e-book´s. Alerta

Si vendes entre 1.000 y 4.000 `e-books´ ya eres un escritor ...
según David González | aviondepapel.tv
Un autor se considera superventas en formato papel cuando supera los más de 100.000 ejemplares vendidos; pero el mundo digital maneja otros registros. . Noticias, última hora, vídeos y fotos de Literatura en lainformacion.com.

Papyrus, una herramienta sencilla para crear ebooks >> Sin Tinta ...
Casi una cuarta parte de los libros que se publican en España son electrónicos. En 2012, según los datos que proporciona la Agencia del ISBN, se publicaron ...
blogs.elpais.com/.../papyrus-una-herrramienta-sencilla-para-cr...




España lee ebooks | Blogs de edirectivos
http://www.rubenalonso.es/2013/01/espana-lee-ebooks.htmlSí sí, aunque no os lo creáis, España lee y ¡muchos ebooks! Según la Agencia del International S...
www.edirectivos.com/blogs/9332.../3750-Espana-lee-ebooks




¿Dónde puedo encontrar 'ebooks' de anatomía? - Yahoo! Respuestas
Encuentra las respuestas de la pregunta ¿Dónde puedo encontrar 'ebooks' de anatomía?, Libros y Autores en Yahoo! Respuestas. Descubre respuestas de las ...
espanol.answers.yahoo.com/question/index?qid...




Hojas Mágicas: Clanes 1. Los Iniciados - Lanzamiento en ebooks
Por el momento el libro solamente estará disponible en ebooks, pero si al cabo de un tiempo consigue una cuota de ventas establecida por la editorial, también ...
hojasmagicas.blogspot.com/.../clanes-1-los-iniciados-lanzamie...


Los niños leen más e-books - Leer en Pantalla - Libros electrónicos ...
Estudios por aquí y por allá que pretenden dar forma y entender lo que está ocurriendo con el mundo editorial y sus destinatarios, los lectores. En cuanto.
leerenpantalla.com/los-ninos-leen-mas-e-books/

Delirio posoperatorio/Postoperative delirium

http://www.smo.edu.mx/











Disfunción postoperatoria cognoscitiva temprana y delirio postoperatorio después de anestesia con varios hipnóticos: protocolo de estudio randomizado y controlado- Estudio PINOCCHIO.
Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial--the PINOCCHIO trial.
Bilotta F, Doronzio A, Stazi E, Titi L, Zeppa IO, Cianchi A, Rosa G, Paoloni FP, Bergese S, Asouhidou I, Ioannou P, Abramowicz AE, Spinelli A, Delphin E, Ayrian E, Zelman V, Lumb P.
Department of Anaesthesiology, Critical Care and Pain Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy. bilotta@tiscali.it
Trials. 2011 Jul 6;12:170. doi: 10.1186/1745-6215-12-170.
Abstract
BACKGROUND: Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient.We designed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery. We also aimed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium. METHODS/DESIGN: After local ethics committee approval, enrolled patients will be randomly assigned to one of three treatment groups. In all patients anaesthesia will be induced with propofol and fentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, or propofol and the analgesic opioid fentanyl.The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia. Cognitive function will be evaluated with two cognitive test batteries (the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale) preoperatively, at baseline, and postoperatively at 20, 40 and 60 min after extubation.Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium, the relation of early postoperative cognitive recovery and postoperative delirium rate. A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium (age, sex, body weight) and to the preoperative score index for delirium. DISCUSSION: The results of this comparative anaesthesiological trial should whether each the three hypnotics tested is related to a significantly different postoperative delirium rate. This information could ultimately allow us to select the most appropriate hypnotic to maintain anaesthesia for specific subgroups of patients and especially for those at high risk of postoperative delirium. REGISTERED AT TRIAL.GOV NUMBER: ClinicalTrials.gov: NCT00507195.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155116/pdf/1745-6215-12-170.pdf

