Intubación fallida en obstetricia/Failed tracheal intubation in obstetrics

Septiembre 13, 2015. No. 2084

Falla de intubación traqueal durante anestesia obstétrica. Revisión de la literatura Failed tracheal intubation during obstetric general anaesthesia: a literature review. Kinsella SM, Winton AL, Mushambi MC, Ramaswamy K, Swales H, Quinn AC, Popat M. Int J Obstet Anesth. 2015 Jun 30. pii: S0959-289X(15)00091-6. doi: 10.1016/j.ijoa.2015.06.008. [Epub ahead of print] Abstract We reviewed the literature on obstetric failed tracheal intubation from 1970 onwards. The incidence remained unchanged over the period at 2.6 (95% CI 2.0 to 3.2) per 1000 anaesthetics (1 in 390) for obstetric general anaesthesia and 2.3 (95% CI 1.7 to 2.9) per 1000 general anaesthetics (1 in 443) for caesarean section. Maternal mortality from failed intubation was 2.3 (95% CI 0.3 to 8.2) per 100000 general anaesthetics for caesarean section (one death per 90 failed intubations). Maternal deaths occurred from aspiration or hypoxaemia secondary to airway obstruction or oesophageal intubation. There were 3.4 (95% CI 0.7 to 9.9) front-of-neck airway access procedures (surgical airway) per 100000 general anaesthetics for caesarean section (one procedure per 60 failed intubations), usually carried out as a late rescue attempt with poor maternal outcomes. Before the late 1990s, most cases were awakened after failed intubation; since the late 1990s, general anaesthesia has been continued in the majority of cases. When general anaesthesia was continued, a laryngeal mask was usually used but with a trend towards use of a second-generation supraglottic airway device. A prospective study of obstetric general anaesthesia found that transient maternal hypoxaemia occurred in over two-thirds of cases of failed intubation, usually without sequelae. Pulmonary aspiration occurred in 8% but the rate of maternal intensive care unit admission after failed intubation was the same as that after uneventful general anaesthesia. Poor neonatal outcomes were often associated with preoperative fetal compromise, although failed intubation and lowest maternal oxygen saturation were independent predictors of neonatal intensive care unit admission. PDF

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

Hiponatremia/Hyponatremia

Agosto 28, 2015. No. 2068

Diagnóstico y tratamiento de la hiponatremia: Guía AGREEing Diagnosis and management of hyponatraemia: AGREEing the guidelines. Maxwell AP. BMC Med. 2015 Feb 13;13:31. doi: 10.1186/s12916-015-0277-8. Abstract Hyponatraemia is a common electrolyte disorder associated with significant complications and controversies regarding its optimal management. Clinical practice guidelines and consensus statements have attempted to provide clinicians with evidence-based diagnostic and treatment strategies for hyponatraemia. Recently published guidance documents differ in their methods employed to review the quality of available evidence. Nagler et al. used the Appraisal of Guideline for Research and Evaluation (AGREE II) instrument in a systematic review of guidelines and consensus statements for the diagnosis and management of hyponatraemia. Nagler and colleagues highlighted the variability in methodological rigour applied to guideline development and inconsistencies between publications in relation to management of hyponatraemia (including the recommended rate of correction of a low serum sodium concentration). These differences could cause confusion for practising physicians managing patients with hyponatraemia. Please see related article: http://www.biomedcentral.com/1741-7015/12/231. PDF   Diagnóstico y manejo de la hiponatremia. Revisión sistemática de guías clínicas y consensos Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements. Nagler EV, Vanmassenhove J, van der Veer SN, Nistor I, Van Biesen W, Webster AC, Vanholder R. BMC Med. 2014 Dec 11;12:1. doi: 10.1186/s12916-014-0231-1. Abstract BACKGROUND: Hyponatremia is a common electrolyte disorder. Multiple organizations have published guidance documents to assist clinicians in managing hyponatremia. We aimed to explore the scope, content, and consistency of these documents. METHODS: We searched MEDLINE, EMBASE, and websites of guideline organizations and professional societies to September 2014 without language restriction for Clinical Practice Guidelines (defined as any document providing guidance informed by systematic literature review) and Consensus Statements (any other guidance document) developed specifically to guide differential diagnosis or treatment of hyponatremia. Four reviewers appraised guideline quality using the 23-item AGREE II instrument, which rates reporting of the guidance development process across six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Total scores were calculated as standardized averages by domain. RESULTS: We found ten guidance documents; five clinical practice guidelines and five consensus statements. Overall, quality was mixed: two clinical practice guidelines attained an average score of >50% for all of the domains, three rated the evidence in a systematic way and two graded strength of the recommendations. All five consensus statements received AGREE scores below 60% for each of the specific domains.The guidance documents varied widely in scope. All dealt with therapy and seven included recommendations on diagnosis, using serum osmolality to confirm hypotonic hyponatremia, and volume status, urinary sodium concentration, and urinary osmolality for further classification of the hyponatremia. They differed, however, in classification thresholds, what additional tests to consider, and when to initiate diagnostic work-up. Eight guidance documents advocated hypertonic NaCl in severely symptomatic, acute onset (<48 h) hyponatremia. In chronic (>48 h) or asymptomatic cases, recommended treatments were NaCl 0.9%, fluid restriction, and cause-specific therapy for hypovolemic, euvolemic, and hypervolemic hyponatremia, respectively. Eight guidance documents recommended limits for speed of increase of sodium concentration, but these varied between 8 and 12 mmol/L per 24 h. Inconsistencies also existed in the recommended dose of NaCl, its initial infusion speed, and which second line interventions to consider. CONCLUSIONS: Current guidance documents on the assessment and treatment of hyponatremia vary in methodological rigor and recommendations are not always consistent. PDF

