Opioides i.v. / I.V. opioids

Revisión clínica de opioides intravenosos en cuidado agudo Clinical review of intravenous opioids in acute care Mark J. McKeen and Sadeq A. Quraishi Journal of Anesthesiology and Clinical Science 2013, Abstract Opioids are routinely used in the management of moderate to severe pain. However, in the acute care setting, consistently undertreated and suboptimally managed pain continues to be a problem. Given the potential for opioids to result in lifethreatening situations, and the increasing complexity of the patients that are cared for in acute care facilities, a thorough understanding of intravenous opioid therapy is a necessity for hospital-based clinicians. Opioids can be classified by chemical structure and/or drug effect (i.e. action on Mu, Kappa, and Delta opioid receptors throughout the body). Endogenous opioids include endorphins, enkephalins, and dynorphins, which moderate the body's natural response to pain. Commonly used exogenous intravenous opioids include morphine, hydromorphone, fentanyl, meperidine, methadone, buprenorphine, butorphanol, and nalbuphine, which vary greatly in potency, duration of action, metabolism, and in their adverse effect profile. A growing body of evidence suggests that patient controlled analgesia may be superior to conventional methods (need for analgesia determined by clinicians) of treating pain in the acute care setting. Newer pump delivery systems may also decrease the risks of human and equipment errors as well as enhance patient safety and satisfaction. The purpose of this review is to help guide clinicians in the safe and effective management of pain in patients requiring intravenous opioid therapy in the acute care setting. Keywords: Acute pain, acute care, opioid, PCA PDF Impacto de la edad, sexo y ruta de administración sobre los eventos adversos de los opioides en el departamento de emergencias. Estudio retrospectivo Impact of age, sex and route of administration on adverse events after opioid treatment in the emergency department: a retrospective study. Daoust R, Paquet J, Lavigne G, Piette É, Chauny JM. Pain Res Manag. 2015 Jan-Feb;20(1):23-8. PDF Estudio clínico aleatorizado de un protocolo con hidromorfona intravenosa versus el cuidado habitual en el dolor agudo de los ancianos en el departamento de urgencias. Randomized clinical trial of an intravenous hydromorphone titration protocol versus usual care for management of acute pain in older emergency department patients. Chang AK, Bijur PE, Davitt M, Gallagher EJ. Drugs Aging. 2013 Sep;30(9):747-54. doi: 10.1007/s40266-013-0103-y. Abstract BACKGROUND AND OBJECTIVES: Opioid titration is an effective strategy for treating pain; however, titration is generally impractical in the busy emergency department (ED) setting. Our objective was to test a rapid, two-step, hydromorphone titration protocol against usual care in older patients presenting to the ED with acute severe pain. METHODS: This was a prospective, randomized clinical trial of patients 65 years of age and older presenting to an adult, urban, academic ED withacute severe pain. The study was registered at http://www.clinicaltrials.gov (NCT01429285). Patients randomized to the hydromorphone titration protocol initially received 0.5 mg intravenous hydromorphone. Patients randomized to usual care received any dose of any intravenous opioid. At 15 min, patients in both groups were asked, 'Do you want more pain medication?' Patients in the hydromorphone titration group who answered 'yes' received a second dose of 0.5 mg intravenous hydromorphone. Patients in the usual care group who answered 'yes' had their ED attending physician notified, who then could administer any (or no) additional medication. The primary efficacy outcome was satisfactory analgesia defined a priori as the patient declining additional analgesia at least once when asked at 15 or 60 min after administration of the initial opioid. Dose was calculated in morphine equivalent units (MEU: 1 mg hydromorphone = 7 mg morphine). The need for naloxone to reverse adverse opioid effects was the primary safety outcome. RESULTS: 83.0 % of 153 patients in the hydromorphone titration group achieved satisfactory analgesia compared with 82.5 % of 166 patients in the usual care group (p = 0.91). Patients in the hydromorphone titration group received lower mean initial doses of opioids at baseline than patients in the usual care group (3.5 MEU vs. 4.7 MEU, respectively; p ≤ 0.001) and lower total opioids through 60 min (5.3 MEU vs. 6.0 MEU; p = 0.03). No patient needed naloxone. CONCLUSIONS: Low-dose titration of intravenous hydromorphone in increments of 0.5 mg provides comparable analgesia to usual care with lessopioid over 60 min. PDF Comparación de nalbufina con morfina en sus efectos analgésicos y seguridad. Meta-análisis de estudios aleatorizados controlados A comparision of nalbuphine with morphine for analgesic effects and safety : meta-analysis of randomized controlled trials. Zeng Z, Lu J, Shu C, Chen Y, Guo T, Wu QP, Yao SL, Yin P. Sci Rep. 2015 Jun 3;5:10927. doi: 10.1038/srep10927. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Las personas que comen chocolate tienen el corazón más sano

