lunes, 14 de agosto de 2017

Reducción de Artefactos Metálicos para Implantes Ortopédicos (O-MAR): Utilidad en la Evaluación de TC de Artroplastia Total de Hombro Reversa

http://www.lesionesdeportivas.com.mx/academia/reduccion-de-artefactos-metalicos-para-implantes-ortopedicos-o-mar-utilidad-en-la-evaluacion-de-tc-de-artroplastia-total-de-hombro-reversa/

Metal Artifact Reduction for Orthopedic Implants (O-MAR): Usefulness in CT Evaluation of Reverse Total Shoulder Arthroplasty

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28796543

http://www.ajronline.org/doi/10.2214/AJR.16.17684

De:

Shim E1,2,Kang Y1,Ahn JM1,Lee E1,Lee JW1,Oh JH3,Kang HS1.

AJR Am J Roentgenol.

2017 Aug 10:1-7. doi: 10.2214/AJR.16.17684. [Epub ahead of print]

Abstract

OBJECTIVE:

The objective of this study is to evaluate the effect of the metal artifact reduction algorithm for orthopedic implants (O-MAR) on CT image quality for patients with reverse total shoulder arthroplasty (RTSA), with emphasis placed on the evaluation of bone in the vicinity of prostheses.

CONCLUSION:

The use of O-MAR improved CT image quality for patients with RTSA in the aspect of metal artifact reduction and soft-tissue profile. However, O-MAR tends to degrade depiction of the bone trabeculae and bone cortex and generate new artifacts, including a pseudocemented appearance and scapular pseudonotching.

KEYWORDS:

CT; arthroplasty; metal artifact; prosthesis; shoulder

Resumen

OBJETIVO:
El objetivo de este estudio es evaluar el efecto del algoritmo de reducción de artefactos metálicos para implantes ortopédicos (O-MAR) en la calidad de la imagen de TC para pacientes con artroplastia total reversa de hombro (RTSA), con énfasis en la evaluación del hueso en la vecindad de la prótesis.

CONCLUSIÓN:
El uso de O-MAR mejoró la calidad de imagen de CT para pacientes con RTSA en el aspecto de la reducción de artefacto metálico y el perfil de tejido blando. Sin embargo, O-MAR tiende a degradar la representación de las trabéculas óseas y corteza ósea y generar nuevos artefactos, incluyendo una apariencia pseudo cementado y pseudo esmerilado escapular.

PALABRAS CLAVE:
CT; Artroplastia; Artefacto de metal; prótesis; hombro

PMID: 28796543 DOI:

10.2214/AJR.16.17684

#tomografia #Artroplastia reversa de hombro #artefacto metálico #prótesis #hombro

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Bloqueos de nervios periféricos en dolor postoperatorio / Peripheral nerve blocks for postoperative pain

Agosto 12, 2017. No. 2778

Bloqueos de nervios periféricos en dolor postoperatorio. Retos y oportunidades

Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities.

Joshi G1, Gandhi K2, Shah N3, Gadsden J4, Corman SL5.

J Clin Anesth. 2016 Dec;35:524-529. doi: 10.1016/j.jclinane.2016.08.041. Epub 2016 Oct 20.Abstract

Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures. cPNB has also been associated with a reduction in time to discharge readiness compared with sPNB. Risks of PNB, regardless of technique or block location, include vascular puncture and bleeding, nerve damage, and local anesthetic systemic toxicity. Site-specific complications include quadriceps weakness in patients receiving femoral nerve block, and pleural puncture or neuraxial blockade in patients receiving interscalene block. The major limitation of sPNB is the short (12-24 hours) duration of action. cPNB may be complicated by catheter obstruction, migration, and leakage of local anesthetic as well as accidental removal of catheters. Potential infectious complications of catheters, although rare, include local inflammation and infection. Other considerations for ambulatory cPNB include appropriate patient selection, education, and need for 24/7 availability of a health care provider to address any complications. The ideal PNB technique would have a duration of action that is sufficiently long to address the most intense period of postsurgical pain; should be associated with minimal risk of infection, neurologic complications, bleeding, and local anesthetic systemic toxicity; and should be easy to perform, convenient for patients, and easy to manage in the postoperative period.

KEYWORDS: Multimodal analgesia; Peripheral nerve block; Postoperative pain

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XIV Congreso Virtual Mexicano de Anestesiología 2017

Octubre 1-Diciembre 31, 2017

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