006-2011. Treatment outcomes were categorised into five groups: (1) treatment completed as planned, (2) modified treatment completed, (3) treatment abandoned in sedation unit and patient referred for treatment under general analgesia (GA), (4) treatment abandoned in sedation unit and patient referred for treatment under local analgesia(LA), (5) child failed to return to complete treatment. RESULTS: In total, the case notes of 453 patients were evaluated. The mean age of the patients was 10.3 ± 2.9 years. Treatment was completed successfully in 63.6% of the cases, 15.9% were referred for treatment under GA, 11.2% failed to return to complete the treatment, 7.1% received modified treatment completed, and only 2.2% were referred for treatment under LA. Treatment outcomes were significantly associated with patient`s age (p = 0.002). The treatment outcome "treatment abandoned and child referred to be treated under GA" had significantly lower mean patient ages than the other outcomes. CONCLUSIONS: The majority of children referred for inhalation sedation, completed their course of treatment. A significantly higher proportion of those in the younger age group required GA to complete their treatment.

KEYWORDS: Children; General analgesia; Inhalation sedation; Treatment outcomes

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Remifentanil para sedación y analgesia durante la división despierta de colgajo de lengua en niños: un informe de dos casos.

Remifentanil for sedation and analgesia during awake division of tongue flap in children: a report of two cases.

Kuroiwa KK1, Nishizawa M1, Kondo N1, Nakazawa H1, Hirabayashi T1.

Author information

JA Clin Rep. 2017;3(1):43. doi: 10.1186/s40981-017-0114-5. Epub 2017 Aug 23.

Abstract

BACKGROUND: The tongue flap is an accepted treatment method for cleft palate repair. Orotracheal or nasotracheal intubation using a fiberoptic scope is preferred for the division of the tongue flap. We report two cases of tongue flap division in which the patients received adequate sedation and analgesia without tracheal intubation. CASE PRESENTATION: Twelve- and 13-year-old male patients were treated at our hospital for tongue flap division, performed as part of a cleft palate repair. We planned to divide the tongue flap under sedation with remifentanil (1 μg/kg/min continuous infusion) and local anesthesia, followed by induction of general anesthesia, and orotracheal intubation after the tongue flap was divided. During the procedure, patients were breathing spontaneously and were cooperative. Patients were able to follow the surgeons' verbal cues to thrust out the tongue during the procedure, so that the surgeons could easily insert the sutures. CONCLUSIONS: During the division of the tongue flap in two children, excellent sedative and analgesic effects were achieved using continuous remifentanil infusion.

KEYWORDS: Cleft palate; Remifentanil; Tongue flap

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Curso Regional de Anestesiología en Obstetricia y Pediatría

Colegio de Anestesiólogos de León AC y FMCA, AC

Mayo 17-19, 2018. León Guanajuato, México

Informes con el Dr. Enrique Hernández Cortez kikinhedz@gmail.com

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

Informes / Information

LIbro sobre trombocitopenia / Book on thrombocytopenia

Marzo 12, 2018. No. 3020

Trombocitopenia

Thrombocytopenia

Edited by Pankaj Abrol, ISBN 978-953-51-3876-1, Print ISBN 978-953-51-3875-4, 104 pages, Publisher: InTech, Chapters published March 07, 2018 under CC BY 3.0 license
DOI: 10.5772/intechopen.69080
Edited Volume
The book "Thrombocytopenia" certainly raises some important issues in its pathogenesis and management. The authors have done a lot of hard work to write state-of-the-art chapters. Each and every chapter is peer-reviewed, evidence-based, and remarkably excellent. Some of the causes of thrombocytopenia are well explained in textbooks, but the topics included in this book are not usually so well described. The chapters are written in such a manner so as to stimulate and keep the reader well-informed. Such an approach is certainly beneficial when aiming to motivate discussion, interaction, innovation, and research. Chapters like "Interferon-Induced Thrombotic Microangiopathy" have been included with the aim to help in understanding the immune pathogenesis of thrombocytopenia. Others have also been selected to keep an eye on the future.

Libro / Book / Buchen

La fisiopatología de las plaquetas sanguíneas y la sepsis: ¿una nueva perspectiva terapéutica en pacientes críticos?