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

Ortopedia. Noticias

Ortopedia
Notificaciones diarias ⋅ 8 de septiembre de 2015
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Angulo7
Separan del cargo a personal de Ortopedia de IMSS; serían cesados
Angulo7
El director de Hospital de Traumatología y Ortopedia del IMSS en Puebla, Carlos Francisco Morales Flores, dijo que los nueve empleados de video ...
IMSS exige sanción por video vergonsozo - El Sol de Cuautla
#Video Trabajador del IMSS se baña en ollas donde preparan los alimentos - Criterio Hidalgo
Suspenden a empleados del IMSS que protagonizaron video en olla - Periodico Central
Cobertura total de la noticia

Jornada Requisitos técnicos y sanitarios para la licencia de...
Ortopedia y Geriatría Profesional
La Federación Española de Técnicos Ortopédicos (Fetor) organiza una jornada informativa titulada “Requisitos Técnicos y Sanitarios para la ...

¿Quien escribió los primeros trabajos dedicados a la ortopedia?
detareas.com
Saludos, quisiera saber que personaje fue el que escribió los primeros trabajos relacionados con laortopedia, espero me puedan ayudar gracias.

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Ortopedia Pediátrica y Reemplazos Articulares. Dr Pablo Tejerina Vargas
Adults with uncorrected genu valgum are typically prone to injury and chronic knee problems such as chondromalacia and osteoarthritis. — Bow Legs ...

manual ortopedia del adulto. a. patel
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Libros de Segunda Mano - Ciencias, Manuales y Oficios - Medicina, Farmacia y Salud: Manual ortopedia del adulto. a. patel - f. honnart. toray masson ...

Medicina de rehabilitación. Noticias

Medicina de rehabilitación
Notificaciones diarias ⋅ 8 de septiembre de 2015
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La Voz de Almería
Hombro doloroso postvacacional
La Voz de Almería
Dr. Chiquero y Dr. Pineda, médicos especialistas en Medicina Física y Rehabilitaciónen el Hospital Mediterraneo. La Voz. El verano es una estación ...




NetNoticiasMx (Comunicado de prensa) (blog)
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NetNoticiasMx (Comunicado de prensa) (blog)
Estefanía Portillo, alumna de quinto semestre de Terapia Física y Rehabilitación, fue la encargada de emitir un discurso a los estudiantes, ...



Inauguran Segunda Semana de la Fisioterapia de la Facultad de Medicina de la Uach
La Opcion
Pero sin límites” que organizan alumnos de la carrera de Terapia Física y Rehabilitación de la Facultad deMedicina y Ciencias Biométricas de la ...


WEB

Medicina Física y rehabilitación
Ozonklinikat
Ofrecemos medicina física y rehabilitación que regenera la movilidad motora provocada por diversas lesiones.



Medicina Rehabilitación
Fútbol ADN
La Rehabilitación es el proceso global y continuo de duración limitada y con objetivos definidos encaminados a permitir que una persona con ...