Fuente
Este artículo es originalmente publicado en:
http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=63923&origen=notiweb&dia_suplemento=martes

Un estudio observa una relación entre el mayor consumo de chocolate y un menor riesgo de sufrir enfermedades cardiovasculares.

FUENTE | El País Digital

Los espacios verdes influyen en el desarrollo cognitivo de los niños

Fuente
Este artículo es originalmente publicado en:
http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=63921&origen=notiweb&dia_suplemento=martes

Los espacios verdes influyen en el desarrollo cognitivo de los niños, según concluye un estudio con 2.600 alumnos de primaria desarrollado por un equipo científico con participación del Consejo Superior de Investigaciones Científicas(CSIC).

FUENTE | CSIC

Más de bloqueo del plexo braquial/More on brachial plexus block

Comparación de técnicas de bloqueo del plexo braquial axilar guiadas por ultrasonido: inyección perineural contra la infiltración perivascular simple o doble. Comparison of ultrasound-guided axillary brachial plexus block techniques: perineural injection versus single or double perivascular infiltration. Cho S, Kim YJ, Baik HJ, Kim JH, Woo JH. Yonsei Med J. 2015 May;56(3):838-44. doi: 10.3349/ymj.2015.56.3.838. Abstract PURPOSE: We compared three methods of ultrasound-guided axillary brachial plexus block, which were single, and double perivascular (PV) infiltration techniques, and a perineural (PN) injection technique. MATERIALS AND METHODS: 78 patients of American Society of Anesthesiologists physical status I-II undergoing surgery of the forearm, wrist, or hand were randomly allocated to three groups. 2% lidocaine with epinephrine 5 μg/mL was used. The PN group (n=26) received injections at the median, ulnar, and radial nerve with 8 mL for each nerve. The PV1 group (n=26) received a single injection of 24 mL at 12-o'clock position of the axillary artery. The PV2 group (n=26) received two injections of 12 mL each at 12-o'clock and 6-o'clock position. For all groups, musculocutaneous nerve was blocked separately. RESULTS: The PN group (391.2±171.6 sec) had the longest anesthetic procedure duration than PV1 (192.8±59.0 sec) and PV2 (211.4±58.6 sec). There were no differences in onset time. The average induction time was longer in PN group (673.4±149.6 sec) than PV1 (557.6±194.9 sec) and PV2 (561.5±129.8 sec). There were no differences in the success rate (89.7% vs. 86.2% vs. 89.7%). CONCLUSION: The PV injection technique consisting of a single injection in 12-o'clock position above the axillary artery in addition to a musculocutaneous nerve block is equally effective and less time consuming than the PN technique. Therefore, the PV technique is an alternative method that may be used in busy clinics or for difficult cases. KEYWORDS: Brachial plexus; nerve block; ultrasonography PDF Dexmedetomidina como adyuvante de ropivacaína en el bloqueo supraclavicular del plexo braquial Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Kathuria S, Gupta S, Dhawan I. Saudi J Anaesth. 2015 Apr-Jun;9(2):148-54. doi: 10.4103/1658-354X.152841. Abstract CONTEXT: Dexmedetomidine as an adjuvant to local anesthetics in peripheral nerve blocks has been used in only a few studies. AIMS: We aimed at assessing the effect of dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. SETTINGS AND DESIGN: Random, controlled, and triple blind. MATERIALS AND METHODS: Sixty American Society of Anesthesiologist grade I and II patients of either sex scheduled for elective upper limb surgery under supraclavicular brachial plexus block were divided into three equal groups in a prospective randomized double-blind controlled manner. For block patients in Group C received 0.5% ropivacaine (30cc), 0.5% ropivacaine with 50 μg dexmedetomidine (30cc) in Group D and 0.5% ropivacaine (30cc) in Group D-IV along with intravenous infusion of 50 μg dexmedetomidine in normal saline. STATISTICAL ANALYSIS USED: IBM-SPSS software version 17, Chi-square test, Mann-Whitney U-test. RESULTS: Demographic profile and surgical characteristics were similar in all the three groups. Sensory block and motor block onset was earlier in group D than in group D-IV and group C. The sensory block and motor block duration was also prolonged in group D when compared with group D-IV and group C. The duration of analgesia was significantly longer in group D and D-IV when compared to group C. CONCLUSIONS: Dexmedetomidine as an adjuvant to 0.5%ropivacaine in ultrasound guided brachial plexus block shortens the sensory as well as motor block onset time, prolongs sensory and motor block duration and also increases the duration of analgesia. The action of dexmedetomidine most probably is local rather than centrally mediated. KEYWORDS: Dexmedetomidine; ropivacaine; supraclavicular brachial plexus block PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Hace 2000 días/Two thousand days ago

