Opioides espinales en DPO/Spinal opioids for POP

Noviembre 11, 2015. No. 2142

Las evidencias actuales para la selección de opioides espinales en el dolor postoperatorio. Current evidence for spinal opioid selection in postoperative pain. Bujedo BM. Korean J Pain. 2014 Jul;27(3):200-9. doi: 10.3344/kjp.2014.27.3.200. Epub 2014 Jun 30. Abstract BACKGROUND: Spinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose-limiting side effects to improve postoperative analgesia. Therefore, physicians must better identify either specific opioids or adequate doses and routes of administration that result in a mainly spinal site of action rather than a cerebral analgesic one. METHODS: The purpose of this topical review is to describe current available clinical evidence to determine what opioids reach high enough concentrations to produce spinally selective analgesia when given by epidural or intrathecal routes and also to make recommendations regarding their rational and safety use for the best management of postoperative pain. To this end, a search of Medline/Embase was conducted to identify all articles published up to December 2013 on this topic. RESULTS: Recent advances in spinal opioid bioavailability, based on both animals and humans trials support the theory that spinal opioid bioavailability is inversely proportional to the drug lipid solubility, which is higher in hydrophilic opioids like morphine, diamorphine and hydromorphone than lipophilic ones like alfentanil, fentanyl and sufentanil. CONCLUSIONS: Results obtained from meta-analyses of RTCs is considered to be the 'highest' level and support their use. However, it's a fact that meta-analyses based on studies about treatment of postoperative pain should explore clinical surgery heterogeneity to improve patient's outcome. This observation forces physicians to use of a specific procedure surgical-based practical guideline. A vigilance protocol is also needed to achieve a good postoperative analgesia in terms of efficacy and security. PDF

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

Más de anestesia en odontopediatría/more on pediatric dental anesthesia

Noviembre 12, 2015. No. 2143

Eventos adversos después de alta de sedación oral en pacientes pediátricos odontológicos Oral Sedation Postdischarge Adverse Events in Pediatric Dental Patients. Huang A, Tanbonliong T. Anesth Prog. 2015 Fall;62(3):91-9. doi: 10.2344/0003-3006-62.3.91. Abstract The study investigated patient discharge parameters and postdischarge adverse events after discharge among children who received oral conscious sedation for dental treatment. This prospective study involved 51 patients needing dental treatment under oral conscious sedation. Each patient received one of various regimens involving combinations of a narcotic (ie, morphine or meperidine), a sedative-hypnotic (ie, chloral hydrate), a benzodiazepine (ie, midazolam or diazepam), and/or an antihistamine (ie, hydroxyzine HCl). Nitrous oxide and local anesthesia were used in conjunction with all regimens. After written informed consent was obtained, each guardian was contacted by phone with specific questions in regard to adverse events following the dental appointment. Out of 51 sedation visits, 46 were utilized for analysis including 23 boys and 23 girls ranging from 2 years 2 months to 10 years old (mean 5.8 years). 60.1% of patients slept in the car on the way home, while 21.4% of that group was difficult to awaken upon reaching home. At home, 76.1% of patients slept; furthermore, 85.7% of patients who napped following the dental visit slept longer than usual. After the appointment, 19.6% exhibited nausea, 10.1% vomited, and 7.0% experienced a fever. A return to normal behavior was reported as follows: 17.4% in <2 hours, 39.1% in 2-6 hours, 28.3% in 6-10 hours, and 15.2% in >10 hours. Postdischarge excessive somnolence, nausea, and emesis were frequent complications. The time to normality ranged until the following morning demonstrating the importance of careful postdischarge adult supervision. KEYWORDS: Chloral hydrate; Conscious sedation; Dental treatment; Diazepam; Hydroxyzine; Meperidine; Midazolam; Morphine; Postdischarge adverse event PDF Comparación de sedación con midazolam/ketamina oral versus intranasal en pacientes dentales no cooperadores de 3-6 años de edad Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3-6-year-old Uncooperative Dental Patients. Fallahinejad Ghajari M, Ansari G, Soleymani AA, Shayeghi S, Fotuhi Ardakani F. J Dent Res Dent Clin Dent Prospects. 2015 Spring;9(2):61-5. doi: 10.15171/joddd.2015.013. Epub 2015 Jun 10. Abstract Background and aims. There are several known sedative drugs, with midazolam and ketamine being the most commonly used drugs in children. The aim of this study was to compare the effect of intranasal and oral midazolam plus ketamine in children with high levels of dental anxiety. Materials and methods. A crossover double-blind clinical trial was conducted on 23 uncooperative children aged 3-6 (negative or definitely negative by Frankel scale), who required at least two similar dental treatment visits. Cases were randomly given ketamine (10 mg/kg) and midazolam (0.5 mg/kg) through oral or intranasal routes in each visit. The sedative efficacy of the agents was assessed by an overall success rate judged by two independent pediatric dentists based on Houpt's scale for sedation. Data analysis was carried out using Wilcoxon test and paired t-test. Results. Intranasal administration was more effective in reduction of crying and movement during dental procedures compared to oral sedation (P<0.05). Overall behavior control was scored higher in nasal compared to oral routes at the time of LA injection and after 15 minutes (P<0.05). The difference was found to be statistically significant at the start and during treatment. However, the difference was no longer significant after 30 minutes, with the vital signs remaining within physiological limits. Recovery time was longer in the intranasal group (P<0.001) with a more sleepy face (P=0.004). Conclusion. . Intranasal midazolam/ketamine combination was more satisfactory and effective than the oral route when sedating uncooperative children. KEYWORDS: Anxiety; intranasal; ketamine; midazolam; oral sedation PDF

