Dependencia a ketamina en un anestesiólogo. ¿Riesgo ocupacional?
Ketamine dependence in an anesthesiologist: an occupational hazard?
Goyal S, Ambekar A, Ray R.
Indian J Psychol Med. 2014 Jul;36(3):335-7. doi: 10.4103/0253-7176.135395.
Abstract
Substance abuse among medical professionals is a cause for concern. Certain psychotropic substances such as ketamine are at easy dispense to anesthesiologists increasing the likelihood of misuse and dependence and raise several issues including safety of patients. We discuss a case demonstrating ketamine dependence in an anesthesiologist from India. The reported psychotropic effects of ketamine ranged from dissociation and depersonalization to psychotic experiences. There was also development of significant tolerance to ketamine without prominent physical withdrawal symptoms and cyclical use of very high doses was observed. Issues related to management of health professionals are also discussed.
KEYWORDS: Anesthesiologist; ketamine; medical professionals
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100428/
Usarla o no. Actualización sobre el uso legal e ilegal de ketamina
To use or not to use: an update on licit and illicit ketamine use.
Li JH, Vicknasingam B, Cheung YW, Zhou W, Nurhidayat AW, Jarlais DC, Schottenfeld R.
Subst Abuse Rehabil. 2011 Mar 16;2:11-20. doi: 10.2147/SAR.S15458. eCollection 2011.
Abstract
Ketamine, a derivative of phencyclidine that was developed in the 1960s, is an anesthetic and analgesic with hallucinogenic effects. In this paper, the pharmacological and toxicological effects of ketamine are briefly reviewed. Ketamine possesses a wide safety margin but such a therapeutic benefit is somewhat offset by its emergence phenomenon (mind-body dissociation and delirium) and hallucinogenic effects. The increasing abuse of ketamine, initially predominantly in recreational scenes to experience a "k-hole" and other hallucinatory effects but more recently also as a drug abused during the workday or at home, has further pushed governments to confine its usage in many countries. Recently, urinary tract dysfunction has been associated with long-term ketamine use. In some long-term ketamine users, such damage can be irreversible and could result in renal failure and dialysis. Although ketamine has not yet been scheduled in the United Nations Conventions, previous studies using different assessment parameters to score the overall harms of drugs indicated that ketamine may cause more harm than some of the United Nations scheduled drugs. Some countries in Southeast and East Asia have reported an escalating situation of ketamine abuse. Dependence, lower urinary tract dysfunction, and sexual impulse or violence were the most notable among the ketamine-associated symptoms in these countries. These results implied that the danger ofketamine may have been underestimated previously. Therefore, the severity levels of the ketamine-associated problems should be scrutinized more carefully and objectively. To prevent ketamine from being improperly used and evolving into an epidemic, a thorough survey on the prevalence and characteristics of illicit ketamine use is imperative so that suitable policy and measures can be taken. On the other hand, recent findings thatketamine could be useful for treating major depressive disorder has given this old drug a new impetus. If ketamine is indeed a remedy for treating depression, more research on the risks and benefits of its clinical use will be indispensable.
KEYWORDS: anti-depressant; cognitive impairment; epidemiology; ketamine; psychedelic effects; urinary tract dysfunction
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3846302/pdf/sar-2-011.pdf
Ketamina. OMS 2012
Ketamine. Expert peer review on critical review report (1). 35th Expert Committee on Drug Dependence, Hammamet, Tunisia
June 4-8, 2012, WHO
http://www.who.int/medicines/areas/quality_safety/4.2.1ExpertreviewKetaminecriticalreview.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
El virus de Ebola se descubrió en
Zaire ahora (el Congo) en 1967 desde entonces han muerto mas de 1000 personas
se encuentra en la costa oeste de africa (ver el mapa)
es un virus RNA de la familia filovirus.
Se considera una ZOONOSIS, ya que el repertorio es un animal, una variedad murciélago
y se transmite al humano por líquidos corporales de animales infectados, o de humanos ( sangre, heces , orina) no se transmite de persona a persona,
Ha habido 20 brotes y han muerto menos de 1600 personas hasta el 2014, El país con mas muertes es Uganda.
![]()
El pedido de incubación es de 4-7 días aunque puede ser mas largo.
el cuadro clínico vean la imagen siguiente
La enfermedad facilita su transmisión ya que hay lugares donde se lava el cuerpo de la persona
que fallece.
![]()
--
la enfermedad no tiene tratamiento especifico, y la mortalidad no es tan alta como se ha comentado
El control y aislamiento del enfermo ayuda a controlar la diseminación del enfermedad
El manejo es solamente de soporte, pero con buenos recursos médicos la mortalidad disminuye mucho.
Terapia no autorizada aun es Ac de Raton Humanizado,
Hay dos vacunas en puerta una que utiliza adenovirus que codifica unas glicoproteinas y otra que utiliza un virus de estomatitis vesicular.
