Libro sobre enfermedades y cirugía hepática / Free book on liver diseases and surgery

Octubre 29, 2015. No. 2129Octubre, mes de lucha contra cáncer de mama.

Avances recientes en enfermedades y cirugía hepática Recent Advances in Liver Diseases and Surgery Edited by Ahmed El-Shaarawy, Tary Salman and Hesham Abdeldayem, ISBN 978-953-51-2193-0, 328 pages, Publisher: InTech, Chapters published October 28, 2015 under CC BY 3.0 license   This book presents the most recent advances in the field of liver diseases and surgery, including the remarkable advances in Hepatitis C therapy, liver tumors, injuries, cysts, resections, transplantation, and preoperative management of patients with liver diseases. The editors are the dean and vice deans of the National Liver Institute, Menoufia University, a dedicated international center of excellence and a leading medical institution in the Middle East for the diagnosis and management of liver diseases and advanced training and research in hepatobiliary sciences. The authors are leading experts from four continents across the globe (North America, Europe, Asia, and Africa). In other words, the book team reflects an international dream team of experts in the area of liver diseases. Libro/Book

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

Bloqueo peridural en ortopedia / Epidural block in orthopedics

Octubre 26, 2015. No. 2126Octubre, mes de lucha contra cáncer de mama.

Comparación de fentanil vs meperidina como suplementos de clonidina-bupivacaína en pacientes de cirugía ortopédica de la extremidad inferior con anestesia espinal-peridural combinada Comparison of fentanyl versus meperidine as supplements to epidural clonidine-bupivacaine in patients with lower limb orthopedic surgery under combined spinal epidural anesthesia. Yousef AA, Atef AM, Awais WM. BMC Anesthesiol. 2015 Oct 14;15(1):146. doi: 10.1186/s12871-015-0126-5. CONCLUSION: The combined administration of epidural clonidine and meperidine provided better intraoperative hemodynamics and prolonged postoperative analgesia than epidural clonidine fentanyl combination in patients undergoing lower limb orthopedic surgery. PDF Estudio comparativo sobre la eficacia y seguridad de anestesia peridural-espinal combinada vs. raquia en ancianos de alto riesgo para cirugías alrededor de la cadera A comparative study-efficacy and safety of combined spinal epidural anesthesia versus spinal anesthesia in high-risk geriatric patients for surgeries around the hip joint. Tummala V, Rao LN, Vallury MK, Sanapala A. Anesth Essays Res. 2015 May-Aug;9(2):185-8. doi: 10.4103/0259-1162.153764.  CONCLUSION: CSEA is a safe, effective, reliable technique with better hemodynamic stability along with the provision of prolonging analgesia compared to spinal anesthesia for high-risk geriatric patients undergoing surgeries around the hip joint. PDF

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

Vía aéra en obstetricia/Airway in obstetrics

Octubre 28, 2015. No. 2128Octubre, mes de lucha contra cáncer de mama.

Intubación fallida durante anestesia general en obstetricia. Revisión de la literaura 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 Nov;24(4):356-74. doi: 10.1016/j.ijoa.2015.06.008. Epub 2015 Jun 30. 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 Guías de la Obstetric Anaesthetists' Association y la Difficult Airway Society para el manejo de la intubación difícil y fallida en obstetricia Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, Quinn AC. Anaesthesia. 2015 Nov;70(11):1286-306. doi: 10.1111/anae.13260. Abstract The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training. PDF

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

Vía aérea pediátrica / Pediatric airway

Octubre 27, 2015. No. 2127Octubre, mes de lucha contra cáncer de mama.

Manejo prehospitalario avanzado de la vía aérea por anestesiólogos en pacientes pediátricos. Estudio descriptivo Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study. Tarpgaard M, Hansen TM, Rognås L. Scand J Trauma Resusc Emerg Med. 2015 Aug 27;23:61. doi: 10.1186/s13049-015-0140-0. Abstract BACKGROUND: Pre-hospital advanced airway management has been named one of the top-five research priorities in physician-provided pre-hospital critical care. Few studies have been made on paediatric pre-hospital advanced airway management. The aim of this study was to investigate pre-hospital endotracheal intubation success rate in children, first-pass success rates and complications related to pre-hospital advanced airway management in patients younger than 16 years of age treated by pre-hospital critical care teams in the Central Denmark Region (1.3 million inhabitants). METHODS: A prospective descriptive study based on data collected from eight anaesthetist-staffed pre-hospital critical care teams between February 1st 2011 and November 1st 2012. Primary endpoints were 1) pre-hospital endotracheal intubation success rate in children 2) pre-hospital endotracheal intubation first-pass success rate in children and 3) complications related to prehospital advanced airway management in children. RESULTS: The pre-hospital critical care anaesthetists attempted endotracheal intubation in 25 children, 13 of which were less than 2 years old. In one patient, a neonate (600 g birth weight), endotracheal intubation failed. The patient was managed by uneventful bag-mask ventilation. All other 24 children had their tracheas successfully intubated by the pre-hospital critical care anaesthetists resulting in a pre-hospital endotracheal intubation success rate of 96 %. Overall first pass success-rate was 75 %. In the group of patients younger than 2 years old, first pass success-rate was 54 %. The total rate of airway management related complications such as vomiting, aspiration, accidental intubation of the oesophagus or right main stem bronchus, hypoxia (oxygen saturation < 90 %) or bradycardia (according to age) was 20 % in children younger than 16 years of age and 38 % in children younger than 2 years of age. No deaths, cardiac arrests or severe bradycardia (heart rate <60) occurred in relation to pre-hospital advanced airway management. CONCLUSION: Compared with the total population of patients receiving pre-hospital advanced airway management in our system, the overall success rate following pre-hospital endotracheal intubations in children is acceptable but the first-pass success rate is low. The complication rates in the paediatric population are higher than in our pre-hospital advanced airway management patient population as a whole. This illustrates that young children may represent a substantial pre-hospital airway management challenge even for experienced pre-hospital critical care anaesthetists. This may influence future training and quality insurance initiatives in paediatric pre-hospital advanced airway management. PDF

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