Hace 2000 días, el primero de Enero 2010, iniciamos este Programa Educativo Alfa como un proyecto dedicado a enviar cada día artículos en PDF o en HTML a un reducido grupo de colegas anestesiólogos, intensivistas, cirujanos, internistas, algólogos y especialidades relacionadas, incluyendo enfermeras y estudiantes de medicina. El proyecto inicial se ha convertido en un programa educativo exitoso que llega a 4500 miembros en los cinco continentes, muy en especial a los países de Latinoamérica. Se han enviado 7,540 artículos, 45 libros, varias revistas completas, y videoclips. Además se han promovido cursos, eventos, congresos y enlaces de interés académico. Al principio teníamos dudas sobre su utilidad, pero al paso de los primeros meses vimos con agrado la buena aceptación y crecimiento lento y paulatino del número de subscritores, con un bajo porcentaje de cancelaciones. Hoy en día no solo se envían artículos completos, sino que hemos agregado enlaces a revistas, a libros, videos y recién creamos el correo con la Imagen del Mes, donde se incluyen fotografías clínicas originales adicionadas de información médica disponible en la WEB. Al paso de estos 2000 días hemos aprendido a seleccionar la información enviada, a escuchar las sugerencias recibidas, a responder las consultas de colegas y pacientes con prontitud, al igual que hemos ido presentando y publicando nuestra propia experiencia en diversos foros y revistas biomédicas. La meta fundamental de nuestro portal www.anestesia-dolor.org es facilitar la educación médica continuada utilizando la información gratuita y selecta disponible en la WEB. Agradecemos el dejarnos llegar con este programa hasta su ordenador, y se le invita a seguir con nosotros, y a difundir este programa educativo entre sus colegas. Si desea hacer un donativo económico que nos ayude a mejorar este programa le estaremos muy agradecidos. Aprovechamos la coincidencia de fechas para FELICITAR a todos los colegas que además de llevar en hombros su responsabilidad profesional, hoy celebran el DIA de los PADRES!   2000 days ago, January first 2010, we initiated this Educational Alfa Program as a project dedicated to daily post articles in PDF or HTML to a small group of colleagues anesthesiologists, intensivists, surgeons, internists, pain medicine, and related specialties, including nurses and medical students. The initial project has become a successful educational program that reaches 4,500 members on five continents, most in Latin America countries. We have sent 7,540 articles, 45 books, several full magazines, and video clips. We have also promoted courses, events, conferences and links with academic interest. We initially had doubts about its usefulness, but over the first few months we saw with pleasure the good acceptance and slow and gradual growth in the number of subscribers, with a very low percentage of cancellations. Besides all this, we've added links to journals, books, videos and newly created the Image of the Month, where original clinical photographs and medical information are included. In these 2000 days we have learned to select the information to be sent, listen to suggestions received, and answer queries from colleagues and patients promptly. We also have been presenting and publishing our own experience in various forums and biomedical journals. The primary goal of our website www.anestesia-dolor.org is to facilitate continuing medical education using select information available free on the Web. We appreciate letting us get this program to your computer, invite you to follow us, and ask you to spread this education program among your colleagues. If you want to make a financial donation to help us to improve this program we would be very grateful. We take this coincidence of dates to congratulate all colleagues that in addition to carrying on their shoulders their professional responsibility, today celebrate Father's Day!  Academic Medicine, Vol. 90, No. 6 / June 2015 Revista/Journal  American Journal of the Medical Sciences: April 2015 - Volume 349 - Issue 4 Revista/Journal  Journal of Clinical Anesthesia 2015  Volume 27, Issue 1, p1-96 Revista/Journal Saudi J Anaesth 2015 July-September. Volume 9, Issue 3 Revista/Journal Anesthesia & Analgesia  June 2014 - Volume 118 - Issue 6 Revista/Journal   Annals of Surgery  May 2015 - Volume 261 - Issue 5 Revista/Journal   Journal of Anesthesia & Critical Care: Open Access 2015:3(2) Revista/Journal  AACN Advanced Critical Care April/June 2011 - Volume 22 - Issue 2 Revista/Journal   British Journal of Pain May 2015 Issue on Cancer Pain Revista/Journal  Topics in Public Health Edited by David Claborn, ISBN 978-953-51-2132-9, 306 pages, Publisher: InTech Libro/Book Autoimmunity - Pathogenesis, Clinical Aspects and Therapy of Specific Autoimmune Diseases Edited by Katerina Chatzidionysiou, ISBN 978-953-51-2134-3, 208 pages, Publisher: InTech Libro/Book