Aunque se considera que el control de la enfermedad se puede lograr con tres pasos
1.- Buenas practicas de salud Publica
2.- Apoyo e integración con las comunidades con problemas
3.- Asistencia Internacional suficientemente generosa
https://app.box.com/s/jkolvbwjmb5j45ury7l0
otros artículos recientes de Ebola virus
https://app.box.com/s/0hbsr5ckyvb9bffzjyg7
henrys
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Enseñando intubación traqueal. Airtraq es superior al laringoscopio de Macintosh
Teaching tracheal intubation: Airtraq is superior to Macintosh laryngoscope.
Zhao H, Feng Y, Zhou Y.
BMC Med Educ. 2014 Jul 16;14:144. doi: 10.1186/1472-6920-14-144.
Abstract
BACKGROUND:Tracheal intubation with Macintosh laryngoscope is taught to medical students as it is a lifesaving procedure. However, it is a difficult technique to learn and the consequences of intubation failure are potentially serious. The Airtraq optical laryngoscope is a relatively novel intubation device, which allows visualization of the glottic plane without alignment of the oral, pharyngeal, and tracheal axes, possessing advantages over Macintosh for novice personnel. We introduced a teaching mode featured with a progressive evaluation scheme for preparation and performance of tracheal intubation with medical students in this prospective randomized crossover trial who had no prior airway management experience to find the superior one. METHODS: Twenty-six medical students of the 8-year programme in the 6th year participated in this trial, when they did their one-week rotation in the department of anaesthesiology. Each of the students intubated 6 patients, who were scheduled for surgeries under general anaesthesia, each laryngoscope for 3 patients respectively. One hundred and forty-nine consecutive patients scheduled for surgical procedures requiring tracheal intubation were enrolled. Patients were randomly allocated to undergo tracheal intubation using Macintosh (n = 75) or Airtraq (n =74) laryngoscope. The progressive evaluation scheme was applied to each intubation attempt. RESULTS: Intubation success rate was significantly higher in Airtraq group than Macintosh group (87.8% vs. 66.7%, P < 0.05). Duration of glottis exposure was significantly shorter in Airtraq group compared to Macintosh group (50 ± 19 s vs. 81 ± 27 s, P < 0.001). A grade I Cormack and Lehane glottic view was obtained in 94.6% of patients in the Airtraq group versus 32% of patients in the Macintosh group (P <0.001). Duration of intubation inAirtraq group was significantly shorter (68 ± 21 s vs. 96 ± 22 s, P < 0.05) compared to Macintosh group. CONCLUSIONS: Airtraq laryngoscope is easier to master for novice personnel with a higher intubation success rate and shorter intubation duration compared with the Macintosh laryngoscope.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107482/pdf/1472-6920-14-144.pdf
Uso del Airtraq para manejo de la vía aérea en atención prehospitalaria. Estudio retrospectivo
Use of the Airtraq® device for airway management in the prehospital setting--a retrospective study.
Gellerfors M, Larsson A, Svensén CH, Gryth D.
Scand J Trauma Resusc Emerg Med. 2014 Feb 3;22:10. doi: 10.1186/1757-7241-22-10.
Abstract
BACKGROUND:Difficulties with prehospital intubations have encouraged the development of indirect laryngoscopy techniques, facilitating laryngeal visualization. Airtraq® is a relatively new single-use indirect laryngoscope. The Airtraq® has been evaluated in several prehospital mannequin intubation trials. However, prehospital clinical experience with the device is limited. METHODS:A retrospective medical chart review was performed for patients who underwent prehospital endotracheal intubation in the Stockholm County between January 2008 and December 2012. Both anaesthesiologists and nurse anaesthetists performed prehospital intubations during the study period. All Airtraq® intubations during this period were included in the analysis. The objective was to estimate the success rate of Airtraq® used in a prehospital setting.RESULTS:During the 5-year period (January 2008- December 2012), 2453 tracheal intubations were performed. Airtraq® was used in 28 cases (1%). The overall Airtraq® intubation success rate was 68%. Among patients with anticipated or unexpected difficult airway (23/28) the Airtraq® success rate was 61% (14/23). Among patients who underwent drug facilitated or rapid-sequence intubation protocols 4/5 (80%) were successfully intubated with Airtraq®. CONCLUSION:In conclusion, this retrospective study showed a higher Airtraq® success rate than previous prospective prehospital trials. However, compared to other prehospital direct and indirect intubation methods the Airtraq success rate is low. Further clinical trials are necessary to evaluate the role of Airtraq® in the prehospital airway management.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922107/pdf/1757-7241-22-10.pdf
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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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Estudio randomizado, controlado sobre la efectividad de midazolam intraarticular versus midazolam i.v. en dolor después de artroscopía
A randomized controlled trial for the effectiveness of intraarticular versus intravenous midazolam on pain after knee arthroscopy.
Sajedi P, Nemati M, Mosavi SH, Honarmand A, Safavi MR.