Blood platelets and sepsis pathophysiology: A new therapeutic prospect in critical ill patients?

Dewitte A1,2, Lepreux S3,4, Villeneuve J5, Rigothier C3,6, Combe C3,6, Ouattara A7,8, Ripoche J3.

Author information

Erratum in

Correction to: Blood platelets and sepsis pathophysiology: A new therapeutic prospect in critically ill patients? [Ann Intensive Care. 2018]

Ann Intensive Care. 2017 Dec 1;7(1):115. doi: 10.1186/s13613-017-0337-7.

Abstract

Beyond haemostasis, platelets have emerged as versatile effectors of the immune response. The contribution of platelets in inflammation, tissue integrity and defence against infections has considerably widened the spectrum of their role in health and disease. Here, we propose a narrative review that first describes these new platelet attributes. We then examine their relevance to microcirculatory alterations in multi-organ dysfunction, a major sepsis complication. Rapid progresses that are made on the knowledge of novel platelet functions should improve the understanding of thrombocytopenia, a common condition and a predictor of adverse outcome in sepsis, and may provide potential avenues for management and therapy.

KEYWORDS: Inflammation; Intensive care; Platelets; Sepsis

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Curso Regional de Anestesiología en Obstetricia y Pediatría

Colegio de Anestesiólogos de León AC y FMCA, AC

Mayo 17-19, 2018. León Guanajuato, México

Informes con el Dr. Enrique Hernández Cortez kikinhedz@gmail.com

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

Informes / Information

Anestesiología y Medicina del Dolor

52 664 6848905

vwhizar@anestesia-dolor.org

anestesia-dolor.org

viernes, 9 de marzo de 2018

¿Por qué una persona debe obtener una prótesis reversa en lugar de un reemplazo estándar del hombro?

www.lesionesdeportivas.com.mx/academia/por-que-una-persona-debe-obtener-una-protesis-reversa-en-lugar-de-un-reemplazo-estandar-del-hombro/

Why should a person get a reverse prosthesis instead of a standard shoulder replacement? https://t.co/RcYeFGzfNt #MedEd #FOAMed #surgery #orthoAZ pic.twitter.com/QhhgePMzfE
— SheldenMartinMD (@SheldenMartinMD) 9 de marzo de 2018

Fuente

Este artículo es publicado originalmente en:

https://www.hopkinsmedicine.org/orthopaedic-surgery/specialty-areas/shoulder/treatments-procedures/reverse-prosthesis.html#why-get

© The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. All rights reserved.

jueves, 8 de marzo de 2018

LA BUENA SALUD DEL HOMBRO

http://www.lesionesdeportivas.com.mx/academia/la-buena-salud-del-hombro/

Dr. Michell Ruiz – Traumatólogo Alta especialidad en Hombro, Codo y Rodilla

🔵 LA BUENA SALUD DEL HOMBRO

Aprender cómo cuidar el hombro para evitar ejercer tensión adicional es indispensable si se tienen molestias en la zona causadas por alguna lesión o mala posición …. e incluso para evitarlas.

Algunas sugerencias para cuidar bien del hombro incluyen:

✔️ Al dormir, acostarse boca arriba o cambiar alternativamente de lado de hombro cada noche.

✔️ Al sentarse, hay que adoptar una buena postura. Mantener la cabeza por encima del hombro y colocar una toalla o almohada por detrás de la región lumbar si se tiene molestias. Mantener los pies ya sea horizontales en el suelo o subidos en un banco para pies.

✔️ Procurar tener una buena postura para mantener los tendones y músculos del manguito de los rotadores en su posición adecuada.

❌ NO cargar un morral o bolso sólo sobre un hombro.

❌ NO trabajar con los brazos por encima del nivel del hombro por mucho tiempo. De ser necesario, utilizar un banco para pies o una escalera.

✔️ Levantar y cargar los objetos cerca del cuerpo. Tratar de no alzar cargas pesadas lejos del cuerpo o por encima de la cabeza.

✔️ Tomar descansos regulares para cualquier actividad que se esté haciendo de manera repetitiva.

✔️ Al alcanzar algo con el brazo, el dedo pulgar debe estar apuntando hacia arriba.

✔️ Guardar los artículos cotidianos que se usen, en lugares que se puedan alcanzar fácilmente.