miércoles, 6 de septiembre de 2017

6º Curso Anual de Hombro ICJR 2017


http://www.mihombroycodo.com.mx/academia/6o-curso-anual-de-hombro-icjr-2017/
Get the latest on shoulder instability management at ICJR's 6th Annual Shoulder Course, November 2-4 in Las Vegas https://t.co/LKGWgI2FdJ pic.twitter.com/O385Zczqh3

Neuroma Interdigital de Morton


Morton’s Neuroma Interdigital Neuroma

Fuente
Este artículo y/o video es publicado originalmente en:
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Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA
Publicado el 31 ago. 2017
Dr. Ebraheim’s animated educational video describing Morton’s Neuroma Interdigital Neuroma.
Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:
https://www.utfoundation.org/foundati…
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LicenciaLicencia de YouTube estándar

Ventilación perioperatoria / Perioperative ventilation

Septiembre 6, 2017. No. 2803



  


Epidemiología, práctica de ventilación y resultado en pacientes con mayor riesgo de complicaciones pulmonares postoperatorias: LAS VEGAS - un estudio observacional en 29 países.
Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries.
Eur J Anaesthesiol. 2017 Aug;34(8):492-507. doi: 10.1097/EJA.0000000000000646.
Abstract
BACKGROUND: Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES: To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs.
 CONCLUSION: The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.
TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, number NCT01601223.
Ventilación intraoperatoria protectora con niveles más altos o más bajos de presión positiva de expiración final en pacientes obesos (PROBESE): protocolo de estudio para un ensayo controlado aleatorio.
Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial.
Trials. 2017 Apr 28;18(1):202. doi: 10.1186/s13063-017-1929-0.
Abstract
BACKGROUND: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. METHODS/DESIGN: The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. DISCUSSION: To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016.
KEYWORDS: Mechanical ventilation; Obesity; Positive end-expiratory pressure; Postoperative pulmonary complication; Recruitment maneuver


XIV Congreso Virtual Mexicano de Anestesiología 2017
Octubre 1-Diciembre 31, 2017
Información / Information
Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros.
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México). 
California Society of Anesthesiologists
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Anestesiología y Medicina del Dolor

52 664 6848905

martes, 5 de septiembre de 2017

Complicaciones respiratorias en cirugía / Respiratory complications of the surgical patient

Septiembre 5, 2017. No. 2802

  


Prevención de complicaciones respiratorias del paciente quirúrgico: plan de acción para la mejora continua del proceso.
Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement.
Curr Opin Anaesthesiol. 2017 Jun;30(3):399-408. doi: 10.1097/ACO.0000000000000465.
Abstract
PURPOSE OF REVIEW:  Postoperative complication (PRCs) increase hospitalization time, 30 day mortality and costs up to $35,000. These outcomes measures have gained prominence as bundled payments have become more common. RECENT FINDINGS: Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders. SUMMARY: Preoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.



XIV Congreso Virtual Mexicano de Anestesiología 2017
Octubre 1-Diciembre 31, 2017
Información / Information
Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros.
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México). 
California Society of Anesthesiologists
Reuniones / Events
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905