Factores de riesgo en cirugía abdominal / Risk factors in abdominal surgery

Julio 6, 2016. No. 2379

Factores de riesgo de complicaciones pulmonares postoperatorias después de cirugía abdominal Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery Kodra N, Shpata V, Ohri I.. Open Access Maced J Med Sci. 2016 Jun 15;4(2):259-63. doi: 10.3889/oamjms.2016.059. Epub 2016 May 22 Abstract BACKGROUND: Incidence of postoperative pulmonary complications (PPC) in patients undergoing non-cardiothoracic surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system. AIM: The aim of the study was to identify risk factors for PPC in patients undergoing adominal surgical procedures. MATERIALS AND METHODS: A prospective cohort study in abdominal surgical patients, admitted to the emergency and surgical ward of the UHC of Tirana, Albania, was conducted during the period: March 2014-March 2015. We collected data on the occurrence of a symptomatic and clinically significant PPC using clinical, laboratory, and radiology data. We evaluated the relations between PPCs and various pre-operative or intra-operative factors to identify risk factors. RESULTS: A total of 450 postoperative patients admitted to the surgical emergency and surgical ward were studied. The mean age were 59.85 ±13.64 years with 59.3% being male. Incidence of PPC was 27.3% (123 patients) and hospital length of stay was 4.93 ± 4.65 days. Length of stay was substantially prolonged for those patients who developed PPC (7.48 ± 2.89 days versus 3.97± 4.83 days, p < 0.0001. PPC were identified as risk factors for mortality, OR: 21.84; 95% CI: 11.66-40.89; P < 0.0001. The multivariate regression analysis identified as being independently associated with an increased risk of PPC: age ≥ 65 years (OR 11.41; 95% CI: 4.84-26.91, p < 0.0001), duration of operation ≥ 2.5 hours (OR 8.38; 95% CI: 1.52-46.03, p = 0.01, history of previous pulmonary diseases (OR 11.12; 95% CI: 3.28-37.65, P = 0.0001) and ASA > 2 (OR 6.37; 95% CI: 1.54-26.36, P = 0.01). CONCLUSION: We must do some efforts in reducing postoperative pulmonary complications, firstly to identify which patients are at increased risk, and then following more closely high-risk patients because those patients are most likely to benefit. KEYWORDS: abdominal surgery; complications; postoperative; pulmonary; risk factor PDF Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/

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

Dolor oncológico / Cancer pain

Junio 25, 2016. No. 2368 La exactitud de un algoritmo diagnóstico para el diagnóstico de dolor episódico por cáncer en comparación con la evaluación clínica Accuracy of a Diagnostic Algorithm to Diagnose Breakthrough Cancer Pain as Compared With Clinical Assessment Katherine Webber, Andrew N. Davies, Martin R. Cowie Journal of Pain and Symptom Management, Vol. 50, Issue 4, p495-500 PDF Meta-análisis de la eficacia de los analgésicos opioides para el manejo de dolor episódico oncológico A Network Meta-Analysis of the Efficacy of Opioid Analgesics for the Management of Breakthrough Cancer Pain Episodes Giovambattista Zeppetella, Andrew Davies, Indra Eijgelshoven, Jeroen P. Jansen Journal of Pain and Symptom Management, Vol. 47, Issue 4, p772-785.e5 PDF  Dolor episódico. Estudio obesrvacional de 1000 pacientes europeos oncológicos Breakthrough Cancer Pain: An Observational Study of 1000 European Oncology Patients Andrew Davies, Alison Buchanan, Giovambattista Zeppetella, Josep Porta-Sales, Rudolf Likar, Wolfgang Weismayr, Ondrej Slama, Tarja Korhonen, Marilene Filbet, Philippe Poulain, Kyriaki Mystakidou, Alexandros Ardavanis, Tony O'Brien, Pauline Wilkinson, Augusto Caraceni, Furio Zucco, Wouter Zuurmond, Steen Andersen, Anette Damkier, Tove Vejlgaard, Friedemann Nauck, Lukas Radbruch, Karl-Fredrik Sjolund, Mariann Stenberg Journal of Pain and Symptom Management, Vol. 46, Issue 5, p619-628 PDF Evidencias del manejo farmacológico en dolor oncológico neuropático. Efectos benéficos y adversos The Evidence for Pharmacologic Treatment of Neuropathic Cancer Pain: Beneficial and Adverse Effects Joost L.M. Jongen, Mark L. Huijsman, Jairo Jessurun, Kennedy Ogenio, David Schipper, Daan R.C. Verkouteren, Peter W. Moorman, Carin C.D. van der Rijt, Kris C. Vissers Journal of Pain and Symptom Management, Vol. 46, Issue 4, p581-590.e1 PDF Influencia del flujo bajo de la saliva en la absorción de citrato de fentanil sublingual en dolor episódico oncológico The Influence of Low Salivary Flow Rates on the Absorption of a Sublingual Fentanyl Citrate Formulation for Breakthrough Cancer Pain Andrew Davies, Gill Mundin, Joanna Vriens, Kath Webber, Alison Buchanan, Melanie Waghorn Journal of Pain and Symptom Management, Vol. 51, Issue 3, p538-545 PDF Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/  Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Ketamina / Ketamine

