Óxido nitroso y depresión mayor / N2O and major depression

Noviembre 2, 2015. No. 2133

Combinación de óxido nitroso con isoflorano o escopolamina para depresión mayor resistente Combination of Nitrous Oxide with Isoflurane or Scopolamine for Treatment-resistant Major Depression. Yang C1, Hashimoto K. Clin Psychopharmacol Neurosci. 2015 Apr 30;13(1):118-20. doi: 10.9758/cpn.2015.13.1.118. PDF El óxido nitroso para tratamiento de la depresión mayor resistente: Un ensayo de prueba de concepto. Nitrous Oxide for Treatment-Resistant Major Depression: A Proof-of-Concept Trial. Nagele P, Duma A, Kopec M, Gebara MA, Parsoei A, Walker M, Janski A, Panagopoulos VN, Cristancho P, Miller JP, Zorumski CF, Conway CR. Biol Psychiatry. 2015 Jul 1;78(1):10-8. doi: 10.1016/j.biopsych.2014.11.016. Epub 2014 Dec 9. Abstract BACKGROUND: N-methyl-D-aspartate receptor antagonists, such as ketamine, have rapid antidepressant effects in patients with treatment-resistantdepression (TRD). We hypothesized that nitrous oxide, an inhalational general anesthetic and N-methyl-D-aspartate receptor antagonist, may also be a rapidly acting treatment for TRD. METHODS: In this blinded, placebo-controlled crossover trial, 20 patients with TRD were randomly assigned to 1-hour inhalation of 50% nitrous oxide/50% oxygen or 50% nitrogen/50% oxygen (placebo control). The primary endpoint was the change on the 21-item Hamilton Depression Rating Scale (HDRS-21) 24 hours after treatment. RESULTS: Mean duration of nitrous oxide treatment was 55.6 ± 2.5 (SD) min at a median inspiratory concentration of 44% (interquartile range, 37%-45%). In two patients, nitrous oxide treatment was briefly interrupted, and the treatment was discontinued in three patients. Depressivesymptoms improved significantly at 2 hours and 24 hours after receiving nitrous oxide compared with placebo (mean HDRS-21 difference at 2 hours, -4.8 points, 95% confidence interval [CI], -1.8 to -7.8 points, p = .002; at 24 hours, -5.5 points, 95% CI, -2.5 to -8.5 points, p < .001; comparison between nitrous oxide and placebo, p < .001). Four patients (20%) had treatment response (reduction ≥50% on HDRS-21) and three patients (15%) had a full remission (HDRS-21 ≤ 7 points) after nitrous oxide compared with one patient (5%) and none after placebo (odds ratio for response, 4.0, 95% CI, .45-35.79; OR for remission, 3.0, 95% CI, .31-28.8). No serious adverse events occurred; all adverse events were brief and of mild to moderate severity. CONCLUSIONS: This proof-of-concept trial demonstrated that nitrous oxide has rapid and marked antidepressant effects in patients with TRD. KEYWORDS: Major depression; Nitrous oxide; Treatment-resistant depression PDF

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Transplante de hígado/Liver transplant

Octubre 30, 2015. No. 2130Octubre, mes de lucha contra cáncer de mama.

Transplante hepático para enfermedades hepáticas por alcoholismo. Lecciones aprendidas y temas no resueltos Liver transplantation for alcoholic liver disease: Lessons learned and unresolved issues. Ursic-Bedoya J, Faure S, Donnadieu-Rigole H, Pageaux GP. World J Gastroenterol. 2015 Oct 21;21(39):10994-1002. doi: 10.3748/wjg.v21.i39.10994. Abstract The use of liver transplantation (LT) as a treatment for alcoholic liver disease (ALD) has been highly controversial since the beginning. The ever increasing shortage of organs has accentuated the low priority given to patients suffering from ALD, which is considered a "self-inflicted" condition. However, by improving the long-term survival rates, making them similar to those from other indications, and recognizing that alcoholism is a primary disease, ALD has become one of the most common indications for LT in Europe and North America, a situation thought unfathomable thirty years ago. Unfortunately, there are still many issues with the use of this procedure for ALD. There are significant relapse rates, and the consequences of excessive drinking after LT range from asymptomatic biochemical and histological abnormalities to graft failure and death. A minimum three-month period of sobriety is required for an improvement in liver function, thus making LT unnecessary, and to demonstrate the patient's commitment to the project, even though a longer abstinence period does not guarantee lower relapse rates after LT. Recent data have shown that LT is also effective for severe alcoholic hepatitis when the patient is unresponsive to corticosteroids therapy, with low relapse rates in highly selected patients, although these results must be confirmed before LT becomes a standard procedure in this setting. Finally, LT for ALD is accompanied by an increased risk of de novo solid organ cancer, skin cancer, and lymphoproliferative disorders, which has a large impact on the survival rates. KEYWORDS: Alcoholic hepatitis; Alcoholic liver disease; Cirrhosis; Liver transplantation; Relapse; Six-month rule; Sobriety; Solid organ cancer; Survival rates  PDF

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

Trauma

Octubre 25, 2015. No. 2125Octubre, mes de lucha contra cáncer de mama.

Operabilidad en trauma Operability in polytrauma. Amaefule KE, Lawal DI. Arch Int Surg 2015;5:131-6 PDF   Neumonía asociada a trauma: tiempo para redefinir la neumonía asociada a la ventilación en pacientes con traumatismos. Trauma-associated pneumonia: time to redefine ventilator-associated pneumonia in trauma patients. Mangram AJ, Sohn J, Zhou N, Hollingworth AK, Ali-Osman FR, Sucher JF, Moyer M, Dzandu JK. Am J Surg. 2015 Sep 18. pii: S0002-9610(15)00480-8. doi: 10.1016/j.amjsurg.2015.06.029. [Epub ahead of print] PDF Trauma de tórax. Una revisión Chest trauma: an overview. Whizar-Lugo V, Sauceda-Gastelum A, Hernández-Armas A, Garzón-Garnica F, Granados-Gómez M. J Anesth Crit Care Open Access 2015;3(1):00082. PDF Derivación y validación de dos instrumentos de decisión para TAC torácica selectiva en trauma contuso: Un estudio multicéntrico observacional prospectivo (NEXUS TAC de tórax). Derivation and Validation of Two Decision Instruments for Selective Chest CT in Blunt Trauma: A Multicenter Prospective Observational Study (NEXUS Chest CT). Rodriguez RM, Langdorf MI, Nishijima D, Baumann BM, Hendey GW, Medak AJ, Raja AS, Allen IE,Mower WR. PLoS Med. 2015 Oct 6;12(10):e1001883. doi: 10.1371/journal.pmed.1001883. eCollection 2015. PDF  Factores de riesgo que afectan el pronóstico de pacientes con contusión pulmonar después de trauma de tórax. Risk Factors Affecting the Prognosis in Patients with Pulmonary Contusion Following Chest Trauma. J Clin Diagn Res. 2015 Aug;9(8):OC17-9. doi: 10.7860/JCDR/2015/13285.6375. Epub 2015 Aug 1Abstract PDF Precisión diagnóstica de la ecografía en la detección de traumatismo abdominal cerrado y la comparación de la ecografía temprana y tardía de 24 horas después del trauma. Diagnostic accuracy of ultrasonography in detection of blunt abdominal trauma and comparison of early and late ultrasonography 24 hours after trauma. Feyzi A, Rad MP, Ahanchi N, Firoozabadi J. Pak J Med Sci. 2015 Jul-Aug;31(4):980-3. doi: 10.12669/pjms.314.6614. PDF

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