http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=57933&origen=notiweb&dia_suplemento=viernes
La función oculta de la 'hormona del amor'
La oxitocina, conocida como la 'hormona del amor, tiene más repercusiones en nuestras interacciones sociales de lo que se creía. Según un equipo de investigadores de la Universidad de Stanford (EE.UU.) la 'hormona del amor' juega un papel relevante en la formación y mantenimiento de los lazos que se crean entre una madre y un hijo, así como en los apegos sexuales. Lo que hasta ahora no estaba claro era qué rol tenía en otros aspectos de la socialización.
FUENTE | ABC Periódico Electrónico S.A. 13/09/2013
En un estudio publicado en la revista Nature, los expertos sugieren que el papel de la oxitocina en las relaciones personales pudo haber evolucionado hacia áreas relacionadas con la afinidad grupal. Los resultados de la investigación abren las puertas a posibles nuevos tratamientos para el autismo y otros trastornos neuropsiquiátricos como la esquizofrenia.
La oxitocina es el centro de un intenso estudio por su aparente papel en el establecimiento de las relaciones personales; de hecho, ya se ha administrado a niños con trastornos del espectro autista en ensayos clínicos con resultados dispares. Así, otro trabajo también publicado en Nature mostraba que la oxitocina podría jugar un papel relevante en la aparición del autismo al ser la encargada de reducir el ruido de fondo cuando se tiene una conversación con otra persona, por lo que "aumenta la intensidad de las señales deseadas". En este sentido, el estudio, explicaba que esta hormona "tiene un efecto notable sobre el paso de la información a través del cerebro", y que en las personas con autismo, se da la circunstancia contraria, ya que "se distraen fácilmente por las características extrañas de su entorno".
RECOMPENSA
Lo que este nuevo estudio explica es la forma única en la que la oxitocina altera la actividad en una parte del cerebro que es crucial para experimentar las sensaciones agradables que los neurocientíficos llaman 'recompensa'. Los resultados no sólo corroboran la validez de los ensayos con oxitocina en personas autistas, sino que también sugieren posibles nuevos tratamientos para enfermedades neuropsiquiátricas en las que la actividad social se ve deteriorada.
"Las personas con trastornos del espectro autista pueden no experimentar la recompensa normal que tenemos el resto de las personas al reunirnos con nuestros amigos", explica Robert Malenka, autor principal del estudio. "Para ellos, las interacciones sociales pueden ser muy dolorosas. Así que nos preguntamos, ¿qué hace que nuestro cerebro disfrute de pasar un rato con los amigos?".
Algunas evidencias genéticas sugieren que la incomodidad ante la interacción social, una característica de los trastornos del espectro autista, puede estar, al menos en parte, relacionada con la oxitocina.
Malenka lleva dos décadas estudiando el sistema de recompensa -una red de regiones cerebrales interconectadas responsables de nuestra sensación de placer en respuesta a una variedad de actividades, como la búsqueda o comer comida cuando tenemos hambre, dormir cuando estamos cansados, tener relaciones sexuales o la adquisición de un compañero, o bien, en un giro patológico, el consumo de drogas adictivas. El sistema de recompensas ha evolucionado para reforzar los comportamientos que promueven nuestra supervivencia, dijo.
COMBINADA CON ANTIDEPRESIVOS
En investigaciones con roedores, conocidos por ser monógamos, se había especulado que la oxitocina podía estar involucrada en este tipo de fenómeno. Pero esta hipótesis era confusa en otros mamíferos, sobre todo en el que más se usa para la investigación científica: el ratón. "En realidad no se sabía lo que intercedía para tener una recompensa social y ni siquiera era seguro que la oxitocina jugara un papel, debido a que los ratones no se casan. Los ratones no buscan una pareja y se quedan con ella de por vida, son promiscuos", explicó a BBC Malenka. "Lo que sugiere este estudio es que quizás la oxitocina, en combinación con pequeñas dosis de antidepresivos, puede funcionar bien. Esto podría ser un tratamiento rápido para problemas sociales que tienen personas con autismo o esquizofrenia".
Así que Malenka, junto con Gül Dolen, líder del estudio, y otros colegas de Stanford, se lanzaron a la tarea de desentrañar las complicaciones neuropsicológicas que respaldan el papel de la hormona del amor en las interacciones sociales. Para ellos se centraron en los acontecimientos biomecánicos que tienen lugar en una región del cerebro llamada núcleo accumbens, crucial para los sistemas de recompensa.
