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http://www.smo.edu.mx/
Sin duda, la historia de la anestesiología involucra a las mentes más precoces de nuestra especialidad y a los eventos que han cambiado la historia de la humanidad. Uno de estos adelantos es el conocimiento y el control del dolor, que sin lugar a dudas, fue un paso trascendental en la conquista de la salud de la humanidad. Estaremos enviando algunos artículos históricos de relevancia internacional.
Certainly, the history of anesthesiology involves the most precocious minds of our specialty and the events that changed the history of mankind. One of these advances is the knowledge of pain and its treatment, which undoubtedly was a major step in the conquest of the health of mankind. We will be sending some internationally important historical items on this topic.
Una historia filatélica de la anestesiología
A philatelic history of anesthesiology.
Sekhar KC.
J Anaesthesiol Clin Pharmacol [serial online] 2013 [cited 2013 Jan 23];29:19-25.
Thematic or topical philately deals with stamp collection based on a particular topic or theme. This article deals with a thematic depiction of the history of anesthesia from ancient to modern times using stamps, postal stationery and cancellations.
Keywords: Anesthesia, history, philately
http://www.joacp.org/text.asp?2013/29/1/19/105788
Calendario de Historia de la Anestesia: Enero
This Month in Anesthesia History: January
http://ahahq.org/Calendar/January.php
Más sobre Historia de la Anestesiología
http://chua2.fiu.edu/Nursing/anesthesiology/COURSES/Semester%203/NGR%206760%20ANE%20Prof%20Aspects/PROF%20STUDY%20GUIDE/ANESTHESIA%20HISTORY%20TIMELINE.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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http://www.smo.edu.mx/
El manejo apropiado de la vía aérea es un reto constante que debe de ser resuelto de forma correcta. Por fortuna, la disponibilidad de nuevos dispositivos para la vía aérea hace que las complicaciones sean menos frecuentes. En los siguientes envíos encontrará información sobre este tema.
Proper management of the airway is a constant challenge that must be resolved correctly. Fortunately, the availability of new devices for airway makes complications less frequent. In the following e-mails you will find important information on this topic.
Dispositivos supraglóticos: avances recientes
Supraglottic airway devices: recent advances
Tim Cook FRCA, Ben Howes FRCA
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 11 Number 2 2011
The classic laryngeal mask airway (cLMA, Intavent Direct, Maidenhead, UK) was introduced into clinical practice in 1988 and by 1989 had been purchased by almost every hospital in the UK. Over the next few years, anaesthetists widened the indications for its use dramatically. Since that revolution, although there have been numerous attempts to compete with the cLMA, further progress has largely been by evolution.
http://ceaccp.oxfordjournals.org/content/11/2/56.full.pdf
Comparación de la ML Proseal vs I-Gel durante laparoscopía ginecológica
Comparison of the Proseal LMA and intersurgical I-gel during gynecological laparoscopy.
Jeon WJ, Cho SY, Baek SJ, Kim KH.
Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea.
Korean J Anesthesiol. 2012 Dec;63(6):510-4. doi: 10.4097/kjae.2012.63.6.510. Epub 2012 Dec 14.
Abstract
BACKGROUND: The relatively recently developed I-gel (Intersurgical Ltd., Workingham, England) is a supraglottic airway device designed for single-use that, unlike conventional LMAs, does not require an inflatable cuff. In addition, the I-gel, much like the Proseal LMA (PLMA), has a gastric drainage tube associated with an upper tube for decompression of the stomach, thereby avoiding acid reflux and decreasing the risk of pulmonary absorption. The purpose of this study was to compare PLMA and I-gel devices in patients undergoing gynecological laparoscopy based on sealing pressure before and during pneumoperitoneum, insertion time, and gas exchange. METHODS: Following Institutional Review Board approval and written informed consent, 30 adult patients were randomly allocated to one of two groups (the PLMA or I-gel group). In each case, insertion time and number of attempts were recorded. After successful insertion, airway leak pressure was measured. RESULTS: Successful insertion and mechanical ventilation with both supraglottic airway devices was achieved on the first attempt in all 30 patients, and there were no significant differences with respect to insertion time. Likewise, leak pressure did not vary significantly either between or within groups after CO(2) insufflation. In addition, differences between leak volume and leak fraction between groups were not significant.
