Dosis baja de ketamina/Ketamine low dose

Septiembre 14, 2015. No. 2085

Efecto de infusión intraoperatoria de dosis bajas de ketamina para analgesia postoperatoria Effect of intraoperative infusion of low-dose ketamine on management of postoperative analgesia. Kaur S, Saroa R, Aggarwal S. J Nat Sci Biol Med. 2015 Jul-Dec;6(2):378-82. doi: 10.4103/0976-9668.160012. Abstract BACKGROUND: Use of opioids for perioperative analgesia is associated with sedation, respiratory depression and postoperative nausea and vomiting. N-methyl-D-aspartate receptor antagonist such as ketamine has both analgesic and antihyperalgesic properties. We studied the effect of intraoperative infusion of low-dose ketamine on postoperative analgesia and its management with opioids.MATERIALS AND METHODS: A total of 80 patients scheduled for open cholecystectomy under general anesthesia were randomly allocated into two equal groups in a randomized double-blinded way. The general anesthetic technique was standardized in both groups. Group K patients (n = 40) received bolus of ketamine 0.2 mg/kg intravenously followed by an infusion of 0.1 mg/kg/h before skin incision, which was continued up to the end of surgery. Similar volume of saline was infused in Group C (n = 40). The pain score at different intervals and cumulative morphine consumption over 24 h was observed. Secondary outcomes such as hemodynamic parameters, patient satisfaction score and incidences of side effects were also recorded. RESULTS: Intraoperative infusion of low-dose ketamine resulted in effective analgesia in first 6 h of the postoperative period, which was evident from reduced pain scores and reduced opioid requirements (P = 0.001). The incidence of side effects and patient satisfaction were similar in both groups. CONCLUSION: Intraoperative low-dose ketamine infusion provides good postoperative analgesia while reducing need of opioid analgesics, which must be considered for better management of postoperative analgesia. KEYWORDS: Ketamine; morphine; postoperative analgesia PDF  Comparación de ketorolaco y dosis bajas de ketamina en la prevención del aumento de presión arterial inducida por el torniquete Comparison of ketorolac and low-dose ketamine in preventing tourniquet-induced increase in arterial pressure. Zaidi R, Ahmed A. Indian J Anaesth. 2015 Jul;59(7):428-32. doi: 10.4103/0019-5049.160949. BACKGROUND AND AIMS: Application of tourniquet during orthopaedic procedures causes pain and increase in blood pressure despite adequate anaesthesia and analgesia. In this study, we compared ketorolac with ketamine in patients undergoing elective lower limb surgery with tourniquet in order to discover if ketorolac was equally effective or better than ketamine in preventing tourniquet-induced hypertension. METHODS: Approval was granted by the Institutional Ethics Review Committee and informed consent was obtained from all participants. A randomised double-blinded controlled trial with 38 patients each in the ketamine and ketorolac groups undergoing elective knee surgery for anterior cruciate ligament repair or reconstruction was conducted. Induction and maintenance of anaesthesia were standardised in all patients, and the minimum alveolar concentration of isoflurane was maintained at 1.2 throughout the study period. One group received ketamine in a dose of 0.25 mg/kg and the other group received 30 mg ketorolac 10 min before tourniquet inflation. Blood pressure was recorded before induction of anaesthesia (baseline) and at 0, 10, 20, 30, 40, 50, and 60 min after tourniquet inflation. RESULTS: The demographic and anaesthetic characteristics were similar in the two groups. At 0 and 10 min, tourniquet-induced rise in blood pressure was not observed in both groups. From 20 min onward, both systolic and diastolic blood pressures were significantly higher in ketorolac group compared to ketamine group. CONCLUSION: We conclude that ketamine is superior to ketorolac in preventing tourniquet-induced increases in blood pressure. KEYWORDS: Ketamine; ketorolac; tourniquet pain; tourniquet-induced hypertension PDF     Dexmedetomidina con dosis bajas de ketamina en cirugía de cataratas bajo bloqueo peribulbar en un paciente con corea de Huntington Dexmedetomidine with low-dose ketamine for cataract surgery under peribulbar block in a patient with Huntington's chorea. Naik S, Shetti AN, Nadkarni AV, Ahuja B. Anesth Essays Res. 2015 Jan-Apr;9(1):92-4. doi: 10.4103/0259-1162.150140. Abstract Huntington's chorea (HC) is a rare hereditary disorder of the nervous system. It is inherited as an autosomal dominant disorder and is characterized by progressive chorea, dementia, and psychiatric disturbances. There are only a few case reports regarding the anesthetic management of a patient with HC and the best anesthetic technique is yet to be established for those patients which are at higher risk of perioperative complications. We report the anesthetic management of a 64-year-old patient with HC admitted for cataract surgery. KEYWORDS: Cataract; Huntington's chorea; dexmedetomidine; ketamine PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Esmolol vs. dexmedetomidina

