Libro sobre Hipercolesterolemia/Free book on Hypercholesterolemia

Septiembre 17, 2015. No. 2088

Libro sobre Hipercolesterolemia Hypercholesterolemia Edited by Sekar Ashok Kumar, ISBN 978-953-51-2169-5, 232 pages, Publisher: InTech, Chapters published September 17, 2015 under CC BY 3.0 license   This book is aimed to accentuate the importance of hypercholesterolemia, since targeting and treating the hypercholesterolemia is increasingly well known as an essential strategy in the prevention of atherosclerosis-induced cardiovascular disease. It is important to look at hypercholesterolemia as it is proved to be crucial as well as the early stage of atherogenesis and can also be managed with appropriate treatment. This book describes the basics of hypercholesterolemia and its causes and various experimental animal models to understand and study the pathophysiology of hypercholesterolemia as well as to present practice-based clinical approaches to treat hypercholesterolemia. Further, the book describes various treatment strategies of hypercholesterolemia in detail, especially the appropriate use of statin. It is well known that the use of statin is an ideal as well as a potent therapy to lower cholesterol level and also has various beneficial pharmacological effects to prevent cardiovascular diseases. However, there exists less awareness about the use of statin. Hence, it is important to understand the appropriate use of statin in terms of doses for different stages of hypercholesterolemia, side effects, resistance of its use, and also interaction of statin with other drugs, which are well described in this book. In short, the major aim of this compendium is to present to the readers comprehensive, updated, and current research perspectives on hypercholesterolemia. Libro/Book

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Farmacodinamia en anestesia pediátrica/Pharmacodynamic in pediatric anesthesia

Septiembre 21, 2015. No. 2092

Modelos de interacciones farmacocinéticas en anestesia pediátrica Pharmacodynamic interaction models in pediatric anesthesia. Hannam JA, Anderson BJ. Paediatr Anaesth. 2015 Oct;25(10):970-80. doi: 10.1111/pan.12735. Epub 2015 Aug 4. Abstract Pharmacokinetic (PK) and pharmacodynamic (PD) models are important tools for summarizing drug dose, concentration, and effect relationships. Co-administration of drugs may alter PK and PD relationships. Traditional methods of evaluating PD interactions include using isoboles, shifts in dose-response curves, or interaction indices based on parameters of potency derived from separate monotherapy and combination therapy analyses. These methods provide an estimation of the magnitude of effect for dose or concentration combinations, but they do not inform us on the time course of that effect, or its associated variability. A better way to investigate PD interactions is to use modeling, and to take advantage of the benefits of population analyses. A population analysis is a statistical method in which a model describing the typical (or population) response, and the variability between individuals within that population, is developed. Models for monotherapy, derived using a population approach, can be combined and extended to incorporate PD interactions between two or more drugs. The purpose of this article was to provide a general road map for understanding and interpreting PD interaction models, including the 'response surface' models. Several types of response surface models exist, and here we review these with examples taken from the literature. We also consider current and future applications for this type of analysis for clinical anesthesia and pediatrics. Keywords: drug interactions, pharmacodynamics, pharmacokinetics, pharmacometrics, population modeling PDF

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

Anemia en el Niño, hipocrómica microcítica, ¿como abordarla?

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 23 Septiembre 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Anemia en el Niño, hipocrómica microcítica, ¿como abordarla?” por el “Dr. Euler Chargoy Vivaldo”, Hematólogo Pediatra de la Cd. De Oaxaca Oax. 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/anemia_pediatria/
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

Más sobre BIS/More on BIS

Septiembre 19, 2015. No. 2090

Efecto del monitoreo BIS sobre los requerimientos de anestesia en TCI para microdiscectomía lumbar The effect of bispectral index monitoring on anaesthetic requirements in target-controlled infusion for lumbar microdiscectomy. Karwacki Z, Niewiadomski S, Rzaska M, Witkowska M. Anaesthesiol Intensive Ther. 2014 Sep-Oct;46(4):284-8. doi: 10.5603/AIT.2014.0046. CONCLUSION: BIS monitoring reduces the doses of opioids and hypnotics used during total intravenous anaesthesia by TCI. PDF Monitoreo BIS durante sedación con propofol y remifentanil para disección endoscópica submucosa. Bispectral index monitoring during anesthesiologist-directed propofol and remifentanil sedation for endoscopic submucosal dissection: a prospective randomized controlled trial. Park WY, Shin YS, Lee SK, Kim SY, Lee TK, Choi YS. Yonsei Med J. 2014 Sep;55(5):1421-9. doi: 10.3349/ymj.2014.55.5.1421. Abstract PURPOSE: Endoscopic submucosal dissection (ESD) is a technically difficult and lengthy procedure requiring optimal depth of sedation. The bispectral index (BIS) monitor is a non-invasive tool that objectively evaluates the depth of sedation. The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol, and thus reduce the incidence of sedation- and/or procedure-related complications. MATERIALS AND METHODS: A total of 180 patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups. The control group (n=90) was monitored by the Modified Observer's Assessment of Alertness and Sedation scale and the BIS group (n=90) was monitored using BIS. The total doses of propofol and remifentanil, the need for rescue propofol, and the rates of complications were recorded. RESULTS: The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group (47.8% vs. 30.0%, p=0.014). There were no significant differences in the incidence of sedation- and/or procedure-related complications. CONCLUSION: BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures. However, this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation. KEYWORDS: Bispectral index; endoscopic submucosal dissection; propofol; remifentanil PDF    BIS en la detección de dolor en pacientes adultos con ventilación mecánica en UCI The use of the bispectral index in the detection of pain in mechanically ventilated adults in the intensive care unit: a review of the literature. Coleman RM, Tousignant-Laflamme Y, Ouellet P, Parenteau-Goudreault É, Cogan J, Bourgault P. Pain Res Manag. 2015 Jan-Feb;20(1):e33-7. Epub 2014 Jul 22. Abstract BACKGROUND: Pain assessment is an immense challenge for clinicians, especially in the context of the intensive care unit, where the patient is often unable to communicate verbally. Several methods of pain assessment have been proposed to assess pain in this environment. These include both behavioural observation scales and evaluation of physiological measurements such as heart rate and blood pressure. Although numerous validation studies pertaining to behavioural observation scales have been published, several limitations associated with using these measures for pain assessment remain. Over the past few years, researchers have been interested in the use of the bispectral index monitoring system as a proxy for the evaluation of encephalography readings to assess the level of anesthesia and, potentially, analgesia. OBJECTIVES: To synthesize the main studies exploring the use of the bispectral index monitoring system for pain assessment, to guide future research in adults under sedation in the intensive care unit. METHOD: The EMBASE, Medline, CINAHL and PsycINFO databases were searched for studies published between 1996 and 2013 that evaluated the use of the bispectral index in assessing pain. RESULTS: Most studies conclude that nociceptive stimulation causes a significant increase in the bispectral index and revealed the importance of controlling certain confounding variables such as the level of sedation. DISCUSSION: Further studies are needed to clearly demonstrate the relationship between nociceptive stimuli and the bispectral index, as well as the specificity of the bispectral index in detecting pain. PDF