CONCLUSIONS: The results of our study indicate that the I-gel is a reasonable alternative to the PLMA for controlled ventilation during laparoscopic gynecologic surgery.
http://ekja.org/Synapse/Data/PDFData/0011KJAE/kjae-63-510.pdf
Capítulo sobre dispositivos supraglóticos
http://www.viaaereadificil.com/sites/default/files/files/Capitulo5.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
http://www.smo.edu.mx/
Uso de introductores para intubación a través de dispositivos supraglóticos para facilitar la intubación traqueal; revisión corta
Use of intubation introducers through a supraglottic airway to facilitate tracheal intubation: a brief review.
Wong DT, Yang JJ, Mak HY, Jagannathan N.
Department of Anesthesia, Toronto Western Hospital, University of Toronto, ON, Canada. david.wong@uhn.ca
Can J Anaesth. 2012 Jul;59(7):704-15. doi: 10.1007/s12630-012-9714-8.
Abstract
PURPOSE: This article is a narrative review regarding the usage and effectiveness of introducers or catheters to facilitate tracheal intubation through a supraglottic airway (SGA) as an alternative intubation technique in normal and difficult airway management. SOURCES:
Relevant articles were obtained through Medline (1948-July 2011). The articles were subsequently cross-referenced for additional literature, and only articles published in English were included. PRINCIPAL FINDINGS: In this review, we consider 32 reports using the LMA Classic™, LMA Unique™, LMA ProSeal™, LMA Supreme™, AuraOnce™, and i-gel™ as SGA conduits for intubation. In 13 articles, the use of an Aintree Intubation Catheter was described as an intubation introducer and resulted in high success rates in both elective and emergent situations. Eight studies used a guidewire exchange catheter technique. Although blind intubation using a guidewire resulted in a high failure rate, these studies found that using a bronchoscope improved successful intubation. Ten studies showed that insertion of a gum elastic bougie with a bronchoscope as an intubation introducer has high success rates compared with blind bougie insertion. One article described the use of a small endotracheal tube as an intermediary for tracheal intubation. CONCLUSIONS: In failed intubation scenarios, supraglottic airways, such as the LMA Classic™ or LMA ProSeal™ can serve as a conduit for tracheal intubation. A number of techniques using introducers or catheters can facilitate the insertion of an adequately sized endotracheal tube, particularly guided by a bronchoscope. Usage of introducers or catheters through a supraglottic airway may be a useful alternative intubation technique in difficult airway management
http://link.springer.com/content/pdf/10.1007%2Fs12630-012-9714-8
Revisión breve: disposistivo supraglótico ML Supreme
Brief review: The LMA Supreme™ supraglottic airway.
Wong DT, Yang JJ, Jagannathan N.
Department of Anesthesia, Toronto Western Hospital, University of Toronto, MC2-405, 399 Bathurst Street, Toronto, Ontario, Canada.david.wong@uhn.ca
Can J Anaesth. 2012 May;59(5):483-93. doi: 10.1007/s12630-012-9673-0. Epub 2012 Feb 9
Abstract
PURPOSE: This article is a review of the efficacy and safety of the Laryngeal Mask Airway (LMA) Supreme™ as a stand-alone supraglottic airway during general anesthesia and as a conduit for tracheal intubation. Relevant articles were obtained using MEDLINE (1948-July 2011) and EMBASE (1980-July 2011). Only original studies with adult human patients and published in English were selected. PRINCIPAL FINDINGS: The LMA Supreme was found to be comparable with the LMA Proseal™ with regard to success rate, insertion time, and complications. However, in three studies, oropharyngeal leak pressure was higher with the LMA Proseal than with the LMA Supreme. The LMA Supreme was superior to the LMA Classic™ with regard to insertion time and oropharyngeal seal pressure. The LMA Supreme was also used successfully in two difficult airway cases, and it has been used as a conduit for tracheal intubation by utilizing an intubation introducer (gum elastic bougie) and subsequently railroading an endotracheal tube over the bougie into the trachea. Techniques for achieving tracheal intubation include the use of the Aintree Intubation Catheter®, a guidewire-exchange catheter, a gum elastic bougie, and a small (<6.0 mm internal diameter) endotracheal tube.