Septiembre 15, 2015. No. 2086

Evaluación de dexmedetomidina y esmolol sobre respuestas hemodinámicas durante colecistectomía laparoscópica Comparative evaluation of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy. Srivastava VK, Nagle V, Agrawal S, Kumar D, Verma A, Kedia S. J Clin Diagn Res. 2015 Mar;9(3):UC01-5. doi: 10.7860/JCDR/2015/11607.5674. Epub 2015 Mar 1. Abstract BACKGROUND: The advent of laparoscopic surgery has benefited the patient and surgeon; however creation of pneumoperitoneum for same has bearings during the perioperative period. These effects of pneumoperitoneum are associated with significant haemodynamic changes, increasing the morbidity of the patient. AIM: The present study compared the efficacy of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy Materials and Methods: A total of 90 patients aged 20-60 y, American Society of Anaesthesiologists (ASA) physical status I or II, of either sex, planned for laparoscopic cholecystectomy were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine loading dose 1 mcg/kg over a period of 15 min and maintenance 0.5 mcg/kg/h throughout the pneumoperitoneum. Group E received esmolol loading dose 1 mg/kg over a period of 5 min and maintenance 0.5 mg/kg/h throughout the pneumoperitoneum. Group C received same volume of normal saline. MEASUREMENTS: Heart rate (HR), systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP) were recorded preoperative, after study drug, after induction, after intubation, after pneumoperitoneum at 15 min intervals, post pneumoperitoneum and postoperative period after 15 min. Propofol induction dose, intraoperative fentanyl requirement and sedation score were also recorded.RESULTS: In group D, there was no statistically significant increase in HR and blood pressure after pneumoperitoneum at any time intervals, whereas in Group E, there was a statistical significant increase in MAP after pneumoperitoneum at 15, 45, and 60 min only and HR during the whole pneumoperitoneum period. There was a significant decrease in induction dose of propofol and intraoperative fentanyl requirement in Group D and E, compared to Group C (p<0.0001). CONCLUSION: Dexmedetomidine is more effective than esmolol for attenuating the hemodynamic response to pneumoperitoneum in elective laparoscopic cholecystectomy. Dexmedetomidine and esmolol also reduced requirements of anaesthetic agents. PDF Evaluación comparativa de esmolol y dexmedetomidina para atenuar la respuesta simpaticomimética a laringoscopía en pacientes neuroquirúrgicos Comparative evaluation of esmolol and dexmedetomidine for attenuation of sympathomimetic response to laryngoscopy and intubation in neurosurgical patients. Srivastava VK, Agrawal S, Gautam SK, Ahmed M, Sharma S, Kumar R. J Anaesthesiol Clin Pharmacol. 2015 Apr-Jun;31(2):186-90. doi: 10.4103/0970-9185.155146. Abstract BACKGROUND AND AIMS: The present study compared the efficacy of esmolol and dexmedetomidine for attenuation of the sympathomimetic response to laryngoscopy and intubation in elective neurosurgical patients. MATERIAL AND METHODS: A total of 90 patients aged 20-60 years, American Society of Anesthesiologists physical status I or II, either sex, scheduled for elective neurosurgical procedures were included in this study. Patients were randomly allocated to three equal groups of 30 each comprising of Control group (group C) 20 ml 0.9% saline intravenous (IV), group dexmedetomidine (group D) 1 μg/kg diluted with 0.9% saline to 20 ml IV and group esmolol (group E) 1.5 mg/kg diluted with 0.9% saline to 20 ml IV. All the drugs were infused over a period of 10 min and after 2 min induction of anesthesia done. Heart rate (HR), systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded baseline, after study drug administration, after induction and 1, 2, 3, 5, 10, and 15 min after orotracheal intubation.RESULTS: In group D, there was no statistically significant increase in HR and blood pressure after intubation at any time intervals, whereas in group E, there was a statistical significant increase in blood pressure after intubation at 1, 2, and 3 min only and HR up to 5 min. CONCLUSION: Dexmedetomidine 1 μg/kg is more effective than esmolol for attenuating the hemodynamic response to laryngoscopy and intubation in elective neurosurgical patients. KEYWORDS: Dexmedetomidine; endotracheal intubation; esmolol; hemodynamic response PDF  Comparación de la eficacia de dexmedetomidina vs. esmolol en atenuar la respuesta a la laringoscopía e intubación después de inducción con secuencia rápida Comparison of the efficacy of dexmedetomidine with that of esmolol in attenuating laryngoscopic and intubation response after rapid sequence induction. Yallapragada SV, Vidadala KS, Vemuri NN, Shaik MS. Anesth Essays Res. 2014 Sep-Dec;8(3):383-7. doi: 10.4103/0259-1162.143154. Abstract CONTEXT: Laryngoscopy and tracheal intubation produce sympathetic overdrive by catecholamine release resulting in hypertension and tachycardia. Various agents are being tried to combat the intubation response over years. AIMS: This study is aimed at comparing dexmedetomidine which is a highly selective alpha-2 agonist with an ultra-short acting beta blocker, esmolol to see which among the two is better in attenuating the hemodynamic response to laryngoscopy and tracheal intubation. SETTINGS AND DESIGN: This was a prospective randomized double-blind control study. SUBJECTS AND METHODS: Sixty patients scheduled for general anesthesia were divided into two groups, D and E with 30 patients in each group. Group-D patients received dexmedetomidine 0.5 mcg/kg and Group-E patients received esmolol 0.5 mg/kg as intravenous premedication over 5 min before a rapid sequence induction and tracheal intubation. Systolic, diastolic and mean arterial pressures along with heart rate were measured using invasive arterial line at various time points. The percentage change of hemodynamic parameters at those time points from the baseline was compared between the groups. STATISTICAL ANALYSIS USED: Descriptive and inferential statistical methods were used to analyze the data. RESULTS: The percentage change of all hemodynamic parameters from base line were less in the dexmedetomidine group than in esmolol group at all-time points of measurement. However, a statistically significant difference was observed often at the time points within 1 min after tracheal intubation. CONCLUSIONS: Dexmedetomidine is superior to esmolol in attenuating the hemodynamic response to laryngoscopy and tracheal intubation. KEYWORDS: Dexmedetomidine; esmolol; hemodynamics; intubation; laryngoscopy PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Niño con Intestino Corto, como abordarlo