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Bibliotecarios.Alerta

Bibliotecarios

NOTICIAS


Peninsular Digital

Capacita el INEGI a bibliotecarios de la UABCS
Peninsular Digital
Con el objetivo de capacitar al personal de atención del Centro de Desarrollo Bibliotecario de la UABCS en el uso del Mapa Digital de México, ...




regionalpuebla.mx

Capacitarán a 36 bibliotecarios para cursos de verano
regionalpuebla.mx
La coordinadora regional de bibliotecarios Lourdes López, informó que son 36 personas de 18 municipios los que acudirán a recibir esta orientación ...




Misiones Cuatro

Capacitan en Encuadernación a docentes y bibliotecarios
Misiones Cuatro
El Taller de Encuadernación bajo parámetros de conservación es una nueva capacitación organizada por la Biblioteca Pública De Las Misiones que ...




Centro Arte

Celebran Día del Bibliotecario en Sagua la Grande
Centro Arte
Coincidiendo con el cierre de la VI Jornada por el Día del Bibliotecario cubano que se ha estado celebrando a lo largo y ancho del país desde el 8 ...



Ministerio de Cultura entregará tecnología a bibliotecas públicas
El Informador - Santa Marta
Los bibliotecarios deben recibir la dotación tecnológica, y gestionar, posteriormente, la firma del acta de entrega de la tecnología por parte del ...

Consideraciones de Oxigenacion en Pediatría

Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 24 de Junio 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Consideraciones de Oxigenacion en Pediatría” por el “Dr. Jesús Guajardo”, Alergologo, Neumologo Pediatra de la Cd. de San Antonio Tx. 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/oxigenacion_pediatrica/
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.