CONCLUSION: The LMA Supreme has been shown to be a safe and efficacious device as a stand-alone supraglottic airway and may also be used as a conduit for tracheal intubation. Further trials are needed to determine the efficacy of the LMA Supreme compared with other supraglottic airways in both elective and emergent airway management situations.
http://link.springer.com/content/pdf/10.1007%2Fs12630-012-9673-0
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Primeros pasos en el mundo de los ebooks
Bitelia
Un ebook es, básicamente, un libro digital, una colección de texto, en algunos casos imágenes, publicados a través de determinadas plataformas para ser accedidos a través de dispositivos y aplicaciones especiales. Si bien algunos consideran que los ...
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Bitelia
'ebooks' de fotos >> Sin Tinta >> Blogs EL PAÍS
Al comprador de libros de fotografía no le resulta extraño que cada ejemplar cueste 30 o 40 euros en la librería. Se trata de libros muy cuidados de cuyas ...
blogs.elpais.com/sin-tinta/2013/01/ebooks-de-fotos.html
Diario de la expedicion de 1822 a los campos del sud de Buenos ...
Download the free eBook: Diario de la expedicion de 1822 a los campos del sud de Buenos Aires by García et al.
www.gutenberg.org/ebooks/41789
Descarga ebooks gratis y de manera legal | AETecno
Con el crecimiento de popularidad de las tablets, cada vez son más las personas que las utilizan para leer libros a través de aplicaciones como iBooks o Kindle ...
tecno.americaeconomia.com/.../descarga-ebooks-gratis-y-de-m...
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El regalo de estas Navidades ha sido sin duda el Tablet. Desde la irrupción del iPad de la innovadora Apple, este dispositivo se ha convertido en objeto de ...
www.elfarodigital.es/.../114338-regalos-navidenos-itablet-o-e-...
e books - Última hora sobre e books, información actualizada de e ...
todo sobre e books, la información mas reciente de e books, noticias internacionales sobre e books, feed de noticias sobre e books.
www.miamidiario.com/tags/e-books
http://www.smo.edu.mx/
Melatonina en la antinocicepción: sus aplicaciones terapéuticas
Melatonin in antinociception: its therapeutic applications.
Srinivasan V, Lauterbach EC, Ho KY, Acuña-Castroviejo D, Zakaria R, Brzezinski A.
Sri Sathya Sai Medical Educational and Research Foundation, Medical Sciences Research Study Center, Prasanthi Nilayam, 40 Kovai Thirunagar, Coimbatore-641014, Tamilnadu, India.
Curr Neuropharmacol. 2012 Jun;10(2):167-78. doi: 10.2174/157015912800604489.
Abstract
The intensity of pain sensation exhibits marked day and night variations. Since the intensity of pain perception is low during dark hours of the night when melatonin levels are high, this hormone has been implicated as one of the prime antinociceptive substances. A number of studies have examined the antinociceptive role of melatonin in acute, inflammatory and neuropathic pain animal models. It has been demonstrated that melatonin exerts antinociceptive actions by acting at both spinal cord and supraspinal levels. The mechanism of antinociceptive actions of melatonin involves opioid, benzodiazepine, α(1)- and α(2)-adrenergic, serotonergic and cholinergic receptors. Most importantly however, the involvement of MT(1)/MT(2) melatonergic receptors in the spinal cord has been well documented as an antinociceptive mechanism in a number of animal models of pain perception. Exogenous melatonin has been used effectively in the management of pain in medical conditions such as fibromyalgia, irritable bowel syndrome and migraine and cluster headache. Melatonin has been tried during surgical operating conditions and has been shown to enhance both preoperative and post-operative analgesia. The present review discusses the available evidence indicating that melatonin, acting through MT(1)/MT(2) melatonin receptors, plays an important role in the pathophysiological mechanism of pain.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3386506/pdf/CN-10-167.pdf
Neurobiología, patofisiología y tratamiento de la deficiencia y disfunción de melatonina
Neurobiology, pathophysiology, and treatment of melatonin deficiency and dysfunction.