"Está claro que a los ratones les gusta pasar el rato con los demás, como nosotros, presumiblemente por una cuestión de supervivencia, para protegerse de depredadores o conseguir alimento con mayor facilidad. Pero también juegan, les gusta jugar -señala Malenka-. Así que la pregunta es por qué les gusta pasar un rato con los demás y por qué es gratificante". Así que hicieron un experimento de comportamiento en el que preguntaron -en sentido figurado- a los ratones si querían estar con sus amigos o solos. "Y su comportamiento nos dijo que sí querían estar con los amigos".
Los expertos descubrieron que los ratones sí tienen receptores de oxitocina en un lugar clave del núcleo accumbens y que el bloqueo de esta hormona disminuye significativamente el apetito de socialización de estos animales. "Esta era nuestra predicción: la oxitocina en el núcleo accumbens era requerida para la satisfacción social", explica Malenka.
SEROTONINA
La gran sorpresa era que no actuaba sola. "La oxitocina causa la liberación de otro químico del cerebro muy importante llamado serotonina". Esto quiere decir que, de acuerdo con el experto, es la acción combinada de la oxitocina y la serotonina lo que se necesita para la recompensa social.
La aparición de la serotonina en la ecuación fue lo que más sorprendió a los investigadores, pues este químico no sólo está implicado en los comportamientos relacionados a la recompensa sino también en aspectos como la regulación del ánimo. De hecho, los antidepresivos más populares, pertenecen a una clase de fármacos conocidos como inhibidores selectivos de la recaptación de serotonina, que aumentan las cantidades disponibles de serotonina en varias regiones del cerebro, incluyendo el núcleo accumbens.
Los hallazgos de este estudio no sólo ofrecen validez a las pruebas que ya se están haciendo con oxitocina en pacientes autistas, sino que también sugiere posibles nuevos tratamientos para este tipo de trastornos neuropsiquiátricos en que se deteriora la actividad social. "Lo que sugiere este estudio es que quizás la oxitocina, en combinación con pequeñas dosis de antidepresivos, puede funcionar bien. Esto podría ser un tratamiento rápido para problemas sociales que tienen personas con autismo o esquizofrenia".
Eficacia analgésica de infusión continua de magnesio: revisión sistemática y meta-análisis
Analgesic efficacy of continuous intravenous magnesium infusion as an adjuvant to morphine for postoperativeanalgesia: a systematic review and meta-analysis.
Murphy JD, Paskaradevan J, Eisler LL, Ouanes JP, Tomas VA, Freck EA, Wu CL.
Department of Anesthesiology and Critical Care Medicine, the Johns Hopkins University and School of Medicine, Baltimore, Maryland 21287, USA.
Middle East J Anesthesiol. 2013 Feb;22(1):11-20.
Abstract
BACKGROUND: The efficacy of perioperative intravenous magnesium administration on postoperative opioid use, opioid-related side effects (e.g., nausea and vomiting) and pain are uncertain, as randomized controlled trials on this topic have reported disparate results. The objective of this systematic review is to determine if perioperative magnesium reduces opioid use, opioid-related side effects, and postoperative pain. METHODS:An electronic search was conducted using the Library of Medicine's PubMed and EMBASE databases. Included studies consisted of randomized controlled trials in an adult population with a clearly defined comparison of perioperative intravenous magnesium administration to a control with a documented assessment of opioid usage and postoperative pain. Relevant data was abstracted from included studies. Pooled estimates for weighted mean difference (WMD) with 95% confidence intervals (CI) were obtained for our primary outcome (opioid usage) using the Cochrane Collaboration's RevMan version 4.2.7 (Cochrane Collaboration; Oxford, United Kingdom). WMD and odds ratios (OR) were calculated using a random effects model. RESULTS: The literature search ultimately yielded 22 trials, enrolling 1177 (599 magnesium, 578 control) patients, who were included in the analysis. A significant decrease in morphine usage by those patients who received magnesium was noted (WMD = -7.40; 95% CI: -9.40 to -5.41, p < 0.00001). Perioperative magnesium administration was not associated with a difference in postoperative nausea or vomiting (RR = 0.76; 95% CI: 0.52 to 1.09, p = 0.14). The pooled visual analog scores for pain at 4-6 hours after surgery were significantly less in those patients who received magnesium surgery (WMD = -0.67; 95% CI: -1.12 to -0.23, p = 0.003); however, there was no difference in pain scores at 20-24 hours after surgery (WMD = -0.25; 95% CI: -0.62 to 0.71, p = 0.17). CONLUSION: Based on the results of this systematic review, perioperative intravenous magnesium may be a usefuladjuvant for the management of postoperative pain providing analgesia through a different mechanism of action than that of opioids and would make a potential addition to a multimodal anlgesic treatment plan; however, the decrease in opioid use with perioperative magnesium infusion does not appear to be associated with a decresea in opioid-related side effects.
http://www.meja.aub.edu.lb/downloads/22_1/11.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Fuego quirúrgico. Un reto intraoperatorio
Surgical fires: An ongoing intra-operative challenge.
