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Bibliotecas: paraísos circulares El Mundo Grandes escritores y filósofos han encontrado su fuente de inspiración en las bibliotecas, donde trabajaron durante un periodo de su vida y gestaron ...
Una biblioteca que fue apadrinada por Borges DiarioPopular.com.ar Por ello, cobra relevancia que una biblioteca continúe gozando de buena salud, cada vez que un libro es abierto para que derroche cultura.
Inauguraron la biblioteca “Rincón Mágico” Diario El Esquiu En el marco de la transformación de las viejas guarderías en Centros de Desarrollo Infantil (CDI), el Ministerio de Desarrollo Social dejó habilitada ...
Blog de la Embajada de la República Argentina en el Reino de España ⋅ emba Biblioteca de Derechos Humanos Eduardo Luis Duhalde · Derechos Humanos · Portada Biblioteca. Sitios de interés. BIBLIOTECA DE DERECHOS ...
Correo Cultural ⋅ Franco Mendoza Como parte de las actividades del Club de Lectura de Poesía que desarrolla Cultura Chacao en la Sala Eugenio Montejo de la Biblioteca Los Palos ...
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itba.edu.ar Nuestra biblioteca ofrece un amplio catálogo de bibliografía actual e histórica, disponible para la comunidad del ITBA, así como para los egresados y ...
Biblioteca virtual itba.edu.ar Con el fin de facilitar el acceso al material de estudio, la Biblioteca pone a disposición una colección de e-books seleccionados a partir de la ...
Concurso en Facebook: “Yo uso mi biblioteca pública” Sistema Nacional de Bibliotecas Públicas Usas regularmente la biblioteca pública de tu comuna? ¿Sientes que es un espacio tuyo, donde puedes leer, usar Internet, hacer talleres o ...
Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 4 de Junio 2014 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Programa Nacional de apoyo a la Lactancia materna, avances” por “Dra. Ericka Garcia Flores”, Pediatra de la Cd. México.La sesión inicia puntualmente las 21 hrs. Para entrar a la Sala de Conferencia: 1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador http://connectpro60196372.adobeconnect.com/programa_nacional/ 2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco 3.- Hacer click en el espacio que dice “Entrar en la Sala” 5.- A disfrutar la conferencia 6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.
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sábado, 31 de mayo de 2014
Un formulario de evaluación preanestésica en UCI reduce información clave perdida
An ICU Preanesthesia Evaluation Form Reduces Missing Preoperative Key Information. Chuy K, Yan Z, Fleisher L, Liu R. J Anesth Clin Res. 2012 Sep 28;3(9). pii: 1000242. Abstract BACKGROUND: A comprehensive preoperative evaluation is critical for providing anesthetic care for patients from the intensive care unit (ICU). There has been no preoperative evaluation form specific for ICU patients that allows for a rapid and focused evaluation by anesthesia providers, including junior residents. In this study, a specific preoperative form was designed for ICU patients and evaluated to allow residents to perform the most relevant and important preoperative evaluations efficiently. METHODS: The following steps were utilized for developing the preoperative evaluation form: 1) designed a new preoperative form specific for ICU patients; 2) had the form reviewed by attending physicians and residents, followed by multiple revisions; 3) conducted test releases and revisions; 4) released the final version and conducted a survey; 5) compared data collection from new ICU form with that from a previously used generic form. Each piece of information on the forms was assigned a score, and the score for the total missing information was determined. The score for each form was presented as mean ± standard deviation (SD), and compared by unpaired t test. A P value < 0.05 was considered statistically significant. RESULTS: Of 52 anesthesiologists (19 attending physicians, 33 residents) responding to the survey, 90% preferred the final new form; and 56% thought the new form would reduce perioperative risk for ICU patients. Forty percent were unsure whether the form would reduce perioperative risk. Over a three month period, we randomly collected 32 generic forms and 25 new forms. The average score for missing data was 23 ± 10 for the generic form and 8 ± 4 for the new form (P = 2.58E-11). CONCLUSIONS: A preoperative evaluation form designed specifically for ICU patients is well accepted by anesthesia providers and helped to reduce missing key preoperative information. Such an approach is important for perioperative patient safety. KEYWORDS: Anesthesia, Intensive care unit, Operating room, Patients http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708313/pdf/nihms479759.pdf