Hardeland R.
Johann Friedrich Blumenbach Institute of Zoology and Anthropology, Georg August University, 37073 Göttingen, Germany. rhardel@gwdg.de
ScientificWorldJournal. 2012;2012:640389. doi: 10.1100/2012/640389. Epub 2012 May 2.
Abstract
Melatonin is a highly pleiotropic signaling molecule, which is released as a hormone of the pineal gland predominantly during night. Melatonin secretion decreases during aging. Reduced melatonin levels are also observed in various diseases, such as types of dementia, some mood disorders, severe pain, cancer, and diabetes type 2. Melatonin dysfunction is frequently related to deviations in amplitudes, phasing, and coupling of circadian rhythms. Gene polymorphisms of melatonin receptors and circadian oscillator proteins bear risks for several of the diseases mentioned. A common symptom of insufficient melatonin signaling is sleep disturbances. It is necessary to distinguish between symptoms that are curable by short melatonergic actions and others that require extended actions during night. Melatonin immediate release is already effective, at moderate doses, for reducing difficulties of falling asleep or improving symptoms associated with poorly coupled circadian rhythms, including seasonal affective and bipolar disorders. For purposes of a replacement therapy based on longer-lasting melatonergic actions, melatonin prolonged release and synthetic agonists have been developed. Therapies with melatonin or synthetic melatonergic drugs have to consider that these agents do not only act on the SCN, but also on numerous organs and cells in which melatonin receptors are also expressed.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354573/pdf/TSWJ2012-640389.pdf
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http://www.smo.edu.mx/
Manejo anestésico para operación cesárea urgente: revisión sistemática de la literatura de técnicas anestésicas para cesárea urgente
José V. Rueda Fuentes, Carlos E. Pinzón Flórez, y Mauricio Vasco Ramírez
r e v c o l o m b a n e s t e s i o l . 2 0 1 2;4 0(4):273-286
No existen publicaciones recientes basadas en la evidencia que contengan información específica del manejo anestésico de cesárea urgente, por lo que se propuso evaluar sistemáticamente la literatura existente del manejo anestésico en pacientes obstétricas sometidas
a cesárea urgente con el fin de definir las intervenciones más adecuadas basadas en la evidencia. Se realizó una rev isión sistemática de la literatura en: MEDLINE, 1966 a diciembre de 2010; Cochrane Collaboration registro de ensayos clínicos; Cochrane database de revisiones sistemáticas, y LILACS. La selección de los estudios se llevó a cabo de manera independiente por 2 investigadores-revisores que identificaron estudios de ensayos clínicos controlados y estudios de cohorte de manejo anestésico de cesárea urgente. En duplicado, los datos fueron extraídos, revisados y evaluados en calidad. De cada una de las fuentes se obtuvieron, respectivamente, 2.297, 36, 221 y 16 artículos potencialmente relevantes, 9 ensayos clínicos y 7 artículos bservacionales. Se realizó un análisis de heterogeneidad utilizando I2, el cual arrojó un resultado del 52%, por lo cual no se realizó metaanálisis. Conclusiones: El anestesiólogo es parte fundamental en el cuidado del binomio madre-hijo. La adecuada priorización de la urgencia en operación cesárea, la extensión anestésica peridural con lidocaína al 2% más coadyuvantes (fentanilo más adrenalina fresca), el uso de vasopresores
(fenilefrina, efedrina) para el manejo agresivo de la hipotensión, la utilización de oxígeno suplementario y un adecuado manejo de la anestesia general cuando está indicada permiten impactar favorablemente en los desenlaces del binomio madre-hijo. Los desenlaces neonatales a largo plazo no están influenciados por el tipo de anestesia suministrada a
la madre.
http://www.revcolanest.com.co/es/manejo-anestesico-operacion-cesarea-urgente/articulo/90156571/
Efecto étnico y del IMC sobre la distancia de la piel al espacio peridural lumbar en parturientas
Effect of ethnicity and body mass index on the distance from skin to lumbar epidural space in parturients.