Abdulrasheed I, Lawal AM, Eneye AM.
Arch Int Surg [serial online] 2013 [cited 2013 Aug 28];3:1-5.
Abstract
Background: A surgical fire is a rare but life-threatening event. They are always unexpected and commonly occur in head and neck surgeries resulting in severe burns, disfigurement, and in some cases death. Injuries are not limited to patients alone as they may also involve health-care personnel in the operating theater. There is a resurgence in the awareness of this intra-operative challenge as well as an understanding of the need for a team approach to prevention. Materials and Methods: The surgical fire triangle is a useful paradigm that describes the three elements necessary for initiation of a surgical fire i.e., ignition source, fuel, and an oxidizer. This review will identify operating theatre contents capable of acting as ignition/oxidizer/fuel sources and highlight the management and prevention of surgical fires. Results: Surgical fires can be prevented by education across all professional boundaries in the operating theater. This will entail information on how the elements of the fire triangle interact, recognizing how standard operating room equipment can initiate a fire, and vigilance for the circumstances that increase the likelihood of a surgical fire. Conclusion: Promoting a culture of fire safety in the theater is not optional. Education on the prevention of surgical fires should be included in the curriculum of undergraduate medical students. There is an urgent need to stimulate debate within National burn associations in this context, leading to the formation of proposals to be incorporated into existing National burn prevention plans.
Keywords: Fire triangle, fuel, ignition, oxidizer, prevention, surgical fire
http://www.archintsurg.org/text.asp?2013/3/1/1/117117
Fuegos quirúrgicos. La comunicación perioperatoria es esencial para prevenir esta complicación pero devastadora
Surgical fires: perioperative communication is essential to prevent this rare but devastating complication.
Bruley ME.
Accident and Forensic Investigation, ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA. mbruley@ecri.org
Qual Saf Health Care. 2004 Dec;13(6):467-71.
Abstract
A fire on or within a surgical patient is a continuing risk in modern surgery. Unfortunately, the sensitivity of surgical and anaesthesia staff to this hazard has waned over the past 25 years with cessation of the use of flammable anaesthetic agents. Prevention of surgical fires requires understanding the risks and effective communication between surgical, anaesthesia, and operating nursing staffs. Preventive measures exist but have yet to diffuse sufficiently across professional boundaries. Based on a review of relevant databases, decades of experience from field investigations, and a review of the medical literature, this paper discusses the incidence of surgical fires, the responsibility for prevention in the perioperative setting, and the procedures for surgical fire prevention and extinguishment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743921/pdf/v013p00467.pdf
Pensando en tres de: Cambios en las prácticas de seguridad del paciente quirúrgico en el complejo quirófano moderno.
Thinking in three's: changing surgical patient safety practices in the complex modern operating room.
Gibbs VC.
Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. verna.gibbs@va.gov
World J Gastroenterol. 2012 Dec 14;18(46):6712-9. doi: 10.3748/wjg.v18.i46.6712.
Abstract
The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgicalsafety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.
KEYWORDS:
Complex adaptive systems, Retained foreign bodies, Retained foreign objects, Retained surgical items, Safety checklist, Surgical fires, Surgical patient safety, Wrong site surgery
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520159/pdf/WJG-18-6712.pdf
Soluciones quirúrgicas a base de alcohol y el riesgo de incendio en la sala de operaciones. Informe de un caso
Alcohol based surgical prep solution and the risk of fire in the operating room: a case report.
Batra S, Gupta R.
Department of Orthopaedic Surgery, Central Institute of Orthopaedics, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi - 110029, India. sumitbatra104@rediffmail.com.
Patient Saf Surg. 2008 Apr 26;2:10. doi: 10.1186/1754-9493-2-10.
Abstract
A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377238/pdf/1754-9493-2-10.pdf
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
El ojo y el sistema visual durante el embarazo. ¿Que esperara? Una revisión profunda
The eye and visual system in pregnancy, what to expect? An in-depth review.
Samra KA.
Oman J Ophthalmol [serial online] 2013 [cited 2013 Aug 20];6:87-91.