J Res Med Sci. 2014 May;19(5):439-44.
Abstract
BACKGROUND: This double-blinded, randomized clinical trial was designed to evaluate the comparison of intravenous versus intraarticular (IA) administration of midazolam on postoperative pain after knee arthroscopy. MATERIALS AND METHODS: In this study, 75 patients randomized in three groups to receive 75 mc/kg IA injection of midazolam and 10 ml intravenous injection of isotonic saline (Group I), 75 mc/kg intravenous injection of midazolam and 10 cc IA injection of isotonic saline (Group II) or IA and intravenous injection of isotonic saline (Group III) at the end of knee arthroscopy. Pain scores, time until the first request for analgesics, cumulative analgesic consumption, satisfaction, sedation, and complications as studied outcomes were assessed. Patients were observed for 24-h. RESULTS: IA administration of midazolam significantly reduced pain scores in the early postoperative period compared with intravenous injection. Mean of time to first analgesic requirement in Group III (33.6 min) was significantly lower than Group II (288.8 min) and Group I (427.5 min). Cumulative analgesic consumption was increased in Groups II (35.5 mg), and III (70 mg) compared with Group I (16 mg), (P < 0.0001). Complications significantly occurred in 3 of 25 patients in Group I in contrast to 20 of 25 patients in Group III (P < 0.0001). At 2-, 4- and 8-h after arthroscopy pain score significantly decreased in Group I than other groups (P < 0.0001). Patients in Group I were significantly satisfy than other groups (P < 0.0001). CONCLUSION: Results show the greater analgesic effect after IA administration of midazolam than after intravenous injection and hence, IA administration may be is the method of choice for pain relief after knee arthroscopy.
KEYWORDS: Intraarticular administration; knee arthroscopy; midazolam; postoperative pain
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116576/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116576/?report=classic
Efecto analgésico de midazolam cuando se agrega a lidocaína i.v. para anestesia regional intravenosa
The analgesic effect of midazolam when added to lidocaine for intravenous regional anaesthesia.
Kashefi P, Montazeri K, Honarmand A, Safavi M, Hosseini HM.
J Res Med Sci. 2011 Sep;16(9):1139-48.
Abstract
BACKGROUND:Midazolam has analgesic properties. The aim of the present study was to assess the analgesic effect of midazolam when added tolidocaine in intravenous regional anesthesia (IVRA). METHODS: Sixty patients undergoing hand surgery were randomly allocated into two groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total volume of 40 mL in the control group (group lidocaine saline ~ LS, n=30) or 50 μg/kg midazolam plus 3 mg/kg 2% lidocaine diluted with saline to a total volume of 40 mL in the midazolam group (group lidocaine midazolam ~ LM, n=30). Before and after the tourniquet application, hemodynamic variables, tourniquet pain, sedation, and analgesic use were recorded.RESULTS:
Shortened sensory and motor block onset time [4.20 (0.84) vs. 5.94 (0.83) min, p = 0.001 and 6.99 (0.72) vs. 9.07 (0.99) min, p = 0.001 in LM and LS groups, respectively], prolonged sensory and motor block recovery times [8.41 (0.94) vs. 5.68 (0.90) min, p = 0.001 and 11.85 (1.18) vs. 7.06 (0.82) min, p = 0.001 in LM and LS groups, respectively], shortened visual analog scale (VAS) scores of tourniquet pain (p < 0.05), and improved quality of anesthesia were found in group LM (p < 0.05). VAS scores were lower in group LM in the postoperative period (p = 0.001). Postoperativeanalgesic requirements were significantly smaller in group LM (p = 0.001). CONCLUSIONS: The addition of 50 μg/kg midazolam to lidocaine for IVRA shortens the onset of sensory and motor block, and improves quality of anesthesia and perioperative analgesia without causing side effects.
KEYWORDS: Anaesthetic Techniques; Analgesics; IV Regional Lidocaine; Midazolam; Postoperative; Tourniquet Pain
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430038/
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Fiabilidad de la escala estado físico de la American Society of Anesthesiologists en la práctica clínica.
Reliability of the American Society of Anesthesiologists physical status scale in clinical practice.
Sankar A, Johnson SR, Beattie WS, Tait G, Wijeysundera DN.
Br J Anaesth. 2014 Sep;113(3):424-32. doi: 10.1093/bja/aeu100. Epub 2014 Apr 11.