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

Monitoreo BIS/BIS monitoring

Septiembre 20, 2015. No. 2091

BIS para mejorar la anestesia y el período postoperatorio Bispectral index for improving anaesthetic delivery and postoperative recovery. Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N. Cochrane Database Syst Rev. 2014 Jun 17;6:CD003843. doi: 10.1002/14651858.CD003843.pub3. Abstract BACKGROUND: The use of clinical signs may not be reliable in measuring the hypnotic component of anaesthesia. The use of bispectral index (BIS) to guide the dose of anaesthetic may have certain advantages over clinical signs. This is the second update of a review originally published in 2007. OBJECTIVES: The primary objective of this review focused on whether the incorporation of BIS into the standard practice for management of anaesthesia can reduce the risk of intraoperative awareness, consumption of anaesthetic agents, recovery time and total cost of anaesthesia in surgical patients undergoing general anaesthesia. SEARCH METHODS: In this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE (1990 to 31 January 2013), EMBASE (1990 to 31 January 2013) and reference lists of articles. Previously, we searched to May 2009. SELECTION CRITERIA: We included randomized controlled trials comparing BIS with standard practice criteria for titration of anaesthetic agents. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality, extracted data and analysed the data. We contacted study authors for further details. MAIN RESULTS: We included 36 trials. In studies using clinical signs as standard practice, the results demonstrated a significant effect of the BIS-guided anaesthesia in reducing the risk of intraoperative awareness among surgical patients at high risk for awareness (7761 participants; odds ratio (OR) 0.24, 95% confidence interval (CI) 0.12 to 0.48). This effect was not demonstrated in studies using end tidal anaesthetic gas (ETAG) monitoring as standard practice (26,530 participants; OR 1.13, 95% CI 0.56 to 2.26). BIS-guided anaesthesia reduced the requirement for propofol by 1.32 mg/kg/hr (672 participants; 95% CI -1.91 to -0.73) and for volatile anaesthetics (desflurane, sevoflurane, isoflurane) by 0.65 minimal alveolar concentration equivalents (MAC) (95% CI -1.01 to -0.28) in 985 participants. Irrespective of the anaesthetics used, BIS reduced the following recovery times: time for eye opening (2557 participants; by 1.93 min, 95% CI -2.70 to -1.16), response to verbal command (777 participants; by 2.73 min, 95% CI -3.92 to -1.54), time to extubation (1501 participants; by 2.62 min, 95% CI -3.46 to -1.78), and time to orientation (373 participants; by 3.06 min, 95% CI -3.63 to -2.50). BIS shortened the duration of postanaesthesia care unit stay by 6.75 min (1953 participants; 95% CI -11.20 to -2.31) but did not significantly reduce the time to home readiness (329 participants; -7.01 min, 95% CI -30.11 to 16.09). AUTHORS' CONCLUSIONS: BIS-guided anaesthesia can reduce the risk of intraoperative awareness in surgical patients at high risk for awareness in comparison to using clinical signs as a guide for anaesthetic depth. BIS-guided anaesthesia and ETAG-guided anaesthesia may be equivalent in protection against intraoperative awareness but the evidence for this is inconclusive. In addition, anaesthesia guided by BIS kept within the recommended range improves anaesthetic delivery and postoperative recovery from relatively deep anaesthesia.   PDF   Capnografía y BIS en sedación pediátrica Capnography and the bispectral index-their role in pediatric sedation: a brief review. Sammartino M, Volpe B, Sbaraglia F, Garra R, D'Addessi A. Int J Pediatr. 2010;2010:828347. doi: 10.1155/2010/828347. Epub 2010 Oct 3. Abstract Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of respiratory impairment. The Bispectral index (BIS) allows the reduction of dose requirements of anaesthetic drugs, the reduction in the time to extubation and eye opening, and the reduction in the time to discharge. In the field of pediatric sedation, capnography should be recommended to prevent respiratory complications, particularly in spontaneous ventilation. The use of the BIS index, however, needs further investigation due to a lack of evidence, especially in infants. In this paper, we will investigate the role of capnography and the BIS index in improving monitoring standards in pediatric sedation. PDF

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