Abstract
Pregnancy represents a real challenge to all body systems. Physiological changes can involve any of the body organs including the eye and visual system. The ocular effect of pregnancy involves a wide spectrum of physiologic and pathologic changes. The latter might be presenting for the first time during pregnancy such as corneal melting and corneal ectasia, or an already existing ocular pathologies that are modified by pregnancy such as diabetic retinopathy and glaucoma. In addition, pregnancy can affect vision through systemic disease that are either specific to the pregnant state itself such as the pre-eclampsia/eclampsia and Sheehan's syndrome, or systemic diseases that occur more frequently in relation to pregnancy such as Graves' disease, idiopathic intracranial hypertension, anti-phospholipid syndrome, and disseminated intravascular coagulation.
Keywords: Complications, eye, ocular effect, pregnancy
http://www.ojoonline.org/text.asp?2013/6/2/87/116626
Apendicitis aguda en el embarazo
Acute appendicitis in pregnancy
Sanda RB, Garba SE.
Arch Int Surg [serial online] 2013 [cited 2013 Aug 28];3:6-10.
Abstract
Background: Frequently, a general surgeon is called upon to consider the diagnosis of appendicitis in a girl or woman who is pregnant or has recently delivered. The burden of clinical decision-making and execution of treatment would rest on the general surgeon, with other specialists playing peripheral, but important supportive roles. This condition is relatively rare in pregnancy. A delay in operative intervention is often incurred in view of the risk of general anesthesia and operation on the fate of the pregnancy. Promptly diagnosed in a patient who sought medical assistance early in the evolution of the disease, acute appendicitis in pregnancy (AAP) should not pose an operative challenge to the contemporary surgeon or risk to the woman and her unborn child. It is the aim of this review to appraise AAP in the light of contemporary evidence based medicine and to demystify it with a view to encouraging general surgeons to boldly confront a potentially lethal disease and not to add to the patient's suffering by hiding behind unnecessary laboratory and imaging investigations. Materials and Methods: Many search engines are used such as MedLine, PubMed and Google scholar to search out discussions related to AAP. All the acquired information was processed to arrive at the conclusions drawn here in this essay. Results: AAP can be promptly diagnosed and treated with high index of suspicion. Awareness of this condition in pregnant patients must be high. The condition if diagnosed early and treated promptly can have a good outcome. Conclusion: Acute appendicitis is a relatively rare condition in pregnancy; surgeons must have a high index of suspicion as early diagnosis and treatment are important factors in a safe outcome of this condition.
Keywords: Acute abdomen, acute appendicitis, fetal outcome, early diagnosis, pregnancy
http://www.archintsurg.org/text.asp?2013/3/1/6/117120
Tratamiento psicológico de la diabetes durante el embarazo
Psychosocial management of diabetes in pregnancy.
Kalra B, Sridhar G R, Madhu K, Balhara YS, Sahay RK, Kalra S.
Indian J Endocr Metab [serial online] 2013 [cited 2013 Aug 29];17:815-8.
Abstract
This consensus based national guideline addresses the need for psychological, psychiatric and social assessment, as well as management, in antenatal women with diabetes. It builds upon the earlier Indian guidelines on psychological management of diabetes, and should be considered as an addendum to the parent guideline.
Keywords: Depression, gestational diabetes mellitus, stress
http://www.ijem.in/text.asp?2013/17/5/815/117216
Tratamiento anestésico de cesárea en una gestante diabética con miocardiopatía hipertrófica y disfunción diastólica restrictiva
C.M. Holgadoa, S. Covesba
Servicio de Anestesiología y Reanimación, Hospital Universitario de Tarragona Juan XXIII,
Rev Esp Anestesiol Reanim. 2012.
Resumen
Los cambios hemodinámicos que se producen durante el embarazo son máximos entre las 28.a y 34.a semanas. En una gestante con enfermedades asociadas o coincidentes, como cardiopatía hipertensiva y diabetes pregestacional estos cambios pueden dar lugar a una hipertensión pulmonar y edema agudo de pulmón de difícil control. Presentamos el caso de una gestante diabética tipo 1 de varios años de evolución, que presentó un cuadro de preeclampsia en un embarazo anterior y que desarrolló una miocardiopatía hipertensiva desde entonces. Había ingresado en la 30.a semana de gestación para control metabólico y de la presión arterial desarrollando una insuficiencia cardiaca congestiva tras la administración de betametasona para maduración pulmonar fetal. Se le realizó un ecocardiograma transtorácico que mostró un ventrículo izquierdo hipertrófico no dilatado con buena función sistólica, alteración diastólica restrictiva e hipertensión arterial pulmonar moderada. Cuando se consiguió mejorar su estado general se decidió realizar una cesárea con anestesia regional para evitar las complicaciones de la hipertensión arterial pulmonar y sistémica. Exponemos el tratamiento anestésico y la resolución de las complicaciones aparecidas tras la administración de oxitocina.