Abstract
BACKGROUND: Previous studies, which relied on hypothetical cases and chart reviews, have questioned the inter-rater reliability of the ASA physicalstatus (ASA-PS) scale. We therefore conducted a retrospective cohort study to evaluate its inter-rater reliability and validity in clinical practice. METHODS: The cohort included all adult patients (≥18 yr) who underwent elective non-cardiac surgery at a quaternary-care teaching institution in Toronto, Ontario, Canada, from March 2010 to December 2011. We assessed inter-rater reliability by comparing ASA-PS scores assigned at the preoperative assessment clinic vs the operating theatre. We also assessed the validity of the ASA-PS scale by measuring its association with patients' preoperative characteristics and postoperative outcomes. RESULTS: The cohort included 10 864 patients, of whom 5.5% were classified as ASA I, 42.0% as ASA II, 46.7% as ASA III, and 5.8% as ASA IV. The ASA-PS score had moderate inter-rater reliability (κ 0.61), with 67.0% of patients (n=7279) being assigned to the same ASA-PS class in the clinic and operating theatre, and 98.6% (n=10 712) of paired assessments being within one class of each other. The ASA-PS scale was correlated with patients' age (Spearman's ρ, 0.23), Charlson comorbidity index (ρ=0.24), revised cardiac risk index (ρ=0.40), and hospital length of stay (ρ=0.16). It had moderate ability to predict in-hospital mortality (receiver-operating characteristic curve area 0.69) and cardiac complications (receiver-operating characteristic curve area 0.70).
CONCLUSIONS: Consistent with its inherent subjectivity, the ASA-PS scale has moderate inter-rater reliability in clinical practice. It also demonstrates validity as a marker of patients' preoperative health status.
http://bja.oxfordjournals.org/content/113/3/424.full.pdf
Variabilidad de la escala de estado físico de la American Society of Anesthesiologists
Variability in the American Society of Anesthesiologists Physical Status Classification Scale.
Aronson WL, McAuliffe MS, Miller K.
AANA J. 2003 Aug;71(4):265-74.
Abstract
The American Society of Anesthesiologists (ASA) Physical Status (PS) Classification is used worldwide by anesthesia providers as an assessment of the preoperative physical health of patients. This score also has been used in policy-making, performance evaluation, resource allocation, and reimbursement of anesthesia services and frequently is cited in clinical research. The purpose of this study was to assess interrater reliability and describe sources of variability among anesthesia providers in assigning ASA PS scores. A questionnaire with 10 hypothetical patients scenarios was given to 70 anesthesia providers who were asked to assign ASA PS scores in each scenario and to provide rationale for their decisions. The data were summarized and stratified according to nurse anesthetist or anesthesiologist and military or nonmilitary anesthesia providers. We hypothesized there would be no difference between any of the anesthesia provider groups in assignment of ASA PS scores. A lack of interrater reliability in assigning ASA PS scores was demonstrated. There were no significant differences between the anesthesia provider groups. There was no correlation between ASA PS scoring and years practicing or any of the other demographic variables. Several sources of variability were identified: smoking, pregnancy, nature of the surgery, potential difficult airway, and acute injury.
http://www.aana.com/newsandjournal/documents/p265-274.pdf
Clasificación del estado físico de la American Society of Anaesthesiologists
American Society of Anaesthesiologists physical status classification.
Daabiss M.
Indian J Anaesth [serial online] 2011 [cited 2014 Aug 21];55:111-5.
Abstract
Although the American Society of Anaesthesiologists' (ASA) classification of Physical Health is a widely used grading system for preoperative health of the surgical patients, multiple variations were observed between individual anaesthetist's assessments when describing common clinical problems. This article reviews the current knowledge and evaluation regarding ASA Classification of Physical Health as well as trials for possible modification.
http://medind.nic.in/iad/t11/i2/iadt11i2p111.pdf
http://www.ijaweb.org/text.asp?2011/55/2/111/79879
http://www.ijaweb.org/article.asp?issn=0019-5049;year=2011;volume=55;issue=2;spage=111;epage=115;aulast=Daabiss
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Biblioteca
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Práctica actual y recomendaciones para la valoración cardiaca preoperatoria en pacientes con cirugía no cardiaca
Current Practice and Recommendation for Presurgical Cardiac Evaluation in Patients Undergoing Noncardiac Surgeries.
Padma S, Sundaram P S.
World J Nucl Med [serial online] 2014 [cited 2014 Aug 12];13:6-15.
Abstract
The increasing number of patients with coronary artery disease (CAD) undergoing major noncardiac surgery justifies guidelines concerning preoperative cardiac evaluation. This is compounded by increasing chances for a volatile perioperative period if the underlying cardiac problems are left uncorrected prior to major noncardiac surgeries. Preoperative cardiac evaluation requires the clinician to assess the patient's probability to have CAD, severity and stability of CAD, placing these in perspective regarding the likelihood of a perioperative cardiac complication based on the planned surgical procedure. Coronary events like new onset ischemia, infarction, or revascularization, induce a high-risk period of 6 weeks, and an intermediate-risk period of 3 months before performing noncardiac surgery. This delay is unwarranted in cases where surgery is the mainstay of treatment. The objective of this review is to offer a comprehensive algorithm in the preoperative assessment of patients undergoing noncardiac surgery and highlight the importance of myocardial perfusion imaging in risk stratifying these patients.
