Magnesio, el ion olvidado

Magnesio - Esencial para los anestesiólogos Magnesium - Essentials for Anesthesiologists Herroeder, Susanne, Schönherr, Marianne E, De Hert, Stefan G, Hollmann, Markus W. Section Editor(s): Warner, David S. M.D., Editor Anesthesiology: April 2011 - Volume 114 - Issue 4 - pp 971-993 doi: 10.1097/ALN.0b013e318210483 Magnesium plays a fundamental role in many cellular functions, and thus there is increasing interest in its role in clinical medicine. Although numerous experimental studies indicate positive effects of magnesium in a variety of disease states, large clinical trials often give conflicting results. However, there is clear evidence for magnesium to benefit patients with eclampsia or torsades de pointes arrhythmias. In addition, magnesium seems to have antinociceptive and anesthetic as well as neuroprotective effects, yet well-designed large clinical trials are required to determine its actual efficacy in pain management or in the state of stroke or subarachnoid hemorrhage. The current review aims to provide an overview of current knowledge and available evidence with respect to physiologic aspects of magnesium and proposed indications and recommendations for its use in the clinical setting. http://journals.lww.com/anesthesiology/Fulltext/2011/04000/Magnesium_Essentials_for_Anesthesiologists.37.aspx   Magnesio en Anestesia y Reanimación E. Alday Muñoz, R. Uña Orejón, F. J. Redondo Calvo, A. Criado Jiménez Servicio de Anestesia y Reanimación. Hospital Universitario La Paz. Madrid. Rev. Esp. Anestesiol. Reanim. 2005; 52: 222-234. Resumen El magnesio es un ión implicado en numerosas funciones fisiológicas y en la fisiopatología de muchas enfermedades que afectan al paciente quirúrgico. La incidencia de hipomagnesemia en el ambiente perioperatorio es alta y en ocasiones menospreciada con importantes implicaciones pronósticas. El magnesio es además empleado como fármaco con distintas indicaciones: en reanimación, obstetricia, cardiología, cirugía cardíaca, tratamiento del dolor, anestesia, neumología, etc. El papel del magnesio en el organismo y sus propiedades farmacológicas siguen siendo objeto de estudio y cada vez aparecen nuevas situaciones en las que este ión adquiere un papel relevante. El conocimiento de sus características farmacológicas, clínicas y fisiológicas se ha vuelto imprescindible para el médico anestesiólogo. El objetivo de esta revisión es dar una visión sencilla y completa del papel del magnesio en el organismo, sus alteraciones en el medio perioperatorio y su relevancia como fármaco eficaz en numerosas situaciones clínicas. Palabras clave: Magnesio. Sulfato de magnesio. Anestesia. Reanimación. http://www.sedar.es/restringido/2005/4/222.pdf   Efecto de la clonidina y el sulfato de magnesio sobre el consumo de anestésicos, hemodinamia y recuperación postoperatoria: Un estudio comparativo Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoperative recovery: A comparative study. Ray M, Bhattacharjee DP, Hajra B, Pal R, Chatterjee N. Department of Anaesthesiology, N.R.S. Medical College, Kolkata, India. Indian J Anaesth. 2010 Mar;54(2):137-41. Abstract This randomised, placebo-controlled, double-blind study was designed to assess the effect of intravenous clonidine and magnesium sulphate on intraoperative haemodynamics, anaesthetic consumption and postoperative recovery. Seventy five patients undergoing elective upper limb orthopaedic surgery were randomised into three groups. Group C received clonidine 3 mug/kg as a bolus before induction and 1mug/kg/hour by infusion intraopertively. Group M received magnesium sulphate 30 mg/kg as a bolus before induction and 10 mg/kg/hour by infusion. Group P received same volume of isotonic saline. Anaesthesia was induced and maintained with fentanyl citrate and propofol. Muscular relaxation was achieved by vecuronium bromide. Induction time, recovery time and consumption of propofol as well as fentanyl citrate were recorded. Induction of anaesthesia was rapid with both clonidine and magnesium sulphate. Time of bispectral index (BIS) to reach 60 was significantly lower in Group C and Group M (P < 0.0001). Requirements of propofol and fentanyl were significantly less in Group C and Group M (P < 0.001). Postoperative recovery was slower in Group M compared with other two groups (P < 0.001). Perioperative use of both clonidine and magnesium sulphate significantly reduced the consumption of propofol and fentanyl citrate. Magnesium sulphate caused a delayed recovery.  http://medind.nic.in/iad/t10/i2/iadt10i2p137.pdf Infusión I.V. de sulfato de magnesio durante anestesia espinal mejora la analgesia postoperatoria I.V. infusion of magnesium sulphate during spinal anaesthesia improves postoperative analgesia. Hwang JY, Na HS, Jeon YT, Ro YJ, Kim CS, Do SH. Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea. Br J Anaesth. 2010 Jan;104(1):89-93. Abstract BACKGROUND: In a randomized, double-blind, prospective study, we have evaluated the effect of i.v. infusion of magnesium sulphate during spinal anaesthesia on postoperative analgesia and postoperative analgesic requirements.METHODS: Forty patients undergoing total hip replacement arthroplasty under spinal anaesthesia were included. After the induction of spinal anaesthesia, the magnesium group (Group M) received magnesium sulphate 50 mg kg(-1) for 15 min and then 15 mg kg(-1) h(-1) by continuous i.v. infusion until the end of surgery. The saline group (Group S) received the same volume of isotonic saline over the same period. After surgery, a patient-controlled analgesia (PCA) device containing morphine and ketorolac was provided for the patients. Postoperative pain scores, PCA consumption, and the incidences of shivering, postoperative nausea, and vomiting were evaluated immediately after surgery, and at 30 min, 4, 24, and 48 h after surgery. Serum magnesium concentrations were checked before the induction of anaesthesia, immediately after surgery, and at 1 and 24 h after surgery. RESULTS: Postoperative pain scores were significantly lower in Group M at 4, 24, and 48 h after surgery (P<0.05). Cumulative postoperative PCA consumptions were also significantly lower in Group M at 4, 24, and 48 h after surgery (P<0.05). Postoperative magnesium concentrations were higher in Group M (P<0.05 at 4, 24, and 48 h after surgery), but no side-effects associated with hypermagnesemia were observed. Haemodynamic variables and the incidences of shivering, nausea, and vomiting were similar in the two groups. CONCLUSIONS: I.V. magnesium sulphate administration during spinal anaesthesia improves postoperative analgesia. http://bja.oxfordjournals.org/content/104/1/89.full.pdf