Trayectorias cognitivas después de delirio postoperatorio
Cognitive trajectories after postoperative delirium.
Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK, Jones RN.
Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA 01605, USA.jane.saczynski@umassmed.edu
N Engl J Med. 2012 Jul 5;367(1):30-9. doi: 10.1056/NEJMoa1112923.
Abstract
BACKGROUND: Delirium is common after cardiac surgery and may be associated with long-term changes in cognitive function. We examined postoperative delirium and the cognitive trajectory during the first year after cardiac surgery. METHODS: We enrolled 225 patients 60 years of age or older who were planning to undergo coronary-artery bypass grafting or valve replacement. Patients were assessed preoperatively, daily during hospitalization beginning on postoperative day 2, and at 1, 6, and 12 months after surgery. Cognitive function was assessed with the use of the Mini-Mental State Examination (MMSE; score range, 0 to 30, with lower scores indicating poorer performance). Delirium was diagnosed with the use of the Confusion Assessment Method. We examined performance on the MMSE in the first year after surgery, controlling for demographic characteristics, coexisting conditions, hospital, and surgery type. RESULTS: The 103 participants (46%) in whom delirium developed postoperatively had lower preoperative mean MMSE scores than those in whom delirium did not develop (25.8 vs. 26.9, P<0.001). In adjusted models, those with delirium had a larger drop in cognitive function (as measured by the MMSE score) 2 days after surgery than did those without delirium (7.7 points vs. 2.1, P<0.001) and had significantly lower postoperative cognitive function than those without delirium, both at 1 month (mean MMSE score, 24.1 vs. 27.4; P<0.001) and at 1 year (25.2 vs. 27.2, P<0.001) after surgery. With adjustment for baseline differences, the between-group difference in mean MMSE scores was significant 30 days after surgery (P<0.001) but not at 6 or 12 months (P=0.056 for both). A higher percentage of patients with delirium than those without delirium had not returned to their preoperative baseline level at 6 months (40% vs. 24%, P=0.01), but the difference was not significant at 12 months (31% vs. 20%, P=0.055). CONCLUSIONS: Delirium is associated with a significant decline in cognitive ability during the first year after cardiac surgery, with a trajectory characterized by an initial decline and prolonged impairment. (Funded by the Harvard Older Americans Independence Center and others.).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433229/pdf/nihms396197.pdf
Atentamente


Anestesiología y Medicina del Dolor


www.anestesia-dolor.org

Cultured Chondrocytes Implantation Live Surgery in a Course 1 st March

http://www.smo.edu.mx/





https://dl.dropbox.com/u/42022195/kneecoursesevilleprogram.pdf


Cultured Chondrocytes Implantation Live Surgery in a Course 1 st March, ESSKA Approved
Hi Friends.
We will show a Cultured Chondrocytes Implantation in a Live Surgery Course next 1 st March 2013, in Sevilla, Spain.
This ESSKA Approved Course is organized by a non profit Organization and fee is a ridiculous €95.
I think is a good opportunity to discuss details with surgeon during the procedure, meet each other and share experience and knwoledge.
Here you are scientific program

https://dl.dropbox.com/u/42022195/kneecoursesevilleprogram.pdf

I hope you find it interesting. I think it is the first time this surgery will be shown in a real time.
dl.dropbox.com dl.dropbox.com

http://colegiomexicanodeortopediaytrauma.blogspot.mx/2013/01/cultured-chondrocytes-implantation-live.html

Las personas mayores deben “darse prisa y morir”

http://sociedad.elpais.com/sociedad/2013/01/22/actualidad/1358865219_550162.html

Hasta en los paises desarrolados los politicos muestran su falta de sensibilidad, en fin quiero ver que él se de prisa para morir

EL PAÍS Madrid 22 ENE 2013 - 16:00 CET408

Taro Aso en una rueda de prensa en 2008. / EFE

Taro Aso, ministro japonés de Finanzas, no se anda con medias tintas. El pasado lunes declaró que las personas mayores deben “darse prisa y morir” para aliviar los gastos del Estado en su atención médica. Declaraciones especialmente alarmantes en una sociedad en la que el 25% de la población tiene más de 60 años. El propio Aso tiene 72 años.