Keywords: Cardiac risk stratification, coronary artery disease, heart, noncardiac surgeries, stress myocardial perfusion imaging, surgery
http://www.wjnm.org/temp/WorldJNuclMed1316-4797246_131932.pdf
http://www.wjnm.org/downloadpdf.asp?issn=1450-1147;year=2014;volume=13;issue=1;spage=6;epage=15;aulast=Padma;type=2
http://www.wjnm.org/text.asp?2014/13/1/6/138568
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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Amazon dice que los ebooks no pueden valer más de 10 dólares
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Según desde donde se lo mire, Amazon, el enorme sitio de ventas por Internet, será héroe o villano. Hace rato viene en una pelea con otro gigante, ...
Amazon asegura que los ebooks no pueden valer más de 10 dólares - Venezuela Al Día
El precio de los ebooks - Sin Mordaza
ERNEST ALÓS / Barcelona - El Periódico
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ComputerHoy
Los 11 mejores lectores de eBooks de 2014, la comparativa
ComputerHoy
Se cumplen, aproximadamente, diez años de la irrupción en el mercado de estos lectores deeBooks o libros electrónicos, y todavía siguen siendo ...
Todo eReaders
¿Crees que es excesivo el precio actual de los eBooks?
Todo eReaders
Esta misma mañana hemos conocido que Amazon le ha pedido al grupo editorial Hachette que reduzca el precio de los eBooks hasta dejarlo en un ...
Amazon quiere que las editoriales rebajen el precio de los eBooks - Todo eReaders
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WWWhat's new?
Sony dice adios al mercado de e-books
FayerWayer
Con la muerte de su tienda de e-books en marzo de este año, el fin del lector de e-books de Sony estaba más que anunciado. Hoy la compañía ...
Informaria Digital
El Ministerio de Turismo de Uruguay lanza un ciclo de Ebooks donde diversifica su calidad de vida
Informaria Digital
El gobierno uruguayo, en su afán por posicionar al país no sólo como un destino de sol y playa, ha diseñado cuatro ebooks que destacan los ...
Juez aprueba que Apple pague 450 millones para zanjar caso de ebooks
Invertia
NUEVA YORK, 2 ago (Reuters) - Un acuerdo para que Apple pague 450 millones de dólares (335 millones de euros) para zanjar las denuncias de ...
WEB
Los pioneros de los e-books en México
Forbes México
La tecnología impone hoy a la industria editorial el reto de dejar atrás el papel; gracias a los e-books.
El futuro del e-book es la web
Forbes México
¿Cómo se puede acelerar la adopción del e-book si tiene problemas para que sus usuarios puedan leerlo en cualquier dispositivo o plataforma?
Efectos de dexmedetomidina intravenosa sobre bupivacaína hiperbárica espinal. Estudio radomizado
Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: A randomized study.
Dinesh CN, Sai Tej NA, Yatish B, Pujari VS, Mohan Kumar RM, Mohan CV.
Saudi J Anaesth. 2014 Apr;8(2):202-8. doi: 10.4103/1658-354X.130719.
Abstract
BACKGROUND AND OBJECTIVES:The present study was designed to evaluate the effect of intravenous dexmedetomidine on spinal anesthesia with 0.5% of hyperbaric bupivacaine. MATERIALS AND METHODS:One hundred American Society of Anesthesiologists (ASA) physical status I/II patients undergoing elective surgeries under spinal anesthesia were randomized into two groups of 50 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group D received a loading dose of 1 μg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 μg/kg/h till the end of surgery, whereas patients in group C received an equivalent quantity of normal saline. RESULTS:The time taken for regression of motor blockade to modified Bromage scale 0 was significantly prolonged in group D (220.7 ± 16.5 min) compared to group C (131 ± 10.5 min) (P < 0.001). The level of sensory block was higher in group D (T 6.88 ± 1.1) than group C (T 7.66 ± 0.8) (P < 0.001). The duration for two-dermatomal regression of sensory blockade (137.4 ± 10.9 min vs. 102.8 ± 14.8 min) and the duration of sensory block (269.8 ± 20.7 min vs. 169.2 ± 12.1 min) were significantly prolonged in group D compared to group C (P < 0.001). Intraoperative Ramsay sedation scores were higher in group D (4.4 ± 0.7) compared to group C (2 ± 0.1) (P < 0.001). Higher proportion of patients in group D had bradycardia (33% vs. 4%) (P < 0.001), as compared to group C. The 24-h mean analgesic requirement was less and the time to first request for postoperative analgesic was prolonged in group D than in group C (P < 0.001). CONCLUSION: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia.Dexmedetomidine provides excellent intraoperative sedation and postoperative analgesia.
KEYWORDS:Dexmedetomidine; Ramsay sedation scale; hyperbaric bupivacaine; intrathecal; spinal anesthesia
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2014;volume=8;issue=2;spage=202;epage=208;aulast=Dinesh;type=2
Administración perineural de dexmedetomidina combinada con ropivacaína prolonga el bloqueo braquial axilar
Perineural administration of dexmedetomidine in combination with ropivacaine prolongs axillary brachial plexus block.