Medicina de rehabilitación. Noticias

Medicina de rehabilitación
Notificaciones diarias ⋅ 12 de septiembre de 2015
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Expreso (Perú)
EsSalud: 700 nuevos médicos especialistas
Expreso (Perú)
... Ginecología, Pediatría, Ortopedía, Traumatología, Radiología, Cardiología, Oncología, Psiquiatría, Neurología y Medicina Física y Rehabilitación, ...
Puno: 715 médicos seguirán su especialización en hospitales de Essalud - Diario Correo
Essalud presentará a 80 médicos que seguirán su especialización en sus hospitales - Andina
PERÚ: 715 médicos seguirán su especialización en hospitales de Essalud - EntornoInteligente
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el periodic
El área de salud Manises y Berklee College se unen en un proyecto de 'musicoterapia' para ...
el periodic
... cualificado entre los que figuran médicos especialistas en medicina interna,rehabilitación o geriatría, neuropsicólogos, fisioterapeutas, enfermeros, ...




La Verdad de Tamaulipas
Tendrá Educación Física Fisioterapeuta de cabecera
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... Médica de la Universidad Autónoma de Nuevo León la Carrera de RehabilitaciónFísica y realizó sus prácticas en Medicina Deportiva de la UANL, ...

Los últimos artículos publicados en Medwave son:

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Proximos cursos a realizarse:

• 23 de septiembre, inicio curso de “Calidad en los procesos asistenciales”. Detalles e inscripciones en http://ecampus.medwave.cl/?page_id=746
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Los últimos artículos publicados en Medwave son:


REPORTE DE CASO

Pileflebitis: reporte de caso y revisión de literatura
Lizeth Flores Anaya, Cinthia León Lozada, William Torres Damas (Perú)

Medwave 2015 Sep;15(8):e6258
http://dx.doi.org/10.5867/medwave.2015.08.6258


ARTÍCULO DE REVISIÓN

Enfermedades y riesgos laborales en trabajadores de servicios de urgencia: revisión de la literatura y acercamiento a Chile
Rosa Jiménez, Juan Ricardo Pavés (Chile)

Medwave 2015 ago;15(7):e6239
http://dx.doi.org/10.5867/medwave.2015.07.6239


ESTUDIOS PRIMARIOS

Herramientas estadísticas en los artículos publicados en una revista de salud pública durante el periodo 2013-2014: estudio bibliométrico transversal
Víctor Arcila Quiceno, Elizabeth García Restrepo, Natalia Gómez Rúa, Gino Montenegro Martínez, Luis Carlos Silva Ayçaguer (Colombia, Cuba)

Medwave 2015 Ago;15(7):e6238
http://dx.doi.org/10.5867/medwave.2015.07.6238


EDITORIAL

Resúmenes Epistemonikos en Medwave: evidencia confiable y amigable que llegó para quedarse
Gabriel Rada, Vivienne C. Bachelet

Medwave 2015 Ago;15(7):e6232
http://dx.doi.org/10.5867/medwave.2015.6232


DE LOS EDITORES
Cuatro estados de ánimo del clínico basado en evidencia: lo que nos dejó el primer suplemento de resúmenes Epistemonikos
Gabriel Rada (Chile)

Medwave 2015 Ago;15(7):6237
http://dx.doi.org/10.5867/medwave.2015.07.6237


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Embarazo patológico/Pathological pregnancy