El ministro arremetió en una reunión del Consejo Nacional de Seguridad Social contra las tácticas de reanimación y los tratamientos para prolongar de vida, según publica hoyThe Guardian. “Se ven obligados a vivir cuando quieren morir. Yo me despertaría sintiéndome mal si sé que el tratamiento está pagado por el Gobierno". El ministro nipón no se quedó ahí. Se refirió a los ancianos que ya no pueden alimentarse a sí mismos como "gente de tubo".

A los pocos días tuvo que rectificar. Reconoció que sus declaraciones habían sido "inadecuadas" en un foro público e insistió en que estaba hablando solo de su preferencia personal. "Es importante que la gente pueda pasar los últimos días de su vida en paz", sentenció.

No es la primera vez que las declaraciones de este ministro tienen que ser matizadas. Aso, uno de los políticos japoneses más ricos y veteranos, ha cuestionado otras veces el papel del Estado con los mayores. En 2008, cuando era primer ministro, calificó de "chochos" a los pensionistas. En otra ocasión, en una reunión de economistas afirmó: "Veo a gente de 67 años o 68 constantemente ir al médico. ¿Por qué tengo que pagar por las personas que sólo comen y beben y no hacen ningún esfuerzo?".


En 50 años un 40% de la población japonesa será mayor de 60 años

Un cuarto de los 128 millones de habitantes de Japón tienen más de 60 años. Es el país más envejecido del mundo y en 50 años este sector de población supondrá el 40% de la población. Esto implica importantes gastos sociales en pensiones y sanidad, que han llevado al Gobierno conservador a aumentar un 10% los impuestos sobre el consumo a pesar de que recortará en los próximos presupuestos, que entran en vigor en abril, esta aportación.

El 40% de los hogares japoneses que reciben asistencia social tiene algún miembro mayor de 65 años, según un informe publicado esta semana. Aumenta el número de mayores que viven solos. En 2010, 4,6 millones de personas mayores vivían solas, y el número de los que murieron en el hogar aumentó un 61% entre 2003 y 2010, según la oficina de bienestar social y de salud pública en Tokio.

Nuevos hábitos de lectura, los niños ya son lectores digitales

http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=55596&origen=notiweb&dia_suplemento=viernes

Nuevos hábitos de lectura, los niños ya son lectores digitales


Casi la mitad de los niños norteamericanos lee e-books en Estados Unidos, según el sondeo realizado por Scholastic Inc. Esta cifra supone una gran noticia para el sector digital, ya que implica que el número de lectores infantiles de formatos electrónicos se ha duplicado respecto a 2010, año en que solo alcanzaba el 25%.
FUENTE | media-tics

Coma y dolor/Coma and pain evaluation

Investigaciones electrofisiológicas de la función del cerebro en coma, en pacientes en estado vegetativo y con mínima conciencia.


Electrophysiological investigations of brain function in coma, vegetative and minimally conscious patients.
Lehembre R, Gosseries O, Lugo Z, Jedidi Z, Chatelle C, Sadzot B, Laureys S, Noirhomme Q.
Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium. Email: remy.lehembre@ulg.ac.be.
Arch Ital Biol. 2012 Jun;150(2-3):122-39. doi: 10.4449/aib.v150i2.1374.
Abstract
Electroencephalographic activity in the context of disorders of consciousness is a swiss knife like tool that can evaluate different aspects of cognitive residual function, detect consciousness and provide a mean to communicate with the outside world without using muscular channels. Standard recordings in the neurological department offer a first global view of the electrogenesis of a patient and can spot abnormal epileptiform activity and therefore guide treatment. Although visual patterns have a prognosis value, they are not sufficient to provide a diagnosis between vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) patients. Quantitative electroencephalography (qEEG) processes the data and retrieves features, not visible on the raw traces, which can then be classified. Current results using qEEG show that MCS can be differentiated from VS/UWS patients at the group level. Event Related Potentials (ERP) are triggered by varying stimuli and reflect the time course of information processing related to the stimuli from low-level peripheral receptive structures to high-order associative cortices. It is hence possible to assess auditory, visual, or emotive pathways. Different stimuli elicit positive or negative components with different time signatures. The presence of these components when observed in passive paradigms is usually a sign of good prognosis but it cannot differentiate VS/UWS and MCS patients. Recently, researchers have developed active paradigms showing that the amplitude of the component is modulated when the subject's attention is focused on a task during stimulus presentation. Hence significant differences between ERPs of a patient in a passive compared to an active paradigm can be a proof of consciousness. An EEG-based brain-computer interface (BCI) can then be tested to provide the patient with a communication tool. BCIs have considerably improved the past two decades. However they are not easily adaptable to comatose patients as they can have visual or auditory impairments or different lesions affecting their EEG signal. Future progress will require large databases of resting state-EEG and ERPs experiment of patients of different etiologies. This will allow the identification of specific patterns related to the diagnostic of consciousness. Standardized procedures in the use of BCIs will also be needed to find the most suited technique for each individual patient.
http://www.architalbiol.org/aib/article/view/150122/23165873