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 16 Septiembre 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Niño con Intestino Corto, como abordarlo” por el “Dr. Jose Luis Martínez Orozco”, Gastroenterologo Pediatra de la Cd. de Fresno Ca. 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/intestino_corto/
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.pediatramendoza.com 

enrique@pediatramendoza.com 

emendozal@yahoo.com.mx

Librerias. Noticias

librerias
Notificaciones semanales ⋅ 17 de agosto de 2015
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Intubación fallida en obstetricia/Failed tracheal intubation in obstetrics

Septiembre 13, 2015. No. 2084

Falla de intubación traqueal durante anestesia obstétrica. Revisión de la literatura Failed tracheal intubation during obstetric general anaesthesia: a literature review. Kinsella SM, Winton AL, Mushambi MC, Ramaswamy K, Swales H, Quinn AC, Popat M. Int J Obstet Anesth. 2015 Jun 30. pii: S0959-289X(15)00091-6. doi: 10.1016/j.ijoa.2015.06.008. [Epub ahead of print] Abstract We reviewed the literature on obstetric failed tracheal intubation from 1970 onwards. The incidence remained unchanged over the period at 2.6 (95% CI 2.0 to 3.2) per 1000 anaesthetics (1 in 390) for obstetric general anaesthesia and 2.3 (95% CI 1.7 to 2.9) per 1000 general anaesthetics (1 in 443) for caesarean section. Maternal mortality from failed intubation was 2.3 (95% CI 0.3 to 8.2) per 100000 general anaesthetics for caesarean section (one death per 90 failed intubations). Maternal deaths occurred from aspiration or hypoxaemia secondary to airway obstruction or oesophageal intubation. There were 3.4 (95% CI 0.7 to 9.9) front-of-neck airway access procedures (surgical airway) per 100000 general anaesthetics for caesarean section (one procedure per 60 failed intubations), usually carried out as a late rescue attempt with poor maternal outcomes. Before the late 1990s, most cases were awakened after failed intubation; since the late 1990s, general anaesthesia has been continued in the majority of cases. When general anaesthesia was continued, a laryngeal mask was usually used but with a trend towards use of a second-generation supraglottic airway device. A prospective study of obstetric general anaesthesia found that transient maternal hypoxaemia occurred in over two-thirds of cases of failed intubation, usually without sequelae. Pulmonary aspiration occurred in 8% but the rate of maternal intensive care unit admission after failed intubation was the same as that after uneventful general anaesthesia. Poor neonatal outcomes were often associated with preoperative fetal compromise, although failed intubation and lowest maternal oxygen saturation were independent predictors of neonatal intensive care unit admission. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015