Zhang Y, Wang CS, Shi JH, Sun B, Liu SJ, Li P, Li EY.
Int J Clin Exp Med. 2014 Mar 15;7(3):680-5. eCollection 2014.
Abstract
To evaluate the hypothesis that adding dexmedetomidine to ropivacaine prolongs axillary brachial plexus block. Forty-five patients of ASA I~II and aged 25-60 yr who were scheduled for elective forearm and hand surgery were randomly divided into 3 equal groups and received 40 ml of 0.33% ropivacaine + 1 ml dexmedetomidine (50 μg) (Group DR1), 40 ml of 0.33% ropivacaine + 1 ml dexmedetomidine (100 μg) (group DR2) or 40 ml of 0.33% ropivacaine + 1 ml saline (group R) in a double-blind fashion. The onset and duration of sensory and motor blocks and side effects were recorded. The demographic data and surgical characteristics were similar in each group. Sensory and motor block onset times were the same in the three groups. Sensory and motor blockade durations were longer in group DR2 than in group R (P < 0.05). There was no significant difference in the sensory blockade duration between group DR1 and group R. Bradycardia, hypertension and hypotension were not observed in group R and occurred more often in group DR2 than in group DR1. Dexmedetomidine added to ropivacaine for an axillary brachial plexus block prolongs the duration of the block. However, dexmedetomidine may also lead to side effects such as bradycardia, hypertension, and hypotension.
KEYWORDS: Dexmedetomidine; brachial plexus; ropivacaine
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992408/pdf/ijcem0007-0680.pdf
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Anestesiología y Medicina del Dolor
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Bibliotecas
Notificaciones semanales ⋅ 10 de agosto de 2014
NOTICIAS
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Las bibliotecas prestarán libros a domicilio a enfermos y personas con minusvalía
Europa Press
Y, precisamente, para resolver estas dificultades, se intentará cumplir el objetivo marcado en su día en las pautas para Bibliotecas Públicas del ...
Las bibliotecas de Leganés llevarán los libros a domicilio desde septiembre -www.politicalocal.es
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La Estrella Digital
Las bibliotecas públicas tendrán que pagar por el préstamo de libros
La Estrella Digital
La cuantía a desembolsar correrá a cargo de los presupuestos de la biblioteca y no del Ministerio de Educación como hasta ahora.
Pago en las Bibliotecas Públicas: a más libros prestados, menos dinero para comprar nuevos -Vozpopuli
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Periodico a.m.
Bibliotecas de la entidad son visitadas por 800 mil queretanos al año
Periodico a.m.
“A veces la equipación de las bibliotecas es muy complicada, porque cada centro de lectura es responsabilidad de cada municipio, lo que hemos ...
Europa Press
Una empresa nacida en la UPCT ayuda a digitalizar las bibliotecas del estado de Colorado
La Verdad
La plataforma de gestión es idónea para bibliotecas y administraciones públicas, ya que permite integrar todo el fondo bibliotecario en una nueva ...
Las bibliotecas tendrán que pagar por cada préstamo
Heraldo de Aragon
Las bibliotecas españolas tendrán que pagar a derechos de autor por valor de 0,004 euros por cada préstamo realizado y 0,05 céntimos por cada ...
La Red de Bibliotecas Municipales de Hellín tiene un censo de 8.677 usuarios
La Tribuna de Albacete
La Red de Bibliotecas Públicas Municipales es el servicio ofertado por el Ayuntamiento que cuenta con mayor aceptación ciudadana, tanto en lo que ...
Amazon dona 1.000 libros a la Red Estatal de Bibliotecas para Pacientes
Lainformacion.com
La empresa Amazon España ha donado a la Red Estatal de Bibliotecas para Pacientes 1.000 libros, fruto del acuerdo de colaboración firmado con la ...
Te Interesa
Grupos municipales de la oposición buscarán irregularidades en el proceso de selección de ...
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El principio del fin de las bibliotecas españolas
Lecturalia Blog ⋅ Alfredo Álamo
El día 1 de agosto de publicó en el BOE el pistoletazo de salida al pago por préstamo en las bibliotecas, lo que supondrá, si nada lo cambia, el inicio ...
Conoce las actividades de la Red de Bibliotecas Públicas entre el 11 y 16 de agosto
Alba Ciudad 96.3 FM ⋅ Luigino Bracci
El Instituto Autónomo Biblioteca Nacional y de Servicios de Bibliotecas, invita a todas y a todos los ciudadanos a participar en las diversas actividades ...
¡Este domingo el Día del Niño se celebra en las bibliotecas y museos de Santiago!