Fiabilidad y validez de la herramienta del comportamiento facial, piernas, actividad, y llanto en la en la evaluación del dolor agudo en pacientes en estado crítico


Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients.
Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S.
University of Michigan Health System, Ann Arbor, USA. terriv@umich.edu
Am J Crit Care. 2010 Jan;19(1):55-61; quiz 62. doi: 10.4037/ajcc2010624.
Abstract
BACKGROUND: Few investigators have evaluated pain assessment tools in the critical care setting. OBJECTIVE: To evaluate the reliability and validity of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale in assessing pain in critically ill adults and children unable to self-report pain. METHODS: Three nurses simultaneously, but independently, observed and scored pain behaviors twice in 29 critically ill adults and 8 children: before administration of an analgesic or during a painful procedure, and 15 to 30 minutes after the administration or procedure. Two nurses used the FLACC scale, the third used either the Checklist of Nonverbal Pain Indicators (for adults) or the COMFORT scale (for children). RESULTS: For 73 observations, FLACC scores correlated highly with the other 2 scores (rho = 0.963 and 0.849, respectively), supporting criterion validity. Significant decreases in FLACC scores after analgesia (or at rest) supported construct validity of the tool (mean, 5.27; SD, 2.3 vs mean, 0.52; SD, 1.1; P < .001). Exact agreement and kappa statistics, as well as intraclass correlation coefficients (0.67-0.95), support excellent interrater reliability of the tool. Internal consistency was excellent; the Cronbach alpha was 0.882 when all items were included.CONCLUSIONS: Although similar in content to other behavioral pain scales, the FLACC can be used across populations of patients and settings, and the scores are comparable to those of the commonly used 0-to-10 number rating scale.


http://ajcc.aacnjournals.org/content/19/1/55.full.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Bibliotecas. Alerta

De las bibliotecas y los bibliófilos en ''Vida entre libros''
Informador.com.mx
Corina Armella presentó esta noche ''Vida entre libros'', publicación que retrata lasbibliotecas de 43 reconocidos personajes en la Ciudad de México y la relación que estos tienen para con los libros. El acto llevado a cabo en el auditorio del Archivo ...
Ver todos los artículos sobre este tema »
Informador.com.mx

Dopaje en las bibliotecas | InVito
según Francisco J. Sáenz de Valluerca López
En la Manly Library de Sydney (Australia), ha aparecido recientemente este aviso de que todos los libros de Lance Armstrong se pasarán a la sección de literatura de ficción. Según Wendy Ford, la bibliotecaria de relación con la comunidad ...
InVito


El Centro de Documentación Europea se integra en la red Europe ...
según Bibliotecas
El astronauta - Bibliotecas USAL ... El nuevo centro compartirá instalaciones con el Centro de Documentación Europea, dirigido por Luis Norberto González Alonso y situado en la BibliotecaFrancisco de Vitoria del Campus Unamuno.
El astronauta - Bibliotecas USAL