http://www.elsevier.es/sites/default/files/elsevier/eop/S0034-9356(12)00088-6.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Biblioteca Nacional lleva educación y cultura a centros ... Venezolana de Televisión
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Huelva, 6 sep (EFE).- La Biblioteca Provincial de Huelva ha puesto en marcha una campaña solidaria por la que se llega incluso a perdonar a sus usuarios las ...Ver todos los artículos sobre este tema »
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Conmemora Biblioteca con la palabra Periódico AM
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Periódico AM
Otorgan a Biblioteca del Estado legado de Phil Weigand Informador.com.mx
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Falla renal aguda y embarazo: Experiencia en un centro terciario del norte de la India
Acute renal failure in pregnancy: Tertiary centre experience from north Indian population.
Patel ML, Sachan R, R, Sachan2 P.
Niger Med J [serial online] 2013 [cited 2013 Jul 5];54:191-5.
Abstract
Background: Obstetrical acute renal failure ARF is now a rare entity in the developed countries but still a common occurrence in developing countries. Delay in the diagnosis and late referral is associated with increased mortality. This study aimed to evaluate the contributing factors responsible for pregnancy-related acute kidney failure, its relation with mortality and morbidity and outcome measures in these patients. Materials and Methods: Total 520 patients of ARF of various aetiology were admitted, out of these 60 (11.5%) patients were pregnancy-related acute renal failure. Results: ARF Acute renal failure occurred in 32 (53.3%) cases in early part of their pregnancy, whereas in 28 (46.7%) cases in later of the pregnancy. Thirty-two (53.3%) patients had not received any antenatal visit, and had home delivery, 20 (33.4%) patients had delivered in hospitals but without antenatal care and eight (13.3%) patients received antenatal care and delivered in the hospitals. Anuria was observed in 23 (38.3%) cases, remaining 37 (61.7%) cases presented with oliguria. Septicemia was present in 25 (41.7%), hypertensive disorder of pregnancy in 20 (33.3%), haemorrhage in eight (13.3%), abortion in 5 (8.3%), haemolysis elevated liver enzymes low platelets counts (HELLP) syndrome in one (1.67%) and disseminated intravascular coagulation in one (1.67%). (61.7%) patients were not dialyzed, 33 (55%) recovered normal renal function with conservative treatment. Complete recovery was observed in 45 (75%) patients, five (8.4%) patients developed irreversible renal failure. Maternal mortality was nine (15%) and foetal loss was 25 (41.7%). Conclusion: Pregnancy-related ARF is usually a consequence of obstetric complications; it carries very high morbidity and mortality.
Keywords: Acute renal failure, hemodialysis, partial recovery, pregnancy
http://www.nigeriamedj.com/text.asp?2013/54/3/191/114586
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
El Dr. Alberto Gutiérrez, de Argentina, realizó diversos cursos y trabajos sobre anestesia metamérica epidural y basándose en los estudios de Jansen sobre la presión negativa en el espacio epidural (EE). En 1933 publicó un artículo en el que llamó la atención sobre la importancia de la aspiración de líquidos hacia el EE. De ahí surge el signo conocido como "aspiración de la gota" o "gota pendiente" de Gutiérrez".
Alberto Gutierrez MD from Argentina, conducted several courses and work on metameric epidural anesthesia based on Jansen studies on the negative pressure in the epidural space. In 1933 he published an article in which he called attention to the importance of aspiration of liquid into the epidural space. From this arises the sign known as "aspiration drop" or "Gutierrez drop pending".
Alberto Gutierrez MD da Argentina, realizou vários cursos e trabalho em anestesia epidural metameric com base em estudos Jansen sobre a pressão negativa no espaço epidural. Em 1933, ele publicou um artigo em que ele chamou a atenção para a importância da aspiração de líquido no espaço epidural. Daí surge o sinal conhecido como "drop aspiração" ou "drop Gutierrez pendente".