Sharma V, Swinson AK, Hughes C, Mokashi S, Russell R.
Singapore General Hospital, Singapore, Singapore. drvvs@rediffmail.com
Anaesthesia. 2011 Oct;66(10):907-12.
Abstract
With the current prevalence of obesity and trends in ethnic diversity amongst parturients in UK maternity units, we performed a prospective, observational study to establish the effect of ethnicity and body mass index on the distance from skin to epidural space in parturients. A total of 1210 parturients participated in this study. The mean (SD) distance from skin to lumbar epidural space was 5.4 (1.1) cm. When tested in a multiple regression model, both body mass index and ethnicity significantly influenced the distance from skin to lumbar epidural space in parturients. The distance from skin to lumbar epidural space amongst ethnic groups differed at any given body mass index. It was significantly greater in Black/British Black and White parturients compared with their Asian and Chinese counterparts. You can respond to this article athttp://www.anaesthesiacorrespondence.com.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2011.06812.x/pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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http://www.smo.edu.mx/
Consideraciones diagnósticas sobre delirio en pediatría. Revisión y propuesta de un algoritmo para las UCIs pediátricas
Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units.
Schieveld JN, van der Valk JA, Smeets I, Berghmans E, Wassenberg R, Leroy PL, Vos GD, van Os J.
Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, European Graduate School of Neuroscience, SEARCH, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands.jan.schieveld@mumc.nl
Intensive Care Med. 2009 Nov;35(11):1843-9. doi: 10.1007/s00134-009-1652-8.
Abstract
CONTEXT: If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required. OBJECTIVE: Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm. RESULTS: Delirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers. DISCUSSION: It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures. Limitations: No sufficiently validated diagnostic instrument covering the entire algorithm is available yet. CONCLUSION: This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765651/pdf/134_2009_
Article_1652.pdf
Sobre la utilidad de los instrumentos de diagnóstico del delirio en niños graves: evaluación de la escala Pediatric Anesthesia Emergence Delirium, de Delirium Rating Scale 88, y de Delirium Rating Scale-Revised R-98.
On the utility of diagnostic instruments for pediatric delirium in critical illness: an evaluation of the Pediatric Anesthesia Emergence Delirium Scale, the Delirium Rating Scale 88, and the Delirium Rating Scale-Revised R-98.
Janssen NJ, Tan EY, Staal M, Janssen EP, Leroy PL, Lousberg R, van Os J, Schieveld JN.
Division of Child and Adolescent Psychiatry and Psychology, Department of Psychiatry and Psychology, European Graduate School of Neuroscience, Maastricht University Medical Centre, SEARCH, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Intensive Care Med. 2011 Aug;37(8):1331-7. doi: 10.1007/s00134-011-2244-y. Epub 2011 May 13.
Abstract
PURPOSE: Delirium is a poor-prognosis neuropsychiatric disorder. Pediatric delirium (PD) remains understudied, particularly at pediatric intensive care units (PICU). Although the Pediatric Anesthesia Emergence Delirium (PAED) scale, the Delirium Rating Scale (DRS-88), and the Delirium Rating Scale-Revised (DRS-R-98) are available, none have been validated for use in PICU settings. The aim of the present study was to investigate the use of the DRS/PAED instruments as diagnostic tools for PD in the PICU. METHODS: A prospective panel study was conducted, under circumstances of routine clinical care, investigating the diagnostic properties of the PAED, DRS-88, and DRS-R-98 in PICU patients at a tertiary university medical center. A total of 182 non-electively admitted, critically ill pediatric patients, aged 1-17 years, were included between November 2006 and February 2010. Sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated. Three psychometric properties were analyzed: (1) internal consistency (2) proportion of items not rateable, and (3) discriminative ability. RESULTS: The PAED could be completed in 144 (93.5%) patients, much more frequently than either the DRS-88 (66.9%) or the DRS-R-98 (46.8%). Compared with the clinical gold standard diagnosis of delirium, the PAED had a sensitivity of 91% and a specificity of 98% (AUC 0.99). The optimal PAED cutoff score as a screening instrument in this PICU setting was 8. Cronbach's alpha was 0.89; discriminative ability was high. CONCLUSIONS: The PAED is a valid instrument for PD in critically ill children, given its reliance on routinely rateable observational signs and symptoms.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136686/pdf/134_2011_
Article_2244.pdf
Delirio; Una frontera emergente en el manejo de los niños graves
Delirium: an emerging frontier in the management of critically ill children.