Plataforma Urbana ⋅ Equipo Plataforma Urbana
Agosto 9, 2014 11:00 a Agosto 10, 2014 18:00. ]La Biblioteca Nacional, el Museo Nacional de Bellas Artes y el Museo Histórico Nacional son solo ...
CURSO TALLER BIBLIOTECAS, MUSEOS, ARCHIVOS E HISTORIA
Morteros 2014 ⋅ Municipalidad de Morteros
Disertantes: Prof. Bib. Julio Fabián Melián. Prof. Arch. Armando Ríos. Fecha: Viernes 08 de agosto. Hora: 12:30 a 17:30. Lugar: Auditorio “Ángel.
Pontecesures no deberá pagar el nuevo canon de bibliotecas.
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No afectará a los municipios menores de 5.000 habitantes. La mitad de las bibliotecas de titularidad municipal de la comunidad, en torno a 160, ...
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(archivos, bibliotecas y museos).
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HISPANA, portal de colecciones digitales de repositorios institucionales españoles (archivos, bibliotecas y museos). Más de 4 millones de objetos ...
Horario de apertura en Verano de las Bibliotecas
Biblioteca Universitaria UCLM
El horario de las Bibliotecas Generales durante el mes de agosto será el siguiente: IMPRESCINDIBLE CARNÉ UNIVERSITARIO PARA ACCEDER A ...
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Biblioteca Nacional de Colombia
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Red de Bibliotecas del Instituto Cervantes
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El archivo digital de las bibliotecas de Bilbao pasa a formar parte de Europeana. El fondo digital Europeana, creado para difundir el patrimonio ...
Libro sobre Parestesias
Paresthesia
Edited by Luiz E. Imbelloni and Marildo A. Gouveia, ISBN 978-953-51-0085-0, 100 pages, Publisher: InTech, Chapters published February 29, 2012 under CC BY 3.0 license
DOI: 10.5772/1567
Paresthesias are spontaneous or evoked abnormal sensations of tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect. Patients generally describe a lancinating or burning pain, often associated with allodynia and hyperalgesia. The manifestation of paresthesia can be transient or chronic. Transient paresthesia can be a symptom of hyperventilation syndrome or a panic attack, and chronic paresthesia can be a result of poor circulation, nerve irritation, neuropathy, or many other conditions and causes. This book is written by authors that are respected in their countries as well as worldwide. Each chapter is written so that everyone can understand, treat and improve the lives of each patient.
http://www.intechopen.com/books/paresthesia
Parestesias y anestesia neuroaxial
Parestesias y déficits sensoriales en la pierna unilateral que surge después de la anestesia espinal por un tumor intramedular no reconocido
Paresthesia and sensory deficits on the unilateral leg arising from an unrecognized intramedullary tumor after spinal anesthesia.
Jeon DG, Kang BJ, Jeon SM.
Korean J Anesthesiol. 2013 May;64(5):472-3. doi: 10.4097/kjae.2013.64.5.472.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668114/pdf/kjae-64-472.pdf
Dirección de la inserción del catéter y la incidencia de parestesias durante anestesia peridural continua en ancianos
Direction of catheter insertion and the incidence of paresthesia during continuous epidural anesthesia in the elderly patients.
Kim JH, Lee JS, Kim DY.
Korean J Anesthesiol. 2013 May;64(5):443-7. doi: 10.4097/kjae.2013.64.5.443. Epub 2013 May 24.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668107/pdf/kjae-64-443.pdf
Factores en la insatisfacción de los pacientes y la negativa con respecto a la anestesia espinal.
Factors in patient dissatisfaction and refusal regarding spinal anesthesia.
Rhee WJ, Chung CJ, Lim YH, Lee KH, Lee SC.
Korean J Anesthesiol. 2010 Oct;59(4):260-4. doi: 10.4097/kjae.2010.59.4.260. Epub 2010 Oct 21.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966707/pdf/kjae-59-260.pdf
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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Consideraciones prácticas del tratamiento farmacológico de la neuralgia postherpética para el médico general
Practical considerations in the pharmacological treatment of postherpetic neuralgia for the primary care provider.
Massengill JS, Kittredge JL.
J Pain Res. 2014 Mar 10;7:125-32. doi: 10.2147/JPR.S57242. eCollection 2014.
Abstract
An estimated one million individuals in the US are diagnosed with herpes zoster (HZ; shingles) each year. Approximately 20% of these patients will develop postherpetic neuralgia (PHN), a complex HZ complication characterized by neuropathic pain isolated to the dermatome that was affected by the HZ virus. PHN is debilitating, altering physical function and quality of life, and commonly affects vulnerable populations, including the elderly and the immunocompromised. Despite the availability of an immunization for HZ prevention and several approved HZ treatments, the incidence of PHN is increasing. Furthermore, management of the neuropathic pain associated with PHN is often suboptimal, and the use of available therapeutics may be complicated by adverse effects and complex, burdensome treatment regimens, as well as by patients' comorbidities and polypharmacy, which may lead to drug-drug interactions. Informed and comprehensive assessments of currently available pharmacological treatment options to achieve effective pain control in the primary care setting are needed. In this article, we discuss the situation in clinical practice, review currently recommended prevention and treatment options for PHN, and outline practical considerations for the management of this neuropathic pain syndrome, with a focus on optimal, individual-based treatment plans for use in the primary care setting.