Pruebas de embarazo preoperatorias
Preoperative pregnancy testing. Maher JL, Mahabir RC. Can J Plast Surg. 2012 Fall;20(3):e32-4. Abstract BACKGROUND: In up to 2% of all pregnancies, the need for general anesthesia in a nonobstetrical surgery arises. Surgery on a pregnant woman may have significant implications for the fetus, patient, physician and hospital. On review of the plastic surgery literature, the authors were unable to find current guidelines or recommendations for preoperative pregnancy testing in the plastic surgery patient population. METHODS: Literature regarding maternal and fetal risk during anesthesia and surgery, as well as preoperative pregnancy testing was identified by performing a PubMed, OVID and MEDLINE key word search. The current literature was subsequently reviewed and summarized. RESULTS: A report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation allows physicians and hospitals to implement their own policies and practices with regard to preoperative pregnancy testing. The overall frequency of an incidentally found positive preoperative pregnancy test ranges from 0.34% to 2.4%. DISCUSSION: Various studies have reported increased rates of spontaneous abortions, congenital anomalies, such as neural tube defects, and low and very low birth weight infants born to mothers exposed to anesthesia and surgery during pregnancy. Because the accepted practice is to postpone elective surgery during pregnancy, identifying these patients before surgery is critical. CONCLUSIONS: Based on the current evidence, the authors' best practice recommendation for preoperative pregnancy testing is provided. KEYWORDS: Anesthesia, Pregnancy testing, Preoperative assessment, Surgery during pregnancy
Evaluación preoperatoria y preparación para anestesia y cirugía
Preoperative evaluation and preparation for anesthesia and surgery. Hippokratia. 2007 Jan;11(1):13-21. Zambouri A. Abstract The ultimate goals of preoperative medical assessment are to reduce the patient's surgical and anesthetic perioperative morbidity or mortality, and to return him to desirable functioning as quickly as possible. It is imperative to realize that "perioperative" risk is multifactorial and a function of the preoperative medical condition of the patient, the invasiveness of the surgical procedure and the type of anesthetic administered. A history and physical examination, focusing on risk factors for cardiac and pulmonary complications and a determination of the patient's functional capacity, are essential to any preoperative evaluation. Laboratory investigations should be ordered only when indicated by the patient's medical status, drug therapy, or the nature of the proposed procedure and not on a routine basis. Persons without concomitant medical problems may need little more than a quick medical review. Those with comorbidity should be optimized for the procedure. Proper consultations with appropriate medical services should be obtained to improve the patient's health. These consultations should ideally not be done in a "last second" fashion. The preoperative preparation involves procedures that are implemented based on the nature of the expected operation as well as the findings of the diagnostic workup and the preoperative evaluation. KEYWORDS: anesthetic risk, perioperative risk, preoperative assessment, preoperative preparation
Biblioteca municipal de Quilleco celebró 10 años de vida La Tribuna de Los Ángeles Desde un comienzo, la biblioteca municipal funciona gracias al convenio firmado entre la municipalidad de Quilleco y la Dibam (Dirección de ...
El Tribuno.com.ar
Buscan apoyo para una biblioteca móvil El Tribuno.com.ar Con esta premisa decidió darle forma al proyecto de una biblioteca móvil. La intención es trasladarla por las escuelas de Orán, plazas, sitios de ...
BIBLIOTECA EMPRESARIA El Cronista Para comprender esta obra pluriindividual, quizá sea necesario entender que el sistema capitalista experimenta no una de sus tantas crisis ...
El Litoral
Cine debate en la biblioteca Mariño El Litoral "Cinco Días sin Nora" se proyectará hoy a las 21.30 en la biblioteca Mariño (Santa Fe 847) como parte del ciclo de cine-debate que se viene ...
Estado de México, sin bibliotecas digitales El Universal Aunque un proyecto impulsado en el Estado de México por el actual gobernador, Eruviel Ávila, se proponía equipar con bibliotecas digitales a todos ...