Henrys


Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La clinica 2520-310
Colonia Sertoma ,Mty N.L. México
CP 64710
Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx

Falla respiratoria postoperatoria/Postoperative respiratory failure

Desarrollo y validación de una puntuación para predecir falla respiratoria aguda postoperatoria en una cohorte multicéntrica Europea. Estudio prospectivo, observacional Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: A prospective, observational study. Canet J, Sabaté S, Mazo V, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P; PERISCOPE group. European Journal of Anaesthesiology July 2015 - Volume 32 - Issue 7 - p 458-470 PDF Eliminar las complicaciones respiratorias postoperatorias: la detección preoperatoria abre la puerta a las vías clínicas que individualizan el tratamiento perioperatorio Eliminate postoperative respiratory complications: preoperative screening opens the door to clinical pathways that individualise perioperative treatment Staehr-Rye, Anne K.; Eikermann, Matthias European Journal of Anaesthesiology: July 2015 - Volume 32 - Issue 7 - p 455-457 Pulmonary complications, including postoperative respiratory failure, represent the second most frequent form of postoperative complications after surgical site infections, with an incidence estimated to range from 2.0 to 7.9%, depending on the definitions and patients studied.1 Postoperative respiratory failure is a severe complication, which leads to a longer hospital stay, higher financial cost and increases the in-hospital death rate by as much as 90-fold.2,3 PDF Validación externa prospectiva de una puntuación predictiva de complicaciones pulmonares postoperatorias. Prospective external validation of a predictive score for postoperative pulmonary complications. Mazo V, Sabaté S, Canet J, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P. Anesthesiology. 2014 Aug;121(2):219-31. doi: 10.1097/ALN.0000000000000334. Abstract BACKGROUND: No externally validated risk score for postoperative pulmonary complications (PPCs) is currently available. The authors tested the generalizability of the Assess Respiratory Risk in Surgical Patients in Catalonia risk score for PPCs in a large European cohort (ProspectiveEvaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe). METHODS: Sixty-three centers recruited 5,859 surgical patients receiving general, neuraxial, or plexus block anesthesia. The Assess RespiratoryRisk in Surgical Patients in Catalonia factors (age, preoperative arterial oxygen saturation in air, acute respiratory infection during the previous month, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration, and emergency surgery) were recorded, along with PPC occurrence (respiratory infection or failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis). Discrimination, calibration, and diagnostic accuracy measures of the Assess Respiratory Risk in Surgical Patients in Catalonia score's performance were calculated for the Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe cohort and three subsamples: Spain, Western Europe, and Eastern Europe. RESULTS: The full Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe data set included 5,099 patients; 725 PPCs were recorded for 404 patients (7.9%). The score's discrimination was good: c-statistic (95% CI), 0.80 (0.78 to 0.82). Predicted versus observed PPC rates for low, intermediate, and high risk were 0.87 and 3.39% (score <26), 7.82 and 12.98% (≥ 26 and <45), and 38.13 and 38.01% (≥ 45), respectively; the positive likelihood ratio for a score of 45 or greater was 7.12 (5.93 to 8.56). The score performed best in the Western Europe subsample-c-statistic, 0.87 (0.83 to 0.90) and positive likelihood ratio, 11.56 (8.63 to 15.47)-and worst in the Eastern Europe subsample. The predicted (5.5%) and observed (5.7%) PPC rates were most similar in the Spain subsample. CONCLUSIONS: The Assess Respiratory Risk in Surgical Patients in Catalonia score predicts three levels of PPC risk in hospitals outside thedevelopment setting. Performance differs between geographic areas. PDF Desarrollo y validación de una calculadora de riesgo para predecir la insuficiencia respiratoria postoperatoria. Development and validation of a risk calculator predicting postoperative respiratory failure. Gupta H1, Gupta PK, Fang X, Miller WJ, Cemaj S, Forse RA, Morrow LE. Chest. 2011 Nov;140(5):1207-15. doi: 10.1378/chest.11-0466. Epub 2011 Jul 14. Abstract BACKGROUND: Postoperative respiratory failure (PRF) (requiring mechanical ventilation > 48 h after surgery or unplanned intubation within 30 days of surgery) is associated with significant morbidity and mortality. The objective of this study was to identify preoperative factors associated with an increased risk of PRF and subsequently develop and validate a risk calculator. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP), a multicenter, prospective data set (2007-2008), was used. The 2007 data set (n = 211,410) served as the training set and the 2008 data set (n = 257,385) as the validation set. RESULTS: In the training set, 6,531 patients (3.1%) developed PRF. Patients who developed PRF had a significantly higher 30-day mortality (25.62% vs 0.98%, P < .0001). On multivariate logistic regression analysis, five preoperative predictors of PRF were identified: type of surgery, emergency case, dependent functional status, preoperative sepsis, and higher American Society of Anesthesiologists (ASA) class. The risk model based on the training data set was subsequently validated on the validation data set. The model performance was very similar between the training and the validation data sets (c-statistic, 0.894 and 0.897, respectively). The high c-statistics (area under the receiver operating characteristic curve) indicate excellent predictive performance. The risk model was used to develop an interactive risk calculator. CONCLUSIONS: Preoperative variables associated with increased risk of PRF include type of surgery, emergency case, dependent functional status, sepsis, and higher ASA class. The validated risk calculator provides a risk estimate of PRF and is anticipated to aid in surgical decision making and informed patient consent. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Medwave. Junio 2015