Junio 27, 2016. No. 2370

Dosis subanestésicas de ketamina para analgesia perioperatoria Intravenous sub-anesthetic ketamine for perioperative analgesia. Gorlin AW1, Rosenfeld DM1, Ramakrishna H1. J Anaesthesiol Clin Pharmacol. 2016 Apr-Jun;32(2):160-7. doi: 10.4103/0970-9185.182085. Abstract Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less) and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine's metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketaminemay be useful in patients with opioid tolerance and for preventing chronic postsurgical pain. PDF Aplicaciones prácticas de las propiedades neuroregenerativas de ketamina: experiencia en el mundo real Practical application of the neuroregenerative properties of ketamine: real world treatment experience. Henderson TA1. Neural Regen Res. 2016 Feb;11(2):195-200. doi: 10.4103/1673-5374.177708. Abstract While controversial, ketamine has emerged as an effective treatment for refractory depression. Serial infusions have been performed 3 times per week, but our practical experience has challenged this precept concerning infusion frequency. Depression is associated with neuron loss, reduced synapse numbers, and dearborization of dendrites. Ketamine appears to potently induce mechanisms which reverse these neurodegenerative processes. Ketamine not only blocks the glutamate receptor, it activates eukaroyotic elongation factor 2 (eEF2). This, in turn, activates brain-derived neurotrophic factor (BDNF) protein synthesis. This is thought to underlie ketamine's enduring benefits. In addition, ketamine alters glycogen synthase kinase-3 (GSK-3) phosphorylation, probably responsible for its rapid antidepressant effect. Notably, inhibition of the BDNF receptor does not block the immediate benefits of ketamine, but does prevent the enduring effects. Neuro-Luminance Ketamine Infusion Centers have been treating patients with serial ketamine infusions for over three years. Our methods differ from what is often reported, as we perform infusions only once per week and generally do not perform more than five infusions. Data from 100 patients showed that 80% of the patients responded. The baseline Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) score was 17.8 ± 2.8. Responders to ketamineshowed a drop in QIDS-SR score of 10.8 ± 3.5, while non-responders showed a 0.8 ± 1.8 change. Moreover, they often had persistent benefits over several months. Recently, it was proposed that psychotomimetic effects are necessary during a ketamine infusion to yield effective antidepressant benefits. Yet, only one patient in our clinic has experienced hallucinations in three years. Nevertheless, 80% of our patients show clinical improvement. Further studies of clinical methods for ketamine infusion therapy are encouraged. KEYWORDS: Ketamine; brain-derived neurotrophic factor; depression; infusion therapy; safety PDF Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/

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