Gangnam Style en las bibliotecas | InVito
Parece que el Gangnam Style ha tenido éxito también en las bibliotecas, y hay unas cuantas que ...
diarium.usal.es/vito/2013/.../gangnam-style-en-las-bibliotecas/

Books Update NYT

http://www.nytimes.com/indexes/2013/01/25/books/booksupdate/index.html


January 25, 2013
Books Update



On the Cover of Sunday's Book Review

'The Insurgents'
By FRED KAPLAN
Reviewed by THANASSIS CAMBANIS


"The Insurgents," by Fred Kaplan, tells the story of David H. Petraeus and the small fraternity of strategists that changed the way America conceived of, and actually fought, war.




Also in the Book Review

'Invisible Armies'
By MAX BOOT
Reviewed by MARK MAZOWER


Max Boot's "Invisible Armies" covers much of the globe to recount the history of guerrilla warfare.

Alain de Botton: By the Book


The author of "How to Think More About Sex" was impressed as a young man by Kierkegaard's claim to read only "writings by men who have been executed."
By the Book: Archive

APPLIED READING
The Heat of Battle
By J. D. BIERSDORFER


Apps that explore the events of the Civil War and World Wars I and II.

'Kind of Kin'
By RILLA ASKEW
Reviewed by JONATHAN EVISON


A fraught issue - illegal immigration - divides an Oklahoma family and their town in Rilla Askew's novel.

'The Inventor and the Tycoon'
By EDWARD BALL
Reviewed by CANDICE MILLARD


Edward Ball explains how Eadweard Muybridge's work for a railroad magnate led to the movies.
Up Front: Candice Millard

'Rage Is Back'
By ADAM MANSBACH
Reviewed by KEVIN BAKER


In this novel, a graffiti crew reunites after 18 years to avenge one of its members.

'On Extinction: How We Became Estranged From Nature'
By MELANIE CHALLENGER
Reviewed by PAUL GREENBERG


Melanie Challenger travels in search of the species, cultures and industries touched by extinction.

Poetry Chronicle
By ERIC McHENRY


New poetry collections by Michael Robbins, Rowan Ricardo Phillips, Paula Bohince and Natalie Diaz.

'The Marlowe Papers'
By ROS BARBER
Reviewed by CHARLES NICHOLL


In Ros Barber's verse-novel, Christopher Marlowe fakes his own death in order to keep writing.

'Venice: A New History'
By THOMAS F. MADDEN
Reviewed by ADAM BEGLEY


A history of Venice, from the city's origins as a lagoon refuge to its apex as a maritime empire to its rebirth as a modern tourist hub.

'One for the Books'
By JOE QUEENAN
Reviewed by LIGAYA MISHAN


Joe Queenan considers his relationship with the printed word.
ArtsBeat Q. & A.: Joe Queenan

'Soundings'
By HALI FELT
Reviewed by MICHAEL WASHBURN


Marie Tharp mapped the seafloor and hit the glass ceiling.

Perdida ósea humeral. Caso clínico.

http://www.smo.edu.mx/



Dr Benjamin Joel Torres Fernanez

Tumores de Columna. Generalidades

http://www.smo.edu.mx/



Dr Rogelio Solano Pérez

XIV Congreso Nacional 2013 AMCICO. México. Mérida. 2013

http://www.smo.edu.mx/

http://www.smo.edu.mx/

Evaluación de Riesgos y Restauración Ambiental

http://www.smo.edu.mx





Evaluación de Riesgos y Restauración Ambiental
Carlos E. Peña
Dean E. Carter
Felix Ayala-Fierro

RECONOCIMIENTO
Este trabajo se realizó gracias al apoyo del Instituto Nacional de Ciencias de la Salud Ambiental del Gobierno de los Estados Unidos de América dentro del Proyecto de Investigación Básica para el Superfund otorgado a la Universidad de Arizona (Grant P42 ESO 4940).