WEBLOG NEWS AT IE UNIVERSITY ⋅ Roberto Arribas El jueves 29 de mayo, a las 19,00 horas, la Biblioteca Pública de Segovia acoge la presentación del último libro del profesor de IE University Juan ...
circa - Biblioteca Nacional | Agenda bn.gov.ar LA BIBLIOTECA ... pertenecientes al nuevo fondo fotográfico de la Biblioteca Nacional de alrededor de 1.400 negativos sobre la primera y segunda ...
Red de Bibliotecas y Archivos del CSIC - csic.es csic.es Nuevo recurso en la Biblioteca Virtual del CSIC: ProQuest Dissertations & Theses Global. Volver a la página índice. Se ha incorporado a colección de ...
Eutanasia y suicidio en la antiguedad: Opinión de los dramaturgos y filósofos
Euthanasia and suicide in antiquity: viewpoint of the dramatists and philosophers. Papadimitriou JD, Skiadas P, Mavrantonis CS, Polimeropoulos V, Papadimitriou DJ, Papacostas KJ. J R Soc Med. 2007 Jan;100(1):25-8 Although more than 3000 years have passed, the dilemma posed by euthanasia still generally divides society-a vexed question which has been debated in the medical, legal, philosophical and theological literature. In antiquity, active euthanasia and suicide were subjects of concern. Active euthanasia was rejected by the majority of both philosophers and dramatists because it was considered to be a violation of the autonomy of the individual and an action against the will of the gods. Passive euthanasia was more acceptable, either on the grounds of physical pain or out of a deep respect for the nature of human life and what fate brings to it. Even though innovations in palliative medicine can offer the best possible quality of life, there is still a minority of patients who suffer from excruciating pain, be it physical or mental. For these patients, it is the primary duty of the physician to alleviate the pain or other sufferings, provided that the doctor plays no role in initiating the course of death, at least in countries where active euthanasia is not legally permitted. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761665/pdf/0025.pdf
Suicidio y eutanasia asistidas por el médico. ¿Puede imaginarse enseñando a sus estudiantes como terminar las vidas de sus pacientes?
Physician-assisted suicide and euthanasia: can you even imagine teaching medical students how to end their patients' lives? Boudreau JD. Perm J. 2011 Fall;15(4):79-84. Abstract The peer-reviewed literature includes numerous well-informed opinions on the topics of euthanasia and physician-assisted suicide. However, there is a paucity of commentary on the interface of these issues with medical education. This is surprising, given the universal assumption that in the event of the legalization of euthanasia, the individuals on whom society expects to confer the primary responsibility for carrying out these acts are members of the medical profession. Medical students and residents would inevitably and necessarily be implicated. It is my perspective that everyone in the profession, including those charged with educating future generations of physicians, has a critical interest in participating in this ongoing debate. I explore potential implications for medical education of a widespread sanctioning of physician-inflicted and physician-assisted death. My analysis, which uses a consequential-basis approach, leads me to conclude that euthanasia, when understood to include physician aid in hastening death, is incommensurate with humanism and the practice of medicine that considers healing as its overriding mandate. I ask readers to imagine the consequences of being required to teach students how to end their patients' lives and urge medical educators to remain cognizant of their responsibility in upholding long-entrenched and foundational professional values.