Septiembre 12, 2015. No. 2083

Embarazo con co-morbilidades: Aspectos anestésicos durante cirugía Pregnancy with co-morbidities: Anesthetic aspects during operative intervention. Bajwa SJ1, Bajwa SK2, Ghuman GS1. Anesth Essays Res. 2013 Sep-Dec;7(3):294-301. doi: 10.4103/0259-1162.123207. Abstract The presence of co-morbidities during pregnancy can pose numerous challenges to the attending anesthesiologists during operative deliveries or during the provision of labor analgesia services. The presence of cardiac diseases, endocrinological disorders, respiratory diseases, renal pathologies, hepatic dysfunction, anemia, neurological and musculoskeletal disorders, connective tissue diseases and many others not only influence the obstetric outcome, but can significantly impact the anesthetic technique. The choice of anesthesia during the pregnancy depends upon the type of surgery, the period of gestation, the site of surgery, general condition of patient and so on. Whatever, the anesthetic technique is chosen the methodology should be based on evidentially supported literature and the clinical judgment of the attending anesthesiologist. The list of co-morbid diseases is unending. However, the present review describes the common co-morbidities encountered during pregnancy and their anesthetic management during operative deliveries. KEYWORDS: Anemia; anesthesia; asthma; cardiac diseases; critically ill; diabetes mellitus; pregnancy PDF Entendiendo y tratando pacientes embarazadas con lupus Understanding and Managing Pregnancy in Patients with Lupus. de Jesus GR, Mendoza-Pinto C, de Jesus NR, Dos Santos FC, Klumb EM, Carrasco MG, Levy RA. Autoimmune Dis. 2015;2015:943490. doi: 10.1155/2015/943490. Epub 2015 Jul 12. Abstract Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that occurs predominantly in women of fertile age. The association of SLE and pregnancy, mainly with active disease and especially with nephritis, has poorer pregnancy outcomes, with increased frequency of preeclampsia, fetal loss, prematurity, growth restriction, and newborns small for gestational age. Therefore, SLE pregnancies are considered high risk condition, should be monitored frequently during pregnancy and delivery should occur in a controlled setting. Pregnancy induces dramatic immune and neuroendocrine changes in the maternal body in order to protect the fetus from immunologic attack and these modifications can be affected by SLE. The risk of flares depends on the level of maternal disease activity in the 6-12 months before conception and is higher in women with repeated flares before conception, in those who discontinue useful medications and in women with active glomerulonephritis at conception. It is a challenge to differentiate lupus nephritis from preeclampsia and, in this context, the angiogenic and antiangiogenic cytokines are promising. Prenatal care of pregnant patients with SLE requires close collaboration between rheumatologist and obstetrician. Planning pregnancy is essential to increase the probability of successful pregnancies. PDF   Encefalitis anti-NMDA receptor en una mujer embarazada Anti-NMDA Receptor Encephalitis in a Pregnant Woman. Kim J, Park SH, Jung YR, Park SW, Jung DS. J Epilepsy Res. 2015 Jun 30;5(1):29-32. doi: 10.14581/jer.15008. eCollection 2015. Abstract Anti N-methyl-D-aspartate (NMDA) receptor encephalitis is one of the most common types of autoimmune synaptic encephalitis. Anti-NMDA receptor encephalitis commonly occurs in young women with ovarian teratoma. It has variable clinical manifestations and treatment responses. Sometimes it is misdiagnosed as a psychiatric disorder or viral encephalitis. To the best of our knowledge, anti-NMDA receptor encephalitis is a rare condition in pregnant women. We report a case of anti-NMDA receptor encephalitis in a pregnant woman who presented with abnormal behavior, epileptic seizure, and hypoventilation. KEYWORDS: NMDA receptor antibodies; Outcome; Ovarian teratoma; Pregnancy PDF  Análisis retrospectivo de la evolución pacientes obstétricas en la UCI de un hospital de tercer nivel de atención A retrospective analysis of obstetric patient's outcome in intensive care unit of a tertiary care center. Gombar S, Ahuja V, Jafra A. J Anaesthesiol Clin Pharmacol. 2014 Oct;30(4):502-7. doi: 10.4103/0970-9185.142843. Abstract BACKGROUND AND AIMS: Admission to an intensive care unit (ICU) is considered as an objective marker of severe maternal morbidity. The aim was to assess the incidence and possible risk factors of obstetric patient admissions in the multidisciplinary ICU of a tertiary care center with emphasis on standardized mortality ratio (SMR).MATERIAL AND METHODS: A retrospective five year ICU record analysis was done for all pregnant women, who were admitted to multidisciplinary ICU of a tertiary care hospital during June 2007-12.RESULTS: During this 5-year period, 21,943 deliveries took place and 164 women required ICU admission. Out of these, the data of 151 patients were analyzed. Maternal mortality rate was 31.1% (47 deaths) for patients admitted to ICU. The simplified acute physiologic score (SAPS) II was 62 (55-68) in nonsurvivor versus 34.00 (28-46) in survivor group (P value < 0.001). The receiver operated characteristic curve was plotted using SAPS II scores and the area under the curve was 0.93 with 95% confidence interval (0.89-0.96). The calculated SMR was 0.97. CONCLUSIONS: Women admitted to ICU with diagnosis of puerperal sepsis and intrauterine death (IUD) with coexisting sepsis had higher mortality as compared to women with hypertensive disease of pregnancy and hemorrhage. The calculated SMR was less than one which is a predictor of good ICU care. KEYWORDS: Developing countries; ICU; IUD; SAPS II; obstetric; obstetric hemorrhage; preeclampsia; pregnancy; puerperal sepsis PDF

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