Técnicas de identificación del espacio epidural
E. Figueredo
Servicio de Anestesia. Hospital Torrecárdenas. Almería
Rev. Esp. Anestesiol. Reanim. 2005; 52: 401-412
Resumen
Gran parte del éxito de una anestesia epidural se basa en la correcta identificación del espacio epidural. En los últimos 100 años se han descrito numerosas técnicas intentando localizar el espacio de la manera más simple, efectiva, segura y fiable. Para juzgar las técnicas empleadas para la identificación del espacio epidural, sus ventajas, inconvenientes y/o complicaciones se ha realizado una búsqueda en Medline entrecruzando las palabras clave "epidural analgesia", "epidural anesthesia", "epidural space", "identification" y "loss of resistance". Se analizan las técnicas clásicas de identificación del espacio epidural, así como los principales métodos complementarios o instrumentales. Se evalúan los resultados de los ensayos clínicos en los que se comparan las distintas técnicas de pérdida de resistencia (LOR). Las técnicas basadas en la LOR, mediante el uso de aire, solución salina isotónica o una combinación de ambos, han demostrado ser las más simples y efectivas. Con respecto a la seguridad, la técnica de LOR con aire es la que presenta más complicaciones (neumoencéfalo, embolismo aéreo, analgesia insuficiente, mayor incidencia de punciones durales accidentales, compresión de raíces nerviosas, enfisema subcutáneo). Si a la técnica de LOR con solución salina, se le agrega una pequeña burbuja de aire dentro de la jeringa, la técnica, además de efectiva y segura, resulta más fiable y su enseñanza más didáctica.
http://www.csen.com/epid.pdf
Incidencia y predictores de complicaciones inmediatas después punciones epidurales no obstétricas
Incidence and predictors of immediate complications following perioperative non-obstetric epidural punctures.
Meyer-Bender A, Kern A, Pollwein B, Crispin A, Lang PM.
Department of Anaesthesiology, University Hospital of Munich, Marchioninistr, 15, 81377, Munich, Germany. philip.lang@med.uni-muenchen.de.
BMC Anesthesiol. 2012 Dec 10;12:31. doi: 10.1186/1471-2253-12-31.
Abstract
BACKGROUND: Epidural Anesthesia (EA) is a well-established procedure. The aim of the present study was to evaluate the incidence of immediatecomplications following epidural puncture, such as sanguineous puncture, accidental dural perforation, unsuccessful catheter placement or insufficient analgesia and to identify patient and maneuver related risk factors. METHODS: A total of 7958 non-obstetrical EA were analyzed. The risk of each complication was calculated according to the preconditions and the level of puncture. For probabilistic evaluation we used a logistic regression model with forward selection. RESULTS:The risk of sanguineous puncture (n = 247, 3.1%) increases with both the patient's age (P = 0.013) and the more caudal the approach (P < 0.01). Dural perforation (n = 123, 1.6%) was found to be influenced only by advanced age (P = 0.019). Unsuccessful catheter placement (n = 68, 0.94%) occurred more often in smaller individuals (P < 0.001) and at lower lumbar sites (P < 0.01). Amongst all cases with successful catheter placement a (partial) insufficient analgesia was found in 692 cases (8.8%). This risk of insufficient analgesia decreased with patient's age (P <0 .01), being least likely for punctures of the lower thoracic spine (P < 0.001). CONCLUSIONS:Compared to more cranial levels, EA of the lower spine is associated with an increased risk of sanguineous and unsuccessful puncture. Insufficient analgesia more often accompanies high thoracic and low lumbar approaches. The risk of a sanguineous puncture increases in elderly patients. Gender, weight and body mass index seem to have no influence on the investigated complications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3566923/pdf/1471-2253-12-31.pdf
Videos para localizar el espacion peridural utilizando la Gota de Lambertus
Video en Español
La gota de Lambertus
http://www.youtube.com/watch?v=UXUDhja6cW0
English video
Lambertus' drop
http://www.youtube.com/watch?v=TvCBDamF4jQ
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Puntos de referencia anatómicos para evaluar el nivel espacio intravertebral para la punción lumbar es erróneo en más de 30%
Anatomical landmarks based assessment of intravertebral space level for lumbar puncture is misleading in more than 30%.
Duniec L, Nowakowski P, Kosson D, Łazowski T.
Department of Teaching Anaesthesiology and Intensive Therapy, Medical University of Warsaw, Poland. dunieclarysa@gmail.com
Anaesthesiol Intensive Ther. 2013 Jan-Mar;45(1):1-6. doi: 10.5603/AIT.2013.0001.