Quitando el tabú del control para morir. Un estudio de la teoría fundamentada De-tabooing dying control - a grounded theory study. Thulesius HO, Scott H, Helgesson G, Lynöe N. BMC Palliat Care. 2013 Mar 13;12:13. doi: 10.1186/1472-684X-12-13. Abstract BACKGROUND:Dying is inescapable yet remains a neglected issue in modern health care. The research question in this study was "what is going on in the field of dying today?" What emerged was to eventually present a grounded theory of control of dying focusing specifically on how people react in relation to issues about euthanasia and physician-assisted suicide (PAS). METHODS:Classic grounded theory was used to analyze interviews with 55 laypersons and health care professionals in North America and Europe, surveys on attitudes to PAS among physicians and the Swedish general public, and scientific literature, North American discussion forum websites, and news sites.RESULTS:Open awareness of the nature and timing of a patient's death became common in health care during the 1960s in the Western world. Open dying awareness contexts can be seen as the start of a weakening of a taboo towards controlled dying called de-tabooing. The growth of the hospice movement and palliative care, but also the legalization of euthanasia and PAS in the Benelux countries, and PAS in Montana, Oregon and Washington further represents de-tabooing dying control. An attitude positioning between the taboo of dying control and a growing taboo against questioning patient autonomy and self-determination called de-paternalizing is another aspect of de-tabooing. When confronted with a taboo, people first react emotionally based on "gut feelings" - emotional positioning. This is followed by reasoning and label wrestling using euphemisms and dysphemisms - reflective positioning. Rarely is de-tabooing unconditional but enabled by stipulated positioning as in soft laws (palliative care guidelines) and hard laws (euthanasia/PAS legislation). From a global perspective three shapes of dying control emerge. First, suboptimal palliative care in closed awareness contexts seen in Asian, Islamic and Latin cultures, called closed dying. Second, palliative care and sedation therapy, but not euthanasia or PAS, is seen in Europe and North America, called open dying with reversible medical control. Third, palliative care, sedation therapy, and PAS or euthanasia occurs together in the Benelux countries, Oregon, Washington and Montana, called open dying with irreversible medical control. CONCLUSIONS: De-tabooing dying control is an assumed secular process starting with open awareness contexts of dying half a century ago, and continuing with the growth of the palliative care movement and later euthanasia and PAS legislation.
Dispositivos médicos para el anestesista: perspectivas actuales.
Medical devices for the anesthetist: current perspectives. Ingrande J, Lemmens HJ. Med Devices (Auckl). 2014 Mar 25;7:45-53. eCollection 2014. Abstract Anesthesiologists are unique among most physicians in that they routinely use technology and medical devices to carry out their daily activities. Recently, there have been significant advances in medical technology. These advances have increased the number and utility of medical devices available to the anesthesiologist. There is little doubt that these new tools have improved the practice of anesthesia. Monitoring has become more comprehensive and less invasive, airway management has become easier, and placement of central venous catheters and regional nerve blockade has become faster and safer. This review focuses on key medical devices such as cardiovascular monitors, airway equipment, neuromonitoring tools,ultrasound, and target controlled drug delivery software and hardware. This review demonstrates how advances in these areas have improved the safety and efficacy of anesthesia and facilitate its administration. When applicable, indications and contraindications to the use of these novel devices will be explored as well as the controversies surrounding their use. KEYWORDS: Catheters, closed-loop anesthesia, echocardiography, fiberoptic bronchoscope, laryngeal mask airway, ultrasound
Arranca la Biblioteca Digital Periódico Zócalo La Secretaría de Educación, a través de la Coordinación General de Bibliotecas, Publicaciones y Librerías del Estado, dio forma a Biblioteca Digital ...
Cuentacuentos en la biblioteca El Correo La biblioteca Joxe Miel Barandiaran acogerá este viernes una nueva sesión de cuentacuentos dirigida a los niños mayores de cuatro años.
Biblioteca Provincial de Maestros ⋅ Biblioteca Provincial de Maestros comunicación para la cooperación y colaboración” está dirigido a directores, dirigentes de bibliotecas populares, docentes, bibliotecarios escolares y ...
RecBib - Recursos Bibliotecarios ⋅ JulianMarquina Bolsa de trabajo de encargado de la biblioteca municipal y contabilidad Puebla ... Abren cinco bibliotecas personales de grandes literatos mexicanos.
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Muestra en la Biblioteca de la UNLP: Libros que Muerden Universidad Nacional de La Plata Del 26 de 30 de mayo se lleva a cabo la jornada “Libros que Muerden” en la Biblioteca Pública de la Universidad Nacional de La Plata, Plaza Rocha ...
En la BIblioteca de Girardota Biblioteca Nacional de Colombia En la BIblioteca de Girardota. Mayo de 2014. Amplia, iluminada y organizada: así es la Biblioteca Pública Municipal Jacinto Benavente, del municipio ...