Los últimos artículos publicados en Medwave son los siguientes:


RESUMENES EPISTEMONIKOS

¿Sirve la goma de mascar para acelerar la recuperación luego de una cirugía abdominal? – Primera actualización
Gabriel Rada, José Viñuela (Chile)

Medwave 2015;15(Suppl 1):e6162
http://dx.doi.org/10.5867/medwave.2015.6162


ESTUDIOS PRIMARIOS

Uso incorrecto de inhaladores de dosis medida en pacientes adultos de un hospital de Callao, Perú, 2014: estudio transversal
Alexandra Cayo-Quiñe, Valeria Martínez-Vargas, Rossi Bustamante-Voysest, Alejandro Piscoya, Yeny Alberca (Perú)

Medwave 2015;15(5):e6163
http://dx.doi.org/10.5867/medwave.2015.05.6163


RESUMENES EPISTEMONIKOS

¿Debemos agregar vancomicina en polvo a la profilaxis antibiótica en cirugía de columna?
Mario López, Marcelo Molina (Chile)

Medwave 2015 Jun;15(Suppl 1):e6160
http://dx.doi.org/10.5867/medwave.2015.6160


¿Tienen un rol los digitálicos en la insuficiencia cardiaca crónica? - Primera actualización
Carmen Rain, Gabriel Rada (Chile)

Medwave 2015 Jun;15(supl 1):e6149
http://dx.doi.org/10.5867/medwave.2015.6149


TEMAS Y CONTROVERSIAS EN BIOESTADÍSTICA

Uso de modelos de regresión para la determinación de factores de riesgo
Sergio Muñoz Navarro, Jorge Rodríguez Tobar (Chile)

Medwave 2015 Jun;15(5):e6154
http://dx.doi.org/10.5867/medwave.2015.05.6154


Además se encuentran abiertas las inscripciones para próximos cursos a realizarse:

Gestión de calidad en la atención abierta de salud: http://www.medwave.cl/link.cgi/eCampus/APIA/

