jueves, 14 de abril de 2016

Anestesia cardiaca / Cardiac anaesthesia

Abril 14, 2016. No. 2296



Lactato, endotelina y saturación venosa central como predictores de mortalidad en pacientes con tetralogía de Fallot
Lactate, endothelin, and central venous oxygen saturation as predictors of mortality in patients with Tetralogy of Fallot.
Ann Card Anaesth. 2016 Apr-Jun;19(2):269-76. doi: 10.4103/0971-9784.179619.
Abstract
BACKGROUND: Lactate and central venous oxygen saturation (ScVO2) are well known biomarkers for adequacy of tissue oxygenation. Endothelin, an inflammatory marker has been associated with patient's nutritional status and degree of cyanosis. The aim of this study was to explore the hypothesis that lactate, ScVO2 and endothelin before induction may be predictive of mortality in pediatric cardiac surgery. METHODS: We conducted a prospective observational study of 150 pediatric (6 months to 12 years) patients who were posted for intracardiac repair for tetralogy of fallot and measured lactate, ScVO2 and endothelin before induction (T1), 20 minutes after protamine administration (T2) and 24 hours after admission to ICU (T3). RESULTS: Preinduction lactate and endothelin levels were found to predict mortality in patients of tetralogy of fallot with an odds ratio of 6.020 (95% CI 2.111-17.168) and 1.292(95% CI 1.091-1.531) respectively. In the ROC curve analysis for lactate at T1, the AUC was 0.713 (95% CI 0.526-0.899 P = 0.019). At the cutoff value of 1.750mmol/lt, the sensitivity and specificity for the prediction of mortality was 63.6% and 65.5%, respectively. For endothelin at T1, the AUC was 0.699 (95% CI 0.516-0.883, P = 0.028) and the cutoff value was ≤2.50 (sensitivity, 63.6%; specificity, 58.3 %). ScVO2 (odds ratio 0.85) at all three time intervals, suggested that improving ScVO2 can lead to 15% reduction in mortality. CONCLUSIONS: Lactate, ScVO2 and endothelin all showed association with mortality with lactate having the maximum prediction. Lactate was found to be an independent, reliable and cost-effective measure of prediction of mortality in patients with tetralogy of fallot.
Cuidado postanestésico especializado mejora el manejo fast-track en cirugía cardiaca. Estsudio prospectivo randomizado
A specialized post anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial.
Crit Care. 2014 Aug 15;18(4):468. doi: 10.1186/s13054-014-0468-2.
Abstract
INTRODUCTION: Fast-track treatment in cardiac surgery has become the global standard of care. We compared the efficacy and safety of a specialised post-anaesthetic care unit (PACU) to a conventional intensive care unit (ICU) in achieving defined fast-track end-points in adult patients after elective cardiac surgery.....
CONCLUSIONS: Treatment in a specialised PACU rather than an ICU, after elective cardiac surgery leads to earlier extubation and quicker discharge to a step down unit, without compromising patient safety.
Tiamina como terapia adjunta en cirugía cardiaca. Estudio randomizado, doble ciego, placebo controlado, de fase II
Thiamine as an adjunctive therapy in cardiac surgery: a randomized, double-blind, placebo-controlled, phase II trial.
Crit Care. 2016 Mar 14;20(1):92. doi: 10.1186/s13054-016-1245-1.
Abstract
BACKGROUND: Thiamine is a vitamin that is essential for adequate aerobic metabolism. The objective of this study was to determine if thiamine administration prior to coronary artery bypass grafting would decrease post-operative lactate levels as a measure of increased aerobic metabolism....
CONCLUSIONS: There were no differences in post-operative lactate levels or clinical outcomes between patients receiving thiamine or placebo. Post-operative oxygen consumption was significantly increased among patients receiving thiamine.
Committee for European Education in Anaesthesiology (CEEA)
Colegio de Anestesiólogos de León AC
MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor.
Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.  
En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016.
Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com

          
Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015

miércoles, 13 de abril de 2016

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Tratamiento exitoso de perforación coronaria grado III tras angioplastia percutánea en un paciente de alto riesgo: reporte de un caso
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Anestesia general y desarrollo erebral infantil / General anesthesia and children's brain development

Abril 13, 2016. No. 2295


 



Isoflorano es más deletereo sobre el desarrollo cerebral que el desflurano. Papel de la vía de señalización Akt/GSK3β
Isoflurane Is More Deleterious to Developing Brain Than Desflurane: The Role of the Akt/GSK3β Signaling Pathway.
Biomed Res Int. 2016;2016:7919640. doi: 10.1155/2016/7919640. Epub 2016 Feb 1.
Abstract
Demand is increasing for safer inhalational anesthetics for use in pediatric anesthesia. In this regard, researchers have debated whether isoflurane is more toxic to the developing brain than desflurane. In the present study, we compared the effects of postnatal exposure to isoflurane with those of desflurane on long-term cognitive performance and investigated the role of the Akt/GSK3β signaling pathway. Postnatal day 6 (P6) mice were exposed to either isoflurane or desflurane, after which the phosphorylation levels of Akt/GSK3β and learning and memory were assessed at P8 or P31. The phosphorylation levels of Akt/GSK3β and learning and memory were examined after intervention with lithium. We found that isoflurane, but not desflurane, impaired spatial learning and memory at P31. Accompanied by behavioral change, only isoflurane decreased p-Akt (ser473) and p-GSK3β (ser9) expressions, which led to GSK3β overactivation. Lithium prevented GSK3β overactivation and alleviated isoflurane-induced cognitive deficits. These results suggest that isoflurane is more likely to induce developmental neurotoxicity than desflurane in context of multiple exposures and that the Akt/GSK3β signaling pathway partly participates in this process. GSK3β inhibition might be an effective way to protect against developmental neurotoxicity.
Efectos de la anestesia sobre el desarrollo cerebral de los infantes
Effects of Anesthesia on Children's Brain Development.
Hernández-Cortez E
J Anesth Crit Care Open Access 2015;(6): 00079. DOI: 10.15406/jaccoa.2015.02.00079
Abstract
Nowadays, the administration of most of the anesthetics is being questioned. The quality of reversibility of these medications is being questioned, especially when administered to children under 3 years old. The administration of isoflurane elevates intracellular calcium levels which are critical for cell damage resulting in apoptosis. The NMDA and GABA receptors are indirectly involved in the effect of immature brains. The immaturity of the central nervous system associated to the administration of anesthetic agents such as inhaled anesthetics, ketamine, midazolam, nitrous oxide, and others, produces important changes in the brain that have an impact in the child's later life. There are two important elements in the neurotoxicity of anesthetics, dosage and time administration. Repeating anesthetics produces more brain changes. These modifications have resulted in serious behavioral and memory changes in experiments in animals. It is suspected that a similar situation may arise in children who manifest learning disabilities in later stages.
Keywords: Apoptosis; Anesthetics; Children
Committee for European Education in Anaesthesiology (CEEA)
Colegio de Anestesiólogos de León AC
MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor.
Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.  
En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016.
Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com 
          
Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015

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