El Diálogo Biblioteca Nacional | Agenda Celebraciones y buenas noticias en el cine argentino. Ciclo de Cine independiente y de autor de la BibliotecaNacional y La Nave de los Sueños.
La recolección y archivado de las publicaciones en línea Biblioteca Nacional de España La necesidad de abordar recolecciones web colaborativas a nivel mundial, las expectativas de los investigadores ante estas colecciones, ...
Leer más Biblioteca Nacional | Agenda Panel con la participación de Carlos Abalo y Guillermo Wierzba. Organiza Comisión de Capacitación - ATE BibliotecaNacional. Encuentros.
Biblioteca Vasconcelos Biblioteca Vasconcelos Secretaría de Educación Pública - Conaculta Biblioteca Vasconcelos ... Dirección General de Bibliotecas (DGB) ·Biblioteca de México (Ciudadela).
Biblioteca Vasconcelos Biblioteca Vasconcelos La Biblioteca Vasconcelos y la Embajada de Israel en México te invitan al Ciclo de Cine de Israel. "Vals con Bashir" Lunes 26 mayo 2014 17:00 horas
Las bibliotecas catalanas venderán ebooks Todo eReaders Este novedoso acuerdo en nuestro país, ya que en otros países ya existe la cosa, permitirá a los usuarios de las bibliotecas comprar ebooks y libros, ...
ComputerHoy
Lektu: ebooks gratis si lo tuiteas ComputerHoy Lektu es una tienda de ebooks que trabaja con editoriales y autores independientes, aunque gracias a su relación con firmas como Gigamesh tiene ...
Editorial Ink 'inyecta tinta' a e-books El Financiero A diferencia de los libros electrónicos tradicionales, la compañía ofrece a los lectores toda una experiencia con sonidos, fotografías, videos y luces, ...
BitLit, el nuevo hijo de Michael Serbinis Todo eReaders Ya hace meses que Michael Serbinis dejó Kobo y aunque parece que había dejado de lado el mundo de los ebooks, Serbinis ha vuelto y a lo grande, ...
Comunicación Cultural ⋅ José Antonio Vázquez Esta transparencia va a acompañada de una fuerte apuesta por la venta de los ebooks sin DRM, una actitud cada vez más frecuente en mercados ...
Analgesia neonatal: un tema descuidado en los trópicos
Neonatal analgesia: A neglected issue in the tropics . Obu HA, Chinawa JM. Niger Med J [serial online] 2014 [cited 2014 May 7];55:183-7. Abstract Pain control in newborns is poorly understood and often neglected in neonatal practice in many settings in our environment. Managing pain among newborns can be quite challenging and the effectiveness of various interventions used to ameliorate pain in this category of patients are either unknown or poorly understood by many a people engaged in the care of newborns in one way or the other. A search for published works on neonatal analgesia was performed using Google and PubMed. The Cochrane Database of Systematic Reviews was also searched. The areas of focus were definition, pathophysiology and management of pain in neonates. Relevant information was extracted and processed. Contrary to what is widely believed in many quarters, howbeit erroneously, there is compelling evidence that newborns do indeed feel pain. Supportive care, comprising of use of sucrose, glucose, breastfeeding, kangaroo mother care are worthwhile measures in ameliorating pain in the newborn. Novel therapies (such as sensorial saturation and swaddling) have been evaluated and proven useful. The use of sedation did not show any beneficial results. Keywords: Control, neonates, pain
La primera biblioteca de la provincia cumple 104 años TerritorioDigital.com La biblioteca popular Patricias Argentinas de esta localidad es la más antigua de la provincia y conserva libros del Siglo XIX, tiene una sala dedicada ...
Biblioteca de COVINUVI cumple 33 años El Acontecer Diario La actividad es abierta a todo público y gratuita, y estará comenzando a la hora 19:30, realizándose en el propio local de la Biblioteca, en Avda.
La Biblioteca adquirió ejemplares en la Feria del Libro Veradia.com La Biblioteca “Dr. Andrés Sanséau” adquirió numerosos ejemplares en la Feria Internacional del Libro, a través de la visita realizada por la directora ...