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

Bibliotecas populares

bibliotecas populares
Notificaciones semanales ⋅ 4 de noviembre de 2015
NOTICIAS


El Tribuno.com.ar

La biblioteca Sarmiento forma parte del gran patrimonio cultural sureño
El Tribuno.com.ar
Desde 1910 funciona en el edificio actual, que está ubicado en el centro de la ciudad. La biblioteca popular Domingo Faustino Sarmiento de Rosario ...



Las bibliotecas aún no cobran
Diario El Argentino
Las Bibliotecas Populares de la provincia de Entre Ríos siguen esperando el cobro de los meses adeudados. En realidad, el Gobierno de la provincia ...




Diario La Opinión

Material bibliográfico
Diario La Opinión
LEHMANN. - Desde la Comuna local se hizo saber que la Biblioteca popular recibió material bibliográfico, audiovisual y multimedia. En el marco de ...




El Civismo

Feria del Libro de Luján
El Civismo
... experiencias y dificultades que tenemos en las bibliotecas populares, ya que su funcionamiento es muy diferente al de las bibliotecas escolares”.



En pocas palabras
LA MAÑANA de Córdoba
Dichas actividades se desarrollarán en El Galpón Biblioteca Popular Babel (La Falda), en la Biblioteca Popular José Mármol (Valle Hermoso), en La ...




Diario El Sol de Quilmes

Victoria Ocampo, usina de escritores
Diario El Sol de Quilmes
Celia Torres, de la Biblioteca Popular y Centro Cultural Victoria Ocampo, destacó la labor que se desarrolla en ese ámbito cultural. Recientemente ...

Fibrosis Quística ¿existe en México?

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 18 Noviembre 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Fibrosis Quística ¿existe en México?” por el “Dr. Rodolfo Boites Velarde”, Neumólogo Pediatras, de Cd. Obregón Son. 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/fibrosis_quistica/
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