Abstract
BACKGROUND: The anatomical landmark which is used to identify the correct level for lumbar puncture is the line connecting both iliac crests. This crosses the vertebra column at the level of the L4-L5 intervertebral space or L4 vertebra. It can be difficult to determine in a group of orthopaedic patients due to chronic orthopaedic disorders, chronic pain, overweight, or difficulties with positioning for lumbar puncture. The objective of this study was to determine if identification of intervertebral space by a physical exam differs from that of an ultrasound assessment. METHODS:Adult patients scheduled for lower limb surgery under spinal block were enrolled in this study. The intervertebral space suitable for lumbarpuncture was determined by physical exam by an anaesthetist in the sitting or lateral position. This was followed by a lumbar ultrasound. Primarily, a transducer was placed in paramedian sagittal view followed by transverse interlaminar view to confirm the identification of the interlaminar spaces. The 'counting-up' approach starting with the L5-1 space was applied. RESULTS: One hundred and twenty two patients (122) were included in this study. Lumbar intervertebral spaces were identified by ultrasound in all cases. There was concordance of intervertebral space identification (between clinical and ultrasound examination) in 78 cases (64%). Mean deviation of inacuracy was one intervertebral space with no statistical difference among cephalad and caudal direction. There were no statistically significant differences fund in terms of demographic data (sex, age, height, weight, or BMI), positioning for lumbar puncture, or intervertebral space chosen for the puncture between the concordant and the nonconcordant identification groups. The only statistically significant difference found was the difference in the years of experience of the anaesthetist performing the clinical assessment and puncture. CONCLUSIONS:The concordance rate between clinical examination and using assessment of intervertebral space identification for lumbar puncture is 64% among patients undergoing lower limb surgery. No special parameters were found which could make an anaesthetist aware that a patient is at greater risk of inadequate intervertebral space level assessment. Spinal ultrasound can reduce the incidence of inappropriate lumbar puncture level in orthopaedic patients.
http://czasopisma.viamedica.pl/ait/article/view/AIT.2013.0001/24858
Uso del ultrasonido para determinar el nivel de punción lumbar en la mujer embarazada
Use of the ultrasound to determine the level of lumbar puncture in pregnant women.
Locks Gde F, Almeida MC, Pereira AA.Maternidade Carmela Dutra, Hospital Universitário, Universidade Federal de Santa Catarina. giovanilocks@gmail.com
Rev Bras Anestesiol. 2010 Jan-Feb;60(1):13-9.
Abstract
BACKGROUND AND OBJECTIVES: An imaginary line connecting both iliac crests is used to determine the vertebral level for lumbar puncture. This line crosses the spine at the level of L4 or the L4-L5 space. This anatomical reference can be inaccurate in a large proportion of patients. The objective of the present study was to determine whether the identification of the L3-L4 space by the physical exam differs from that of the ultrasound in obese and non-obese pregnant women. METHODS:Adult patients undergoing elective cesarean sections under spinal block participated in this study. Patients were divided in two groups: obese and non-obese. The L3-L4 space was determined by physical exam with the patient in the sitting position. This was followed by a lumbarultrasound. After the sacrum was identified, the transducer was directed in the cephalad direction to identify the spinous processes of the lumbarvertebrae. The clinically estimated L3-L4 level was recorded. RESULTS: Ninety patients, 43 obese and 47 non-obese, were included in this study. Lumbar intervertebral spaces were identified by ultrasound in all patients. The L3-L4 space clinically identified corresponded to the ultrasound identification in 53% and 49% of the cases in the non-obese and obese groups, respectively. There was no significant difference between groups. CONCLUSIONS:The L3-L4 space is correctly identified in a low percentage of obese and non-obese pregnant women. Spinal ultrasound can reduce the incidence of mistaken identification of the L3-L4 space in obese and non-obese pregnant women.
http://www.scielo.br/pdf/rba/v60n1/en_v60n1a02.pdf
Evaluación de ultrasonido del nivel vertebral de la línea intercristal en el embarazo.
Ultrasound assessment of the vertebral level of the intercristal line in pregnancy.
Lee AJ, Ranasinghe JS, Chehade JM, Arheart K, Saltzman BS, Penning DH, Birnbach DJ.
Department of Anesthesiology, University of Miami, Jackson Memorial Hospital, 1611 NW 12th Ave. (C-301), Miami, FL 33136, USA. alee@med.miami.edu
Anesth Analg. 2011 Sep;113(3):559-64. doi: 10.1213/ANE.0b013e318222abe4. Epub 2011 Jun 16.