DESCRIPCIÓN GENERAL
1. INTRODUCCIÓN
2. TOXICOLOGIA AMBIENTAL
3. EVALUACIÓN DE RIESGOS AMBIENTALES
4. RESTAURACIÓN AMBIENTAL
5. PREVENCIÓN DE LA CONTAMINACIÓN
6. ANEXO
7. ÍNDICE DE FIGURAS Y TABLAS


Atte.
Dr.Máximo Cuadros Chávez

Bibliotecas. Alerta

http://www.smo.edu.mx/



Una biblioteca de Sydney cambia libros de Armstrong a la zona de ...
CNN México.com
(EFE) — Una biblioteca de Sydney trasladó todos los libros sobre Lance Armstrong a la sección de ficción, después de que el eciclista estadounidense confesara que consumió sustancias dopantes, informaron este lunes medios locales. "Todos los libros de ...
Ver todos los artículos sobre este tema »
CNN México.com

Biblioteca Nacional de España cumple 300 años
CanalNTN24
... video to your playlist. Sign in. Transcript Statistics Report. Published on Jan 20, 2013. La BibliotecaNacional de España festeja a lo grande su tercer centenario con una exposición que recoge las huellas del jazz, su historia y recorrido por el ...
Ver todos los artículos sobre este tema »

Biblioteca de Sídney cambia libros de Lance Armstrong a la sección ...
Una biblioteca de Sídney trasladó todos los libros sobre el exciclista estadounidense Lance Armstrong a la sección de ficción, después de que éste confesara ...
entretenimiento.terra.com/.../biblioteca-de-sidney-cambia-libro...



Biblioteca Nacional amplía su horario este 2013
Desde el siete de enero, la Biblioteca Nacional funciona bajo un nuevo horario, este va de las ...
www.culturacr.net/.../Biblioteca_Nacional_amplia_su_horario...



¿alguna biblioteca virtual que sirva de mucho apoyo por favor ...
Encuentra las respuestas de la pregunta ¿alguna biblioteca virtual que sirva de mucho apoyo por favor?, Libros y Autores en Yahoo! Respuestas. Descubre ...
espanol.answers.yahoo.com/question/index?qid...


Biblioteca de Sídney cambia libros de Lance Armstrong a la sección ...
Biblioteca de Sídney cambia libros de Lance Armstrong a la sección de ficción ♢ Una biblioteca de Sídney trasladó todos los libros sobre el exciclista ...
www.paginanoticias.com/.../Biblioteca-de-Sídney-cambia-libro...

Analgesia obstétrica/Obstetric analgesia

Dosis analgésica única intratecal para control del dolor del parto: ¿Una útil alternativa analgésica al bloqueo epidural?


Single-dose intrathecal analgesia to control labour pain: is it a useful alternative to epidural analgesia?
Minty RG, Kelly L, Minty A, Hammett DC.
Northern Ontario School of Medicine, Sioux Lookout.rminty@gosiouxlookout.com
Can Fam Physician. 2007 Mar;53(3):437-42.
Abstract
OBJECTIVE: To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) during labour. QUALITY OF EVIDENCE: MEDLINE was searched and the references of 2 systematic reviews and a meta-analysis were reviewed to find articles on obstetric analgesia and pain measurement. The 33 articles selected included 14 studies, 1 meta-analysis, and 2 systematic reviews, all providing level I evidence. MAIN MESSAGE: The literature supports use of ITN as a safe and effective alternative to epidural anesthesia. The recent decrease in rates of episiotomies and use of forceps during deliveries means patients require less dense perineal anesthesia. The advantage of single-dose ITN is that fewer physicians and nurses are needed to administer it even though its safety and effectiveness are comparable with other analgesics. Use of ITN is associated with a shorter first stage of labour and more rapid cervical dilation. A combination of 2.5 mg of bupivacaine, 25 microg of fentanyl, and 250 microg of morphine intrathecally usually provides a 4-hour window of acceptable analgesia for patients without complications not anticipating protracted labour. The evolution in dosing of ITN warrants a re-examination of its usefulness in modern obstetric practice. CONCLUSION: Physicians practising modern obstetrics in rural and small urban centres might find single-dose ITN a useful alternative to parenteral or epidural analgesia for appropriately selected patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949078/pdf/0530437.pdf