Las bibliotecas catalanas venderán ebooks Todo eReaders Este novedoso acuerdo en nuestro país, ya que en otros países ya existe la cosa, permitirá a los usuarios de lasbibliotecas comprar ebooks y libros, ...
El Sol de Tijuana
Abandonan bibliotecas del este de la ciudad El Sol de Tijuana Tijuana.- Bibliotecas de Tijuana necesitan atención por parte de las autoridades para hacerlas atractivas a toda la comunidad, sobre todo aquellas de ...
El Nacional.com
Fisgón de bibliotecas: José Ramón Medina El Nacional.com Un amigo de Kafka, el libro de relatos de Isaac Bashevis Singer, en la edición de la BibliotecaUniversal Planeta de la década del setenta, está sobre ...
El Universal
Dirección de Bibliotecas fomenta lectura digital El Universal Con el objetivo de satisfacer las necesidades de los lectores digitales, la Dirección General deBibliotecas (DGB), del Consejo Nacional para la ...
Bibliotecas en los parques a partir de la próxima semana El Faro del Guadarrama A partir de la próxima semana, y hasta el mes de septiembre, las bibliotecas de Collado Villalba saldrán a los parques para incentivar la lectura entre ...
RecBib - Recursos Bibliotecarios ⋅ JulianMarquina López López, Pedro and Vives-Gràcia, Josep. Ética y derechos humanos para bibliotecas y archivos., 2013 ANABAD. [Book]
Universo Abierto ⋅ julio Monográfico: Libros electrónicos en bibliotecas Monográfico La integración del libro electrónico en las bibliotecassupone una oportunidad de.
El Blog de Cumplasa ⋅ CRA En ellas, se han ofrecido estrategias para potenciar el entorno virtual de las bibliotecas, la mejora de la educación en información del alumnado, ...
Javier Leiva Aguilera ⋅ Javier Francisca Pulgar me envía un video que han realizado en el Servicio de Bibliotecas de Euskadi y que sirve para conmemorar a través de fotos ...
Hacia la Evaluación y Acreditación de Bibliotecas Universitarias ⋅ Rosa María Merino Desde su fundación las actividades del grupo se concentran en desarrollar las capacidades de las bibliotecasuniversitarias en la provisión de ...
RecBib - Recursos Bibliotecarios ⋅ JulianMarquina Quince bibliotecas públicas catalanas, entre las que se encuentran dos de Barcelona, cuatro de Girona, la Provincial de Lleida o la de Cornellà, son ...
AtocTli ⋅ admin Un día entré a una biblioteca pública, nadie me dijo nada. Pasé mucho tiempo entretenida mirando libros y revistas que pensé me servirían para ...
EdoMex Al Día ⋅ Jorge EDOMEX LUGAR CON MÁS BIBLIOTECAS EN EL PAÍS. Eruviel Ávila Villegas, destacó que el Estado de México tiene un lugar preponderante en el ...
RINCON DEL BIBLIOTECARIO ⋅ Ernesto Della Riva En las Bibliotecas Populares son los propios coordinadores de los 2 mil recintos los que deciden qué comprar, cuántos ejemplares de cada título ...
WEB Mi Biblioteca | Bibliotecas Universidad de Salamanca usal.es Mi Biblioteca. La tarjeta universitaria permite acceder a sus datos personales y a la información sobre los documentos que tiene en préstamo y que ...
Twitter / Search - #Bibliotecas twitter.com #biblioteques #bibliotecas,un centenario de éxito. pic.twitter.com/ ... Las #bibliotecas públicas catalanas venderán #libros de papel y digitales desde ...
Cooperación | Bibliotecas Universidad de Salamanca usal.es Cooperación. La red de bibliotecas de la Universidad de Salamanca pertenece a las siguientes redes y consorcios: BUCLE. Consorcio de Bibliotecas ...
Normativas | Bibliotecas Universidad de Salamanca usal.es Normativas. Reglamentos del Servicio de Bibliotecas de la Universidad de Salamanca. Adenda a los Reglamentos de préstamo de documentos y ...