Lesión renal aguda / Acute Kidney Injury

Noviembre 9, 2015. No. 2140

Hipotensión intraoperatoria: un factor causal descuidado en la lesión renal aguda adquirida en el hospital; una experiencia del Sistema de Salud de la Clínica Mayo revisitado. Intraoperative hypotension - a neglected causative factor in hospital-acquired acute kidney injury; a Mayo Clinic Health System experience revisited. Onuigbo MA, Agbasi N. J Renal Inj Prev. 2015 Sep 1;4(3):61-7. doi: 10.12861/jrip.2015.13. eCollection 2015. Abstract Acute kidney injury (AKI) is a relatively common complication of cardiothoracic surgery and has both short- and long-term survival implications, even when AKI does not progress to severe renal failure. Given that currently, there are no active effective treatments for AKI, other than renal replacement therapy when indicated, the focus of clinicians ought to be on prevention and risk factor management. In the AKI-surgery literature, there exists this general consensus that intraoperative hypotension (IH) following hypotensive anesthesia (HA) or controlled hypotension (CH) in the operating room has no significant short-term and long-term impacts on renal function. In this review, we examine the basis for this consensus, exposing some of the flaws of the clinical study data upon which this prevailing consensus is based. We then describe our experiences in the last decade at the Mayo Clinic Health System, Eau Claire, in Northwestern Wisconsin, USA, with two selected case presentations to highlight the contribution of IH as a potent yet preventable cause of post-operative AKI. We further highlight the causative although neglected role of IH in precipitating postoperative AKI in chronic kidney disease (CKD) patients. We show additional risk factors associated with this syndrome and further make a strong case for the elimination of IH as an achievable mechanism to reduce overall, the incidence of hospital acquired AKI. We finally posit that as the old saying goes, prevention is indeed better than cure. KEYWORDS: Acute kidney injury; Chronic kidney disease; Estimated glomerular filtration rate; Renal replacement therapy; Serum creatinine trajectory PDF   Lesión renal aguda Acute Kidney Injury Daniel Patschan, Gerhard Anton Müller Journal of Injury and Violence Research, Vol 7, No 1 (2015) Abstract Acute kidney injury is a frequent and serious complication in hospitalized patients. Mortality rates have not substantially been decreased during the last 20 years. In most patients AKI results from transient renal hypoperfusion or ischemia. The consequences include tubular cell dysfunction/damage, inflammation of the organ, and post-ischemic microvasculopathy. The two latter events perpetuate kidney damage in AKI. Clinical manifestations result from diminished excretion of water, electrolytes, and endogenous / exogenous waste products. Patients are endangered by cardiovascular complications such as hypertension, heart failure, and arrhythmia. In addition, the whole organism may be affected by systemic toxification (uremia). The diagnostic approach in AKI involves several steps with renal biopsy inevitable in some patients. The current therapy focuses on preventing further kidney damage and on treatment of complications. Different pharmacological strategies have failed to significantly improve prognosis in AKI. If dialysis treatment becomes mandatory, intermittent and continuous renal replacement therapies are equally effective. Thus, new therapies are urgently needed in order to reduce short- and long-term outcome in AKI. In this respect, stem cell-based regimens may offer promising perspectives. PDF Incidencia de la injuria renal aguda en unidad de paciente crítico y su mortalidad a 30 días y un año Incidence and consequences of acute kidney injury among patients admitted to critical care units Boltansky A, Bassa C, Melani S, Sepúlveda A, Maldonado I, Postigo J, Sotta E, Vidueira P, Cavagnaro C, Cavada G, Benavente C, Villamizar G, Vukusich A, Irarrázabal CE. Rev Med Chil. 2015 Sep;143(9):1114-20. doi: 10.4067/S0034-98872015000900003. Abstract BACKGROUND: Acute Kidney Injury (AKI) increases morbidity, mortality and hospital stay in critical patients units (CPU).AIM: To determine the incidence and mortality of AKI in CPU. MATERIAL AND METHODS: Review of electronic medical records of 1,769 patients aged 61 ± 20 years (47% males) discharged from a CPU during one year. Acute Kidney Injury diagnosis and severity was established using the Acute Kidney Injury Network (AKIN) criteria. RESULTS: A history of hypertension and Diabetes Mellitus was present in 44 and 22% of patients, respectively. APACHE II and SOFA scores were 14.6 ± 6.8 and 3.6 ± 2.1 respectively. AKI incidence was 28.9% (stage I, 16.7%, stage II, 5.3% and stage III, 6.9%). Mortality during the first 30 days and during the first year was 8.1 and 20.0% respectively. Patients with stage III AKI had the highest mortality (23.8 and 40.2% at 30 days and one year respectively). Compared with patients without AKI, the Odds ratio for mortality at 30 days and one year of patients with AKI stage III was 3.7 and 2.5, respectively. CONCLUSIONS: Thirty percent of patients admitted to UPC develop an AKI, which influences 30 days and one year mortality. PDF

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