Gestion de costos en organizaciones de Salud. Inicio: 24 de junio

Para mayor información y detalles escribir a: mguillen@medwave.cl


PORTADA MEDWAVE
http://www.medwave.cl

PORTADA eCAMPUS
http://www.medwave.cl/link.cgi/eCampus/Capacitacion

CPPD/PDPH / Cefalea postpunción dural

Cefalea postpunción dural Post-dural puncture headache. Ghaleb A, Khorasani A, Mangar D. Int J Gen Med. 2012;5:45-51. doi: 10.2147/IJGM.S17834. Epub 2012 Jan 12. Abstract Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH) has been a problem for patients following dural puncture. Clinical and laboratory research over the last 30 years has shown that use of smaller-gauge needles, particularly of the pencil-point design, are associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients < 50 years, post-partum, in the event a large-gauge needle puncture is initiated, an epidural blood patch should be performed within 24-48 hours of dural puncture. The optimum volume of blood has been shown to be 12-20 mL for adult patients. Complications caused by autologous epidural blood patching (AEBP) are rare. KEYWORDS: cause; gauge; incidence; needles; post-dural puncture headache; risk PDF Medicamentos para prevenir la cefalea postpunción dural Drug therapy for preventing post-dural puncture headache. Basurto Ona X1, Uriona Tuma SM, Martínez García L, Solà I, Bonfill Cosp X. Cochrane Database Syst Rev. 2013 Feb 28;2:CD001792. doi: 10.1002/14651858.CD001792.pub3. Abstract BACKGROUND: Post-dural (post-lumbar or post-spinal) puncture headache (PDPH) is one of the most common complications of diagnostic, therapeutic or inadvertent lumbar punctures. Many drug options have been used to prevent headache in clinical practice and have also been tested in some clinical studies, but there are still some uncertainties about their clinical effectiveness. OBJECTIVES: To assess the effectiveness and safety of drugs for preventing PDPH in adults and children. SEARCH METHODS: The search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2012, Issue 5), MEDLINE (from 1950 to May 2012), EMBASE (from 1980 to May 2012) and CINAHL (from 1982 to June 2012). There was no language restriction. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) that assessed the effectiveness of any drug used for preventing PDPH. DATA COLLECTION AND ANALYSIS: Review authors independently selected studies, assessed risks of bias and extracted data. We estimated risk ratios (RR) for dichotomous data and mean differences (MD) for continuous outcomes. We calculated a 95% confidence interval (CI) for each RR and MD. We did not undertake meta-analysis because participants' characteristics or assessed doses of drugs were too different in the included studies. We performed an intention-to-treat (ITT) analysis. MAIN RESULTS: We included 10 RCTs (1611 participants) in this review with a majority of women (72%), mostly parturients (women in labour) (913), after a lumbar puncture for regional anaesthesia. Drugs assessed were epidural and spinal morphine, spinal fentanyl, oral caffeine, rectal indomethacin, intravenous cosyntropin, intravenous aminophylline and intravenous dexamethasone.All the included RCTs reported data on the primary outcome, i.e. the number of participants affected by PDPH of any severity after a lumbar puncture. Epidural morphine and intravenous cosyntropin reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to placebo. Also, intravenous aminophylline reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to no intervention, while intravenous dexamethasone increased it. Spinal morphine increased the number of participants affected by pruritus when compared to placebo, and epidural morphine increased the number of participants affected by nausea and vomiting when compared to placebo. Oral caffeine increased the number of participants affected by insomnia when compared to placebo.The remainder of the interventions analysed did not show any relevant effect for any of the outcomes.None of the included RCTs reported the number of days that patients stayed in hospital. AUTHORS' CONCLUSIONS: Morphine and cosyntropin have shown effectiveness for reducing the number of participants affected by PDPH of any severity after a lumbar puncture, when compared to placebo, especially in patients with high risk of PDPH, such as obstetric patients who have had an inadvertent dural puncture. Aminophylline also reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to no intervention in patients undergoing elective caesarean section. Dexamethasone increased the risk of PDPH, after spinal anaesthesia for caesarean section, when compared to placebo. Morphine also increased the number of participants affected by adverse events (pruritus and nausea and vomiting)There is a lack of conclusive evidence for the other drugs assessed (fentanyl, caffeine, indomethacin and dexamethasone).These conclusions should be interpreted with caution, owing to the lack of information, to allow correct appraisal of risk of bias and the small sample sizes of studies. PDF Comparando el efecto de pregabalina, gabapentina y acetaminofen en la cefalea postpunción dural Comparing the effect of pregabalin, gabapentin, and acetaminophen on post-dural puncture headache. Mahoori A, Noroozinia H, Hasani E, Saghaleini H. Saudi J Anaesth. 2014 Jul;8(3):374-7. doi: 10.4103/1658-354X.136436. Abstract INTRODUCTION: Post-dural puncture headache (PDPH) is a common complication of lumbar puncture for any purpose. To avoid the need for invasive methods of treating PDPH such as blood patch, the search for novel pharmacological agents to manage PDPH continues. The aim of this study was to compare the effects of acetaminophen, gabapentin and pregabalin in controlling PDPH in patients who underwent surgery under spinal anesthesia. MATERIALS AND METHODS: A total of 90 patients who underwent elective orthopedic surgery under spinal anesthesia and suffered from PDPH consequently were enrolled in this randomized trial. Patients were categorized randomly into three groups. Group A, B and C have received Acetaminophen, Gabapentin and Pregabalin (3 times a day for 3 days), respectively. The effect of medications on the severity of PDPH was evaluated and compared using visual analog scale (VAS). RESULTS: The mean VAS score was significantly lower in pregabalin group compared with others 24, 48 and 72 h after the onset of headache (P = 0.001 for all of them) and lower in Gabapentin group compared with Acetaminophen group 24, 48 and 72 h after the onset of headache (P = 0.001 for all analyses). No adverse outcome was reported in groups. CONCLUSION: Pregabalin and gabapentin are both useful and safe in management of PDPH, but pregabalin is more effective in this regard. KEYWORDS: Acetaminophen; gabapentin; post-dural puncture headache; pregabalin PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Dexmedetomidina en geriatría/Dexmedetomidine in geriatrics