KEYWORDS:clinical practice; herpes zoster; pharmacological treatment; postherpetic neuralgia; practical guidelines; primary care
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956687/pdf/jpr-7-125.pdf
Prescripción de antivirales después de herpes zoster en medicina general. ¿Quién recibe tratamiento?
Prescription of antiviral therapy after herpes zoster in general practice: who receives therapy?
Forbes HJ, Thomas SL, Smeeth L, Langan SM.
Br J Gen Pract. 2012 Dec;62(605):e808-14. doi: 10.3399/bjgp12X659277.
Abstract
BACKGROUND: Antivirals can accelerate rash healing during an acute zoster episode and can limit the severity and duration of pain. Their use within 7 days of rash onset is recommended among specific patient groups. AIM: To describe antiviral prescription patterns and patient characteristics associated with antiviral receipt after zoster diagnosis. DESIGN AND SETTING:
Descriptive study and risk factor analysis using electronic healthcare records from UK general practice. METHOD: Incident adult zoster cases occurring between 2000 and 2011 were identified in the General Practice Research Database. Therapy records were searched for antiviral prescriptions of aciclovir, famciclovir, or valaciclovir within 7 days of zoster diagnosis. The proportion of incident zostercases receiving antivirals was calculated and multivariable logistic regression used to assess associations between patient characteristics and antiviral use. RESULTS: Of 142 216 incident zoster cases 58.1% received an antiviral prescription. The majority (69.0%) were aciclovir. The proportion receiving antiviral prescriptions increased with age up to 65 years, then declined to 56.8% among patients aged ≥85 years. Being female and of higher socioeconomic status were associated with higher antiviral receipt. Antivirals were more commonly prescribed to immunosuppressed patients withherpes zoster (odds ratio 1.27; 95% CI = 1.22 to 1.33), however they were not given routinely to this patient group. CONCLUSION: Antiviral therapies for zoster are under-prescribed in UK general practice even among groups, such as immunosuppressed and older individuals, for whom guidelines recommend treatment. Patients may present too late to receive treatment or physicians may decide that antivirals are not essential treatment. Consideration could be given to reviewing the guidelines.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505413/pdf/bjgp62-e808.pdf
Diagnóstico y tratamiento de la neuralgia postherpética
Diagnosing and managing postherpetic neuralgia.
Nalamachu S, Morley-Forster P.
Drugs Aging. 2012 Nov;29(11):863-9. doi: 10.1007/s40266-012-0014-3
Abstract
Postherpetic neuralgia (PHN) represents a potentially debilitating and often undertreated form of neuropathic pain that disproportionately affects vulnerable populations, including the elderly and the immunocompromised. Varicella zoster infection is almost universally prevalent, making prevention of acute herpes zoster (AHZ) infection and prompt diagnosis and aggressive management of PHN of critical importance. Despite the recent development of a herpes zoster vaccine, prevention of AHZ is not yet widespread or discussed in PHN treatment guidelines. Diagnosis of PHN requires consideration of recognized PHN signs and known risk factors, including advanced age, severe prodromal pain, severe rash, and AHZ location on the trigeminal dermatomes or brachial plexus. PHN pain is typically localized, unilateral and chronic, but may be constant, intermittent, spontaneous and/or evoked. PHN is likely to interfere with sleep and daily activities. First-line therapies for PHN include tricyclic antidepressants, gabapentin and pregabalin, and the lidocaine 5 % patch. Second-line therapies include strong and weak opioids and topical capsaicin cream or 8 % patch. Tricyclic antidepressants, gabapentinoids and strong opioids are effective but are also associated with systemic adverse events that may limit their use in many patients, most notably those with significant medical comorbidities or advanced age. Of the topical therapies, the topical lidocaine 5 % patch has proven more effective than capsaicin cream or 8 % patch and has a more rapid onset of action than the other first-line therapies or capsaicin. Given the low systemic drug exposure, adverse events with topical therapies are generally limited to application-site reactions, which are typically mild and transient with lidocaine 5 % patch, but may involve treatment-limiting discomfort with capsaicin cream or 8 % patch. Based on available clinical data, clinicians should consider administering the herpes zoster vaccine to all patients aged 60 years and older. Clinicians treating patients with PHN may consider a trial of lidocaine 5 % patch monotherapy before resorting to a systemic therapy, or alternatively, may consider administering the lidocaine 5 % patch in combination with a tricyclic antidepressant or a gabapentinoid to provide more rapid analgesic response and lower the dose requirement of systemic therapies.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693437/pdf/40266_2012_Article_14.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