Smith HA, Fuchs DC, Pandharipande PP, Barr FE, Ely EW.
Pediatrics and Anesthesiology Division of Critical Care, Department of Pediatrics, 5121 Doctor's Office Tower, 2200 Children's Way, Nashville, TN 37232-9075, USA. heidi.smith@vanderbilt.edu
Crit Care Clin. 2009 Jul;25(3):593-614, x. doi: 10.1016/j.ccc.2009.05.002.
Abstract
The objectives of this article are (1) to introduce pediatric delirium and provide understanding of acute brain dysfunction with its classification and clinical presentations (2) to understand how delirium is diagnosed and discuss current modes of delirium diagnosis in the critically ill adult population and translation to pediatrics (3) to understand the prevalence and prognostic significance of delirium in the adult and pediatric critically ill population (4) to discuss the pathophysiology of delirium as currently understood, and (5) to provide general management guidelines for delirium.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793079/pdf/nihms135370.pdf
Delirio en los niños graves: fenomenología, correlación clínica y respuesta terapéutica
Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit.
Schieveld JN, Leroy PL, van Os J, Nicolai J, Vos GD, Leentjens AF.
University Hospital Maastricht, Division of Child and Adolescent Psychiatry, Department of Psychiatry, 5800, 6202, AZ Maastricht, The Netherlands.jan.schieveld@spsy.azm.nl
Intensive Care Med. 2007 Jun;33(6):1033-40. Epub 2007 Apr 25.
Abstract
OBJECTIVE: To study the phenomenology, clinical correlates, and response to treatment of delirium in critically ill children in the pediatric intensive care unit (PICU). DESIGN, SETTING AND PATIENTS: Descriptive study of a cohort of child psychiatric consultations from a tertiary PICU between January 2002 and December 2005. Demographic data, clinical presentation, and response to treatment of children subsequently diagnosed with delirium were analyzed. RESULTS: Out of 877 admissions (age distribution 0-18 years) arose 61 requests for psychiatric assessment. Of the 61 children, 40 (15 girls and 25 boys) were diagnosed with delirium (cumulative incidence 5%; mean age 7.6 years). Age-specific incidence rates varied from 3% (0-3 years) to 19% (16-18 years). In addition to the classical hypoactive and hyperactive presentations, a third presentation was apparent, characterized mainly by anxiety, with a higher prevalence in boys. All but 2 of the 40 children received antipsychotic medication: 27 (68%) haloperidol, 10 (25%) risperidone, and 1 both in succession. Two children treated with haloperidol experienced an acute torticollis as side effect. All children made a complete recovery from the delirium; five, however, died of their underlying disease. CONCLUSION: The rate of delirium in critically ill children on a PICU is not negligible, yet prospective studies of the phenomenology, risk factors and treatment of childhood delirium are very rare. Once pediatric delirium has been recognized, it generally responds well to treatment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1915613/pdf/134_2007_
Article_637.pdf
Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Administración transdérmica de drogas en el manejo del dolor
Transdermal drug delivery in pain management
Sanjay Bajaj MD DNB FRCA, Abigail Whiteman MA MB BChir FRCA, Brigitta Brandner MD FRCA FFFPMRCA
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 11 Number 2 2011
Key points
Transdermal drug delivery offers pharmacokinetic and practical advantages over the oral or parenteral routes for some patients. Patch design has important implications, for example, reservoir patches should never be cut whereas matrix patches can be trimmed. Topical diclofenac is at least as effective as the oral form; it may be superior. Development of a local subcutaneous drug reservoir beneath the patch means that buprenorphine and fentanyl patches require 24-72 h before the peak effect is achieved and there is delayed elimination after patch removal. New technology to actively drive drug molecules through the transdermal barrier may reduce time to onset and allow patch delivery to be useful in the management of acute pain.