Delirio en el anciano: Uso de la dexmedetomidina Delirium tremens in the elderly: Papel de la dexmedetomidina Sehgal V, Bajwa SJ, Consalvo JA, Bajaj A, Sehgal R. Int J Nutr Pharmacol Neurol Dis [serial online] 2015 [cited 2015 Jun 8];5:89-94. Abstract The elderly are more predisposed to depression, which puts them at high risk for alcohol abuse and alcohol-related disorders such as delirium tremens (DTs). But its clinical presentation is often complicated by underlying comorbid conditions, such as congestive heart failure (CHF), atrial fibrillation (AF), sepsis, chronic kidney disease (CKD), electrolyte imbalance, dementia, malglycemia, nutritional deficiencies, and polypharmacy. The current review is aimed at defining the appropriate management of these clinical conundrums that frequently accompany alcohol abuse in the elderly, leading to increased morbidity and mortality. It also emphasizes the emerging role of dexmedetomidine in treating the elderly with DTs. Keywords: Alcohol abuse, atrial fibrillation (AF), chronic kidney disease (CKD), delirium tremens (DTs), dexmedetomidine, elderly, malglycemia, polypharmacy PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Bibliotecas populares. Alerta

bibliotecas populares

NOTICIAS


El Tribuno.com.ar

Biblioteca Sarmiento, un baluarte de la cultura
El Tribuno.com.ar
La biblioteca popular Domingo Faustino Sarmiento fue fundada el 22 de junio de 1874. Es la segunda creada en la provincia, una de las primeras del ...




Nuevo Diario de Santiago del Estero

El reconocido profesional fue declarado visitante ilustre en la ciudad. Agradeció este gesto.
Nuevo Diario de Santiago del Estero
... salón escolar del Instituto de Formación Docente Nº 23 de Tintina sobre “La importancia de lasbibliotecas populares en las sociedades actuales”, ...




Diario El Argentino

La próxima semana se realizará la XXXII Semana del Libro para Niños
Diario El Argentino
Los días miércoles 17 y jueves 18 de junio en la Biblioteca Popular “Francisco Hernández López Jordán”, se llevará a cabo una nueva edición de la ...



Con la presencia del "Cotón" Reveco, se inaugura otra biblioteca saludable
Sitio Andino
"Contenedores" surge a partir de un convenio firmado entre la obra social OSEP y la federación de bibliotecas populares de Mendoza. Este acuerdo ...



Se inauguró una biblioteca saludable con la presencia de Reveco
Sitio Andino
Este lunes, en horas de la mañana, se llevó a cabo la inauguración de una biblioteca saludable en la sala de obstetricia del Hospital El Carmen.