Bloqueo del plano abdominal transverso para analgesia post cesárea. Revisión sistemática y meta-análisis


Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis.
Mishriky BM, George RB, Habib AS.
Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA.
Can J Anaesth. 2012 Aug;59(8):766-78. doi: 10.1007/s12630-012-9729-1. Epub 2012 May 24.
Abstract
PURPOSE: To assess the efficacy of transversus abdominis plane (TAP) block in improving analgesia following Cesarean delivery (CD). SOURCE: We searched MEDLINE, CENTRAL, EMBASE, and CINAHL for randomized controlled trials that assessed the efficacy of TAP block following CD and reported on postoperative pain scores and/or opioid consumption. Studies were combined according to the use or non-use of intrathecal morphine (ITM). Another analysis was performed for studies comparing TAP block with ITM. PRINCIPAL FINDINGS: Nine studies were included. Transversus abdominis plane block significantly reduced opioid consumption (mg morphine equivalents) after Cesarean delivery at six hours (mean difference [MD] -10.18; 95% confidence interval [CI] -13.03 to -7.34), at 12 hr (MD -13.83; 95% CI -22.77 to -4.89), and at 24 hr (MD -20.23; 95% CI -33.69 to -6.77). The TAP block also reduced pain scores for up to 12 hr and nausea in patients who did not receive ITM. When added to ITM, TAP block produced a small reduction in pain scores on movement in the first six hours (MD -0.82, 95% CI -1.52 to -0.11). When compared with ITM, pain scores on movement and opioid consumption at 24 hr were lower (MD 0.98; 95% CI 0.06 to 1.91 and MD 8.42 mg; 95% CI 1.74 to 15.10, respectively), and time to first rescue analgesic was longer with ITM (8 hr vs 4 hr), although opioid-related side effects were more common. CONCLUSION: Transversus abdominis plane block significantly improved postoperative analgesia in women undergoing CD who did not receive ITM but showed no improvement in those who received ITM. Intrathecal morphine was associated with improved analgesia compared with TAP block alone at the expense of an increased incidence of side effects.


http://link.springer.com/content/pdf/10.1007%2Fs12630-012-9729-1




Analgesia combinada epidural espinal versus analgesia peridural en trabajo de parto. ¿La analgesia espinal inicial reduce las concentraciones subsecuentes mínimas de bupivacaína peridural?
Combined spinal epidural vs epidural labour analgesia: does initial intrathecal analgesia reduce the subsequent minimum local analgesic concentration of epidural bupivacaine?
Patel NP, Armstrong SL, Fernando R, Columb MO, Bray JK, Sodhi V, Lyons GR.
Research Fellow in Obstetric Anaesthesia, University College London Hospitals NHS Trust, London, UK.
Anaesthesia. 2012 Jun;67(6):584-93.
Abstract
Labour analgesia initiated using a combined spinal-epidural (CSE) technique may reduce subsequent epidural bupivacaine requirements compared with an epidural-only technique. We compared the minimum local analgesic concentrations (MLAC) of epidural bupivacaine following initial intrathecal or epidural injection. In a prospective, double-blind study, 115 women requesting epidural analgesia were randomly assigned to receive either an epidural with bupivacaine 20 mg and fentanyl 40 μg or a CSE with intrathecal bupivacaine 2.5 mg and fentanyl 5 μg. Analgesia was assessed using a visual analogue pain score. When further analgesia was requested, bupivacaine 20 ml was given, and the concentration was determined using the technique of up-down sequential allocation. The MLAC of bupivacaine in the epidural group was 0.032% wt/vol (95% CI 0.020-0.044) compared with 0.047% wt/vol (95% CI 0.042-0.052) in the CSE group. Bupivacaine requirements for the second injection were increased following intrathecal analgesia by a factor of 1.45 (p = 0.026) compared with epidural analgesia.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2011.07045.x/pdf





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

e-books. Alerta

http://www.smo.edu.mx/



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