martes, 25 de enero de 2011

Riesgo de hipoxemia postoperatoria en cirugía ortopédica ambulatoria en pacientes con apnea obstructiva del sueño: estudio observacional retrospectivo

Riesgo de hipoxemia postoperatoria en cirugía ortopédica ambulatoria en pacientes con apnea obstructiva del sueño: estudio observacional retrospectivo

Risk of postoperative hypoxemia in ambulatory orthopedic surgery patients with diagnosis of obstructive sleep apnea: a retrospective observational study.
Liu SS, Chisholm MF, John RS, Ngeow J, Ma Y, Memtsoudis SG.
Department of *Anesthesiology, Hospital for Special Surgery, Weill College of Medicine of Cornell University, 535 East 70th Street, New York, NY 10021, USA. liusp@hss.edu.
Patient Saf Surg. 2010 Jun 21;4(1):9.

Abstract
BACKGROUND: It is unclear when it is safe to discharge patients with a diagnosis of Obstructive Sleep Apnea (OSA) after ambulatory surgical procedures due to concern for postoperative respiratory compromise and hypoxemia. Our OSA patients undergoing ambulatory-type orthopedic procedures are monitored overnight in the PACU, thus we reviewed patient records to determine incidence of complications. METHODS: Two hundred and six charts of patients with preoperative diagnosis of OSA based on ICD-9 codes were reviewed for outcomes including episodes of hypoxemia. Univariate analysis followed by logistic regression and propensity analysis was performed to determine independent risk factors for hypoxemia and association with adverse outcomes. RESULTS: The majority of patients had regional anesthesia (95%). Thirty four percent of patients had hypoxemia in the PACU. Initial risk factors for hypoxemia identified by univariate analysis were BMI >/= 35, increased age, history of COPD, upper extremity procedure, and use of peripheral nerve block. Independent risk factors identified by logistic regression were history of COPD (OR 3.64 with 95% CI 1.03-12.88) and upper extremity procedure (2.53, 1.36-4.68). After adjustment with propensity scores, adverse events were rare, and unplanned hospital admission after PACU stay was not increased with hypoxemia (11% vs 16%). CONCLUSIONS: Episodes of postoperative hypoxemia in OSA patients undergoing ambulatory surgery with regional anesthesia are not associated with increased adverse outcomes or unplanned hospital admission.

Artículo en PDF

Atentamente
Anestesiología y Medicina del Dolor

www.anestesia-dolor.org

La influencia de los niveles de hierro y los polimorfismos genéticos en el gen HFE en el riesgo de complicaciones postoperatorias después de la cirugía bariátrica: un estudio de cohorte prospectivo en 1.064 pacientes

La influencia de los niveles de hierro y los polimorfismos genéticos en el gen HFE en el riesgo de complicaciones postoperatorias después de la cirugía bariátrica: un estudio de cohorte prospectivo en 1.064 pacientes

The influence of iron status and genetic polymorphisms in the HFE gene on the risk for postoperative complications after bariatric surgery: a prospective cohort study in 1,064 patients

Glenn S Gerhard, Ravi Chokshi, Christopher D Still, Peter Benotti, G C Wood, Mollie Freedman-Weiss, Cody Rider and Anthony T Petrick.

Patient Safety in Surgery 2011, 5:1doi:10.1186/1754-9493-5-1

Abstract (provisional)

Background

Gastric bypass surgery is a highly effective therapy for long-term weight loss in severely obese patients, but carries significant perioperative risks including infection, wound dehiscence, and leaks from staple breakdown. Iron status can affect immune function and wound healing, thus may influence peri-operative complications. Common mutations in the HFE gene,the gene responsible for the iron overload disorder hereditary hemochromatosis, may impact iron status. Methods. We analyzed 1064 extremely obese Caucasian individuals who underwent open and laparoscopic Roux-en-Y gastric bypass surgery at the Geisinger Clinic. Serum iron, ferritin, transferrin, and iron binding capacity were measured pre-operatively. All patients had intra-operative liver biopsies and were genotyped for the C282Y and H63D mutations in the HFE gene. Associations between surgical complications and serum iron measures, HFE gene status, and liver iron histology were determined. Results. We found that increased serum iron and transferrin saturation were present in patients with any post-operative complication, and that increased serum ferritin was also increased in patients with major complications. Increased serum transferrin saturation was also associated with wound complications in open RYGB, and transferrin saturation and ferritin with prolonged lengths of stay. The presence of 2 or more HFE mutations was associated with overall complications as well as wound complications in open RYGB. No differences were found in complication rates between those with stainable liver iron and those without. Conclusion. Serum iron status and HFE genotype may be associated with complications following RYGB surgery in the extremely obese

Artículo en PDF

Paradoja de la obesidad y recuperación funcional en sobrevivientes a un primer infarto cerebral: estudio PREMIER

E. Chiquete, C. Cantú-Brito, J. Villarreal-Careaga, L.M. Murillo-Bonilla, R. Rangel-Guerra, C. León-Jiménez, A. Ochoa-Guzmán, A. Ramos-Moreno, A. Arauz, F. Barinagarrementería, A. Panduro, J.L. Ruiz-Sandoval
REV NEUROL 2010;51:705-713

Introducción. Se denomina 'paradoja de la obesidad' al descenso del riesgo de muerte por enfermedad cardiovascular, con un índice de masa corporal (IMC) alto, aun cuando éste es un factor de riesgo para vasculopatía. Nuestro objetivo fue analizar la influencia de la obesidad en la recuperación funcional que sigue a un ictus isquémico. Pacientes y métodos. Analizamos 510 pacientes con un primer infarto cerebral, sin historia de ictus y sin recurrencia o muerte en 12 meses de seguimiento. A 501 sujetos sanos se les evaluó mediante bioimpedancia tetrapolar, para comparar el índice cintura/talla (ICT), perímetro abdominal e IMC en la discriminación de adiposidad, para aplicarlos a pacientes con ictus. Resultados. En individuos sanos, el ICT se desempeñó notablemente mejor que el IMC o el perímetro abdominal para identificar adiposidad corporal. En un modelo de riesgos proporcionales de Cox ajustado por múltiples covariables, la edad (riesgo relativo, RR = 1,11; intervalo de confianza del 95%, IC 95% = 1,08-1,14), puntuación de la National Institutes of Health Stroke Scale (RR = 1,03; IC 95% = 1,01-1,05) e ICT > 70 (RR = 2,44; IC 95% = 1,33-4,48) se asociaron a mayor riesgo de alcanzar una puntuación mayor o igual a 3 en la escala de Rankin modificada a los 12 meses, mientras que un IMC > 35 (RR = 0,33; IC 95% = 0,11-0,98) fue protector. Conclusión. El exceso de adiposidad, según el ICT, aumenta la probabilidad de discapacidad grave después del ictus. Dado que el IMC refleja también masa magra, es arriesgado concluir que existe un efecto protector de la obesidad en la recuperación del ictus, pero es posible que cierta masa corporal sea necesaria para prevenir una discapacidad grave

Artículo en PDF

Atentamente
Anestesiología y Medicina del Dolor

www.anestesia-dolor.org

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