Atentamente Dr. Enrique Hernández-Cortez  Anestesiología y Medicina del Dolor www.anestesia-dolor.org

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Citicolina: revisión farmacológica y clínica, actualización 2010

J.J. Secades

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Meconium aspiration syndrome - the experience of a tertiary center y varios mas

• Meconium aspiration syndrome - the experience of a tertiary center
  Publicado en Rev Port Pneumol.2011; 17 :71-6 - vol.17 núm 02
  http://www.elsevier.es/sites/default/files/elsevier/pdf/320/320v17n02a90002027pdf001.pdf
  
  Resumen
  Background: Approximately 5 % of infants born with a meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS). Aim: The aims of this study were to analyse demographic data, morbidity and mortality associated with MAS and to identify possible risk factors. Methods: Retrospective chart review of newborns with MAS delivered at a tertiary centre from January 1st, 1997 to December 31st, 2008. Results: MAS was responsible for 1.4 % of all Neonatal Intensive Care Unit (NICU) admissions, with a trend towards a decreasing incidence during the study duration, especially in the cases of thin meconium. Seventy two newborns were analysed during the study period: 55.6 % (n = 40) were of the female gender, 62.5 % were delivered by caesarean section, 93 % had > 36 weeks of gestational age and 91.2 % had a birth weight over 2500g. Sixty-nine percent had an Apgar score < 7 at 1 minute and 23.6 % an Apgar score < 7 at 5 minutes; foetal bradicardia was present in 26.4 % of the newborns and tachycardia in 1.4 %. The presence of meconium was associated with severe asphyxia and carried a bad prognosis with an increased risk of developing hypoxia (58.3 %), need of mechanical ventilatory support (43.1 %), respiratory and/or metabolic acidosis (30.6 %), pulmonary hypertension (11.1 %) and hypoxic ischemic encephalopathy (29.2 %). The mortality rate was 2.8 %. Thick meconium was associated with higher morbidity and mortality rates. Conclusion: The number of admissions for MAS has been decreasing mostly because of a lower admission rate due to thin meconium; the number of cases with thick meconium has remained constant throughout the years. An Apgar score < 7 at 1 minute and signs of foetal distress during labour were associated with MAS. The MAS related morbidity remains significant.

