Ultrasonido en bloqueos neuroaxiales en obesos / Ultrasound for Neuraxial Block in Obese Patients

Marzo 22, 2016. No. 2273

Altas tasas de éxito del uso de ultrasonido en bloqueos neuroaxiales en pacientes obesos. High Success Rates Using Ultrasound for Neuraxial Block in Obese Patients. Shaylor R, Saifi F, Davidson E, Weiniger CF. Isr Med Assoc J. 2016 Jan;18(1):36-9. Abstract BACKGROUND: Successful neuraxial block performance relies on assessment and palpation of surface landmarks, potentially challenging in patients with a high body mass index (BMI). OBJECTIVES: To evaluate the use of ultrasound-assisted neuraxial bock in a non-obstetric population with BMI above versus below 30 kg/m2. METHODS: Healthy adult patients undergoing extracorporeal shock wave lithotripsy (ESWL) under neuraxial block were observed in this quality assurance study. Prior to the neuraxial block, an ultrasound examination was performed to identify the puncture site. Neuraxial anesthesia block was performed under aseptic surgical conditions with the patient in the sitting position. Following block placement, external landmarks were palpated. Our primary study outcome was the number of attempts (skin insertions with the needle) after pre-puncture ultrasound identification of the insertion point, comparing patients with BMI above versus below 30 kg/m2. Our secondary outcome was assessment by palpation of external anatomical landmarks. RESULTS: Our study group included 63 consecutive patients undergoing neuraxial block for ESWL. Data were assessed according to BMI (above versus below 30 kg/m2). An overall success rate at the first attempt of 90.5% (CI 0.8-0.95) was achieved using ultrasound-guided neuraxial block. This block placement success rate was similar for all patients, regardless of BMI above versus below 30 kg/m2. In contrast, the ease of palpation of anatomic landmarks, P = 0.001, and the ease of palpation of iliac crest, P < 0.001, differed significantly between the patients above versus below 30 kg/m2. The reported verbal pain scores (VPS) due to block insertion was similar among all patients regardless of BMI category (above versus below 30 kg/m2). CONCLUSIONS: We observed high success rates when ultrasound-assisted neuraxial block is performed, regardless of BMI above versus below 30 kg/m2, despite expected differences in surface landmark palpation.  PDF

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

Cuba y Estados Unidos de América / Cuba and the United States of America

Marzo 22, 2016. No. 2273

Hacia una sinergia científica: Cuba y Estados Unidos Alberto J. Dorta-Contreras Rev Neurol 2015; 60 (3): 97-98   El 17 de diciembre de 2014 se comunicó oficial y simultáneamente por Washington y La Habana el restablecimiento de relaciones diplomáticas entre Cuba y los Estados Unidos de América. Sin pretender adentrarnos en cuestiones ajenas al perfil de Revista de Neurología, resulta difícil soslayar la repercusión que esto puede tener en el desarrollo de la ciencia en ambos países y en particular en las neurociencias- no sólo para éstos, sino para el contexto iberoamericano y mundial. PDF Una vieja barrera se está rompiendo. Cuba y Estados Unidos de América intentan renovar sus relaciones. ¿Cuál será el impacto en la anestesiología y ciencias relacionadas? An Old Barrier is Breaking Down: Cuba and the United States of America Attempt to Renew Relations. What will be its Impact on Anesthesiology and Related Sciences?. Whizar-Lugo VM J Anesth Crit Care Open Access2015;2(4): 00062. DOI: 10.15406/jaccoa.2015.02.00062   Science and politics should not be seen as separate activities as both have been a crucial piece of mankind progress since man realized that it was necessary to link actions evolve in both fields of thought and engagement of societies, regardless of their basic differences. One of the inalienable characteristics of human beings is to be a political animal, that under the current globalized conditions allow us to live the dilemmas of the most remote corner of the globe; every day we are aware of the joy of living in progress, the food shortage of impoverished, the anguish of helpless sadness of those who will die, the fortune of the millionaire, the frustration in the midst of a war, the fame of whom has achieved success, as we have access to the latest advances in science. In the scientific ambience, some colleagues have been forced to share the rejection of several medical communities, geopolitical rejection dictated by irrational leaders, nationalists personalities who fail to grasp that knowledge has to become universal. PDF

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

Ultrasonido pulmonar y reclutamiento / Real-time images of tidal recruitment using lung ultrasound

Marzo 23, 2016. No. 2274

Imágenes en tiempo real de ¨reclutamiento tidal¨ utilizando ultrasonido pulmonar Real-time images of tidal recruitment using lung ultrasound. Tusman G1, Acosta CM2, Nicola M3, Esperatti M4, Bohm SH5, Suarez-Sipmann F6,7. Crit Ultrasound J. 2015 Dec;7(1):19. doi: 10.1186/s13089-015-0036-2. Epub 2015 Dec 12. Abstract BACKGROUND: Ventilator-induced lung injury is a form of mechanical damage leading to a pulmonary inflammatory response related to the use of mechanical ventilation enhanced by the presence of atelectasis. One proposed mechanism of this injury is the repetitive opening and closing of collapsed alveoli and small airways within these atelectatic areas-a phenomenon called tidal recruitment. The presence of tidal recruitment is difficult to detect, even with high-resolution images of the lungs like CT scan. The purpose of this article is to give evidence of tidal recruitment by lung ultrasound. FINDINGS: A standard lung ultrasound inspection detected lung zones of atelectasis in mechanically ventilated patients. With a linear probe placed in the intercostal oblique position. We observed tidal recruitment within atelectasis as an improvement in aeration at the end of inspiration followed by the re-collapse at the end of expiration. This mechanism disappeared after the performance of a lung recruitment maneuver. CONCLUSIONS: Lung ultrasound was helpful in detecting the presence of atelectasis and tidal recruitment and in confirming their resolution after a lung recruitment maneuver. KEYWORDS: Atelectasis; Lung ultrasound; Recruitment maneuvers; Tidal recruitment; VILI PDF

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