Abstract
BACKGROUND: The intercristal line is known to most frequently cross the L4 spinous process or L4-5 interspace; however, it is speculated to be positioned higher during pregnancy because of the exaggerated lumbar lordosis. Clinical estimation of vertebral levels relying on the use of the intercristal line has been shown to often be inaccurate. We hypothesized that the vertebral level of the intercristal line determined by palpation would be higher than the level determined by ultrasound in pregnant women. METHODS: Fifty-one term pregnant patients were recruited. Two experienced anesthesiologists performed estimates of the position of the intercristal line by palpation. Using ultrasound, another anesthesiologist who was blinded to the clinical estimates, determined the position of the superior border of the iliac crest in the transverse and longitudinal planes and then identified the lumbar vertebral levels. The vertebral level at which the clinical estimates of the intercristal line crossed the spine was recorded and compared with the ultrasound-determined level of the superior border of the iliac crest. RESULTS: The clinical estimates of the spinal level of the intercristal line agreed with the ultrasound measurement 14% of the time (14 of 101; 95% confidence interval [CI]: 8%, 22%). The clinical estimates were 1 level higher than the ultrasound measurement 23% of the time (23 of 101; 95% CI: 16%, 32%) and >1 level higher 25% of the time (25 of 101; 1-tailed 95% CI: >18%). The distribution of the clinical estimates found clinicians locating the intercristal line at L3 or L3-4 54% of the time (54 of 101; 95% CI: 44%, 63%) and at L2-3 or higher 27% of the time (27 of 101; 1-tailed 95% CI: >20%). CONCLUSION: The anatomical position of the intercristal line was at L3 or higher in at least 6% of term pregnant patients using ultrasound. Clinical estimates were found to be ≥1 vertebral level higher than the anatomical position determined by ultrasound at least 40% of the time. This disparity may contribute to misidentification of lumbar interspaces and increased risk of neurologic injury during neuraxial anesthesia.
http://www.anesthesia-analgesia.org/content/113/3/559.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Consideraciones perioperatorias en pacientes con hipertensión pulmonar
Perioperative Considerations of Patients with Pulmonary Hypertension
Henry Liu, Philip L. Kalarickal, Yiru Tong, Daisuke Inui, Michael J. Yarborough, Kavitha A. Mathew, Amanda Gelineau, Alan D. Kaye and Charles Fox
http://cdn.intechopen.com/pdfs/43689/InTech-Perioperative_considerations_of_patients_with_pulmonary_hypertension.pdf
Libro sobre Hipertensión Pulmonar
Pulmonary Hypertension
Edited by Jean M. Elwing and Ralph J. Panos, ISBN 978-953-51-1165-8, Hard cover, 233 pages, Publisher: InTech, Chapters published July 17, 2013 under CC BY 3.0 license
DOI: 10.5772/45912
This volume presents overviews as well as in depth reviews of many aspects of the clinical presentation, pathophysiology, and treatment of Pulmonary Hypertension (PH) especially PH related to thromboembolic disease. Saleem Sharieff presents a comprehensive synopsis of the epidemiologic, clinical, histopathologic, and therapy of PAH. Next, Dimitar Sajkov, Bliegh Mupunga, Jeffrey J. Bowden, and Nikolai Petrovsky comprehensively review World Health Organization group III PH. The cellular and biochemical pathophysiology of PH are summarized by Rajamma Mathew. Specific mechanisms implicated in the pathogenesis of PH are presented by Junko Maruyama, Ayumu Yokochi, Erquan Zhang, Hirohumi Sawada, Kazuo Maruyama; and Aureliano Hernandez and Rafael A. Areiza. Jean Elwing and Ralph Panos discuss PH associated with acute thromboembolism. Mehdi Badidi and M Barek Naz discuss PH caused by chronic thromboembolic disease. Juan C. Grignola, Maria J. Ruiz-Cano, Juan P. Salisbury, Gabriela Pascal, Pablo Curbelo, and Pilar Escribano present the physiologic assessment of patients with chronic thromboembolic disease prior to surgical pulmonary endarterectomy and, finally, Henry Liu, Philip L. Kalarickal, Yiru Tong, Daisuke Inui, Michael J Yarborough, Kavitha A. Mathew, Amanda Gelineau, and Charles Fox comprehensively review the clinical perioperative evaluation and management of patients with PH due to chronic thromboembolic disease.
http://www.intechopen.com/books/pulmonary-hypertension
Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Pediatric cuffed endotracheal tubes: an evolution of care.
Taylor C, Subaiya L, Corsino D.
Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2011 Spring;11(1):52-6.
Abstract
PURPOSE: To examine the history of pediatric endotracheal intubation and the issues surrounding the change from uncuffed endotracheal tubes to cuffed endotracheal tubes, including pediatric airway anatomy, endotracheal tube design, complications, and safety concerns. METHOD:Review of the literature. CONCLUSIONS:Although the use of cuffed endotracheal tubes in infants and children remains a topic of debate, the literature supports this change in practice. Meticulous attention must be given to intracuff pressure. Cuffed endotracheal tubes designed especially for the pediatric patient may increase the margin of safety.
KEYWORDS:Cuffed endotracheal tube, equipment design, pediatric airway, stridor, subglottic stenosis, tracheal intubation, ventilation
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096176/pdf/i1524-5012-11-1-52.pdf
Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