http://ceaccp.oxfordjournals.org/content/11/2/39.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
La biblioteca de Alcalá de Guadaíra recibió la visita de más de ...
20minutos.es
El Servicio Municipal de Biblioteca, que incluye el trabajo y las acciones de las dos bibliotecaspúblicas de Alcalá de Guadaíra, cierra 2012 con la realización de numerosas actividades culturales y otras destinadas al fomento de la lectura dirigidas a ...
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Biblioteca mueve a ficción libros de Lance Armstrong (videos)
El Diario
Sídney, Australia - Una biblioteca de Sídney trasladó todos los libros sobre el exciclista estadounidense Lance Armstrong a la sección de ficción, después de que éste confesara que consumió sustancias dopantes, informaron hoy medios locales. “Todos los ...
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Broma de biblioteca australiana sitúa libros de ciclista Armstrong en ...
El Sentinel
SIDNEY (Reuters) - Una nota de broma de una biblioteca australiana declarando que los libros sobre el desacreditado ciclista Lance Armstrong serían trasladados a la sección de ficción se propagó masivamente en internet, y un comentarista afirmó que "el ...
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La Biblioteca Nacional Francesa puja por el libro más escandaloso ...
Qué.es
La Biblioteca Nacional de Francia (BNF) está dispuesta a pagar unos 5 millones de dólares para poseer el manuscrito original de «Las 120 jornadas de Sodoma y Gomorra», el legendario relato escrito por el Marqués de Sade en la prisión de la Bastilla ...
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Qué.es
Inauguran biblioteca denominada ´Dra. Flora Adelaida Bolívar ...
Radio Programas del Perú
El presidente de la Junta de Fiscales Superiores del Cusco, Carlos Alberto Pérez Sánchez, inauguró labiblioteca institucional denominada “Dra. Flora Adelaida Bolívar Arteaga”. En total son 466 textos de diversas editoriales, tanto nacionales como ...
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CHIRIGOTA MURCIANA con asalto a la biblioteca Regional ...
YouTube
Chema Ruiz y los locos de AVIMUR.com asaltan la biblioteca regional de Murcia en plenos exámenes para alegrar un poco la vida de los estudiantes cantando una chirigota murciana para promocionar el viaje a los carnavales de Cádiz que organiza ...
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¿donde consultar una biblioteca virtual de pedagogia.? - Yahoo ...
hola que tal quisiera saber si alguien me podria recomendar alguna biblioteca ... Ricon del vago todo gunto xd ...
espanol.answers.yahoo.com/question/index?qid...
Biblioteca australiana desplaza libros de Armstrong a estantería de ...
Una biblioteca del norte de Sídney anunció este lunes que los libros en su poder sobre el exciclista estadounidense Lance Armstrong iban a pasar a est.
entretenimiento.kolbi.msn.com/biblioteca-australiana-desplaza...
Biblioteca Derecho (BiblioDerecho) on Twitter
Biblioteca Derecho. @BiblioDerecho. Twitter no official de La biblioteca salmantina de mas glamour!! Donde lo que hace el de al lado, es lo mas importante!
https://twitter.com/BiblioDerecho
Biblioteca australiana desplaza libros de Armstrong a estantería de ...
Biblioteca australiana desplaza libros de Armstrong a estantería de ficción ♢ Una biblioteca del norte de Sídney anunció este lunes que los libros en su poder ...
www.paginanoticias.com/.../Biblioteca-australiana-desplaza-lib...
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/
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http://www.smo.edu.mx/
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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