Twitter / Search - #Bibliotecas twitter.com El @Govern impulsará la ubicación de #librerías en las #bibliotecas - http://goo.gl/ .... Recordamos los horarios de las #bibliotecas de @unisevilla ...
Twitter / Search - #bibliotecas twitter.com Ya tienes disponibles los carteles de los 6 Congresos de #Bibliotecas ... Red Bibliotecas CSIC Red de Bibliotecas Biblioteca Catalunya Biblioteca do ...
Rendimiento de técnica aséptica de analgesia neuroaxial para el trabajo de parto antes y después de la publicación de las guías internacionales sobre asepsia
Performance of aseptic technique during neuraxial analgesia for labor before and after the publication of international guidelines on aseptic technique. Ioscovich A, Davidson EM, Orbach-Zinger S, Rudich Z, Ivry S, Rosen LJ, Avidan A, Ginosar Y. Isr J Health Policy Res. 2014 Mar 25;3(1):9. doi: 10.1186/2045-4015-3-9. Abstract BACKGROUND:Aseptic technique and handwashing have been shown to be important factors in perioperative bacterial transmission, however compliance often remains low despite guidelines and educational programs. Infectious complications of neuraxial (epidural and spinal) anesthesia are severe but fortunately rare. We conducted a survey to assess aseptic technique practices for neuraxial anesthesia in Israel before and after publication of international guidelines (which focused on handwashing, jewelry/watch removal and the wearing of a mask and cap). CONCLUSION:Self-reported aseptic technique by Israeli anesthesiologists improved in the survey conducted after the publication of international guidelines. Although the before-after study design cannot prove a cause-effect relationship, it does show an association between the publication of international guidelines and significant improvement in self-reported aseptic technique. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987696/pdf/2045-4015-3-9.pdf
Efectos maternos y neonatales por la adición de morfina y a dosis de bupivacaína para analgesia epidural en trabajo de parto
Maternal and neonatal effects of adding morphine to low-dose bupivacaine for epidural labor analgesia.
Dostbil A, Celik M, Alici HA, Erdem AF, Aksoy M, Ahiskalioglu A.
AIM:Labor is one of the most painful experiences a woman may face during her lifetime. One of the most effective methods used for eliminating this pain is epidural analgesia. The aim of this study to determine the impact of adding morphine to low-dose bupivacaine epidural anesthesia on labor and neonatal outcomes, and maternal side effects. MATERIALS AND METHODS: This is a prospective randomized double-blind study comparing two regimens of anesthetic agents used for epidural anesthesia in labor. A total of 120 pregnant women were randomized into two groups with 60 subjects in each study arm. A catheter was inserted, and 0.1% bupivacaine + 2 μg/mL fentanyl in 15 mL saline were given to Group bupivacaine-fentanyl (Group BF), while 0.0625% bupivacaine + 2 μg/ml fentanyl + 2 mg morphine in 15 mL saline were given to Group bupivacaine-fentanyl-morphine (Group BFM) with no test dosing from the needle. No morphine was added to the subsequent epidural injections in Group BFM. RESULTS: The total dose of bupivacaine was significantly lower in Group BFM relative to Group BF (P = 0.0001). The visual analogu scalescores at 15, 30, and 45 min were significantly lower in Group BF compared to thosein Group BFM (P = 0.0001, P = 0.001, and P = 0.006, respectively). The second stage of labor was significantly shorter in Group BFM relative to Group BF (P = 0.027 and P = 0.003, respectively). The satisfaction withanalgesia following the first dose was higher in the nonmorphine group (P = 0.0001). However, maternal postpartum satisfaction was similar in both groups. Either nausea or vomiting was recorded in eight patients in Group BFM. CONCLUSION:We believe that epidural analgesia comprised of a low-dose local anaesthetic and 2 mg morphine provides a painless labor that significantly reducesthe use of local anesthetic without changing the efficiency of the analgesic, ensuring the mother's satisfaction without leading to an adverse effect on the mother or foetus, while mildly (but significantly) shortening the second stage of labor.