Revistas con acceso abierto / Open access journals

Enero 8, 2016. No. 2200

Medicine December 2015 - Volume 94 - Issue 52pp: 1-1,e1734-e2428 Revista / Journal Journal of Neuroanaesthesiology and Critical Care 2016 Jan-April Volume 3 | Issue 1  Page Nos. 1-76 Revista / Journal  Annals of Thoracic Medicine January-March 2016 Volume 11 | Issue 1 Page Nos. 1-87 Revista / Journal Anaesthesia January 2016 Volume 71, Issue 1 Pages 3-117 PDF Anaesthesia  Special Issue: Peri-operative Medicine January 2016 Volume 71, Issue Supplement S1 Pages 1-77 Revista / Journal Pediatric Anesthesia Special Issue: Challenging Orthodoxy January 2015 Volume 25, Issue 1 Pages 1-110 PDF Acta Anaesthesiologica Scandinavica January 2015 Volume 59, Issue 1 Pages 1-136 Revista / Journal Indian Journal of Pain January-April 2016; Vol 30, Issue 1: page 1-69 Revista / Journal Helen Gharaei MD.Anesthesiology and Pain Management

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5° Curso Taller de cirugía de mano /Guadalajara / enero 21-23 2016

RNM y sugammadex/Neuromuscular relaxants and sugammadex

Monitoreo neuromuscular, uso de relajantes musculares, y su reversión en un hospital de enseñanza de tercer nivel 2.5. años después de introducir sugammadex. Cambios de opinión y práctica clínica Neuromuscular monitoring, muscle relaxant use, and reversal at a tertiary teaching hospital 2.5 years after introduction of sugammadex: changes in opinions and clinical practice. Ledowski T, Ong JS, Flett T. Anesthesiol Res Pract. 2015;2015:367937. doi: 10.1155/2015/367937. Epub 2015 Jan 22. PDF   Parálisis residual. ¿Influencia la evolución después de cirugía ambulatoria? Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery? Farhan H1, Moreno-Duarte I1, McLean D1, Eikermann M1. Curr Anesthesiol Rep. 2014 Dec;4(4):290-302. Abstract Neuromuscular blocking agents are used to facilitate tracheal intubation in patients undergoing ambulatory surgery. The use of high-dose neuromuscular blocking agents to achieve muscle paralysis throughout the case carries an increased risk of residual post-operative neuromuscular blockade, which is associated with increased respiratory morbidity. Visually monitoring the train-of-four (TOF) fade is not sensitive enough to detect a TOF fade between 0.4 and 0.9. A ratio <0.9 indicates inadequate recovery. Quantitative neuromuscular transmission monitoring (e.g., acceleromyography) should be used to exclude residual neuromuscular blockade at the end of the case. Residual neuromuscular blockade needs to be reversed with neostigmine, but it's use must be guided by TOF monitoring results since deep block cannot be reversed, and neostigmine administration after complete recovery of the TOF-ratio can induce muscle weakness. The development and use of new selectively binding reversal agents (sugammadex and calabadion) warrants reevaluation of this area of clinical practice. KEYWORDS: Ambulatory surgery; Calabadion; NMBA; Neostigmine; PORC; Residual paralysis; Respiratory complications; Sugammadex PDF

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Mortalidad pediátrica en anestesia/Paediatric anaesthetic-related mortalit

Revisión de mortalidad pediátrica relacionada con anestesia. Eventos adversos severos y incidentes críticos A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents Larissa Cronje South Afr J Anaesth Analg 2015; DOI: 10.1080/22201181.2015.1119503 Abstract Anaesthetists increasingly face questions from parents on the long-term outcomes of anaesthesia, and yet more immediate anaesthetic risks are not understood, nor explained to families. This review focused on paediatric anaesthetic-related mortality, cardiac arrest and anaesthetic-related serious adverse events and critical incidents during general anaesthesia, and within 24 hours of anaesthesia ending. Anaesthetic-related mortality is rare in the developed world, and is approximately 1 per 10 000 anaesthetics, but increases in high-risk children. Serious anaesthetic-related adverse events occur in 1.4 per 1 000 anaesthetics in the developed world. Data are lacking from the developing world but anaesthetic mortality is 2-3 times higher in middle-income countries and may be up to 100-fold greater in low-income countries. A critical incident occurs in 3-8% of anaesthetics and this figure is double that in low-income countries. Anaesthetic-related events are predominantly preventable. Brief recommendations on preventative strategies are made and research goals outlined. PDF

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Dolor neonatal

Dolor neonatal Neonatal pain. Walker SM. Paediatr Anaesth. 2014 Jan;24(1):39-48. doi: 10.1111/pan.12293. Epub 2013 Nov 13. Abstract Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. KEYWORDS:NICU; neonate; neurodevelopment; opioids; pain; regional analgesia PDF Valoración clínica del dolor en unidades de cuidados intensivos neonatales españolas Clinical assessment of pain in Spanish Neonatal Intensive Care Units. [Article in Spanish] Avila-Alvarez A, Carbajal R, Courtois E, Pertega-Diaz S, Anand KJ, Muñiz-Garcia J; Grupo español del proyecto Europain. An Pediatr (Barc). 2015 Nov 6. pii: S1695-4033(15)00381-1. doi: 10.1016/j.anpedi.2015.09.019. [Epub ahead of print] Abstract INTRODUCTION:Clinical scales are currently the best method to assess pain in the neonate, given the impossibility of self-report in this age group. A study is designed with the aim of determining the current practices as regards the clinical assessment of pain in Spanish Neonatal Units and the factors associated with the use of clinical scales. METHODS: A prospective longitudinal observational study was conducted. A total of 30 Units participated and 468 neonates were included. RESULTS: Only 13 Units (43.3%) had pain assessment protocols. Pain was evaluated with a scale in 78 neonates (16.7%, 95% CI; 13.1-20.1) and the mean number of pain assessments per patient and per day was 2.3 (Standard Deviation; 4.8), with a median of 0.75. Of the total number of 7,189 patient-days studied, there was at least one pain assessment in 654 (9.1%). No pain assessment was performed with a clinical scale on any patient in 20 (66.7%) Units. Among those that did, a wide variation was observed in the percentage of patients in whom pain was assessed, as well as in the scales used. The CRIES (C-Crying; R-Requires increased oxygen administration; I-Increased vital signs; E-Expression; S-Sleeplessness) scale was that used in most Units. In the multivariate analysis, only invasive mechanical ventilation was associated with receiving a pain assessment with a scale (OR 1.46, P=.042). DISCUSSION: The majority of neonates admitted into Intensive Care in Spain do not receive a pain assessment. Many units still do not routinely use clinical scales, and there is a wide variation between those that do use them. These results could serve as a basis for preparing national guidelines as regards pain in the neonate. KEYWORDS: Analgesia; Dolor; Neonate; Neonato; Pain; Sedación; Sedation PDF  Dolor neonatal. ¿Es necesario evaluar el dolor por punciones transcutáneas? María Hernández-Trejo, Bernarda Sánchez-Jiménez, Rosalba Barbosa-Ángeles Perinatología y reproducción humana 2011                     PDF

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