  
  
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  Neuropatía inducida por fármacos en un ámbito hospitalario
  M.A. Aibar Arregui, M.P. Martín Fortea, K. Laborda Ezquerra y J. Cuesta Muñoz
  10.1016/j.nrl.2011.01.011
  http://www.elsevier.es/sites/default/files/elsevier/eop/S0213-4853%2811%2900037-5.pdf

  
  
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  Infecciones virales graves en pacientes inmunocompetentes
  Publicado en Med Intensiva. 2011;35:179-85. - vol.35 núm 03
  http://www.elsevier.es/sites/default/files/elsevier/pdf/64/64v35n03a90002301pdf001.pdf
  
  Resumen
  Los virus tienen un papel importante dentro de las infecciones graves en los pacientes adultos, que en algunas ocasiones llegan a necesitar hospitalización e ingreso en unidades de cuidados intensivos, especialmente en casos de síndrome de distrés respiratorio del adulto y encefalitis. Las infecciones por virus influenza y parainfluenza, virus sincitial respiratorio, herpes virus y adenovirus son las que más frecuentemente causan estos cuadros. Se ha realizado una revisión de la literatura pormenorizada y actualizada de epidemiología, patogénesis, manifestaciones clínicas y aproximación terapéutica de las infecciones virales en pacientes inmunocompetentes. Por otro lado, si bien la neumonía asociada a ventilación mecánica tiene como etiología más frecuente las infecciones bacterianas, recientemente el papel de los virus como patógenos en estas infecciones está en debate, por lo que se hace una breve revisión de su papel etiopatogénico en la neumonía asociada a ventilación mecánica.
  Palabras clave Infecciones virales. Inmunocompetente. SDRA. Unidad de Cuidados Intensivos.

  
  
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  Neuroanatomía de las decisiones financieras
  Publicado en Neurologia.2011; 26 :173-81 - vol.26 núm 03
  http://www.elsevier.es/sites/default/files/elsevier/pdf/295/295v26n03a90001691pdf001.pdf
  
  Introducción
  La neuroeconomía es una nueva disciplina que estudia los procesos cerebrales de toma de decisiones, fundamentalmente económicas y que ha adquirido un importante avance en los últimos años con el desarrollo de las modernas técnicas de neuroimagen, como la resonancia magnética cerebral funcional. Este artículo realiza una revisión de la bibliografía sobre los diferentes mecanismos neurológicos implicados en la toma de decisiones financieras, las estructuras cerebrales involucradas y las enfermedades que pueden afectarlos.
  
  Fuentes
  Realizamos una revisión no sistemática de la literatura, tanto en fuentes de información primaria (PubMed) como de información secundaria (Tripdatabase y Cochrane Library). También se utilizó bibliografía cedida por la Asociación Española de Neuroeconomía.
  
  Desarrollo
  Los sistemas de recompensa cerebral y de aversión a la pérdida suponen un equilibrio que hará que optemos por una u otra decisión. En este equilibrio en el que la dopamina desempeña un papel primordial, se han visto involucradas varias estructuras cerebrales como la amígdala, la ínsula, la corteza prefrontal medial, las cortezas cinguladas anterior y posterior, el núcleo accumbens y el área tegmental ventral. Su alteración supone la producción de conductas financieras inapropiadas como tienen lugar en enfermedades tan frecuentes como la depresión, la manía, el alcoholismo, la ludopatía o diversos trastornos del control de impulsos.
  
  Conclusiones
  Los neurólogos deberíamos definir nuestro papel en esta ciencia pluridisciplinar, dada la posición de privilegio de nuestra especialidad para estudiar el funcionamiento cerebral, y al más que posible crecimiento que se espera que la neuroeconomía adquiera en un futuro cercano.
  Palabras clave Neuroeconomía. Núcleo accumbens. Sistema de recompensa cerebral. Área prefrontal medial. Amígdala. Ínsula. Corteza orbitofrontal.

  
  

  Puesta al día de medicina intensiva sobre el enfermo crítico con infección grave: ¿qué hemos aprendido?
  http://www.elsevier.es/sites/default/files/elsevier/pdf/64/64v35n03a90002302pdf001.pdf
  Publicado en Med Intensiva. 2011;35:186-8. - vol.35...Ver más