Cardioprotección / Cardiac protection

Junio 8, 2016. No. 2351

Postcondicionamiento isquémico: la protección cardiaca después del evento. Ischaemic postconditioning: cardiac protection after the event. Jivraj N1, Liew F, Marber M. Anaesthesia. 2015 May;70(5):598-612. doi: 10.1111/anae.12974. Epub 2015 Feb 16. Abstract Ischaemic heart disease remains the leading cause of death worldwide. Novel approaches to improve morbidity and mortality in this population are essential. Cardiac ischaemic postconditioning - the technique of applying alternating cycles of sublethal myocardial ischaemia and reperfusion after a sustained insult - is one cardioprotective strategy that can reduce reperfusion injury. Infarct size reduction and improvements in left ventricular ejection fraction have been demonstrated with mechanical or pharmacological postconditioning, both after spontaneous acutemyocardial infarction, and associated with cardiac surgery. Nonetheless, the benefits of postconditioning can be easily attenuated. For maximal benefit, postconditioning demands a particular patient population (large area at risk, with little collateral blood flow), timely application and the measurement of appropriate clinical endpoints. Furthermore, confounders such age, sex and medication, as well as a plethora of co-morbidities common in patients with ischaemic heart disease, all impact on the efficacy of postconditioning. This fragility requires the security of outcomes from large-scale human trials to ensure robust applicability to everyday clinical practice, and to provide assurance of an impact on long-term clinical outcome. This review highlights the development of current postconditioning algorithms, the findings from current proof-of-concept trials, and the barriers that may limit its broad uptake into clinical practice. PDF    Cardioprotección por condicionamiento isquémico remoto. Mecanismos y evidencias clínicas Cardioprotection by remote ischemic conditioning: Mechanisms and clinical evidences. Aimo A1, Borrelli C1, Giannoni A1, Pastormerlo LE1, Barison A1, Mirizzi G1, Emdin M1, Passino C1. World J Cardiol. 2015 Oct 26;7(10):621-32. doi: 10.4330/wjc.v7.i10.621. Abstract In remote ischemic conditioning (RIC), several cycles of ischemia and reperfusion render distant organ and tissues more resistant to theischemia-reperfusion injury. The intermittent ischemia can be applied before the ischemic insult in the target site (remote ischemic preconditioning), during the ischemic insult (remote ischemic perconditioning) or at the onset of reperfusion (remote ischemic postconditioning). The mechanisms of RIC have not been completely defined yet; however, these mechanisms must be represented by the release of humoral mediators and/or the activation of a neural reflex. RIC has been discovered in the heart, and has been arising great enthusiasm in the cardiovascular field. Its efficacy has been evaluated in many clinical trials, which provided controversial results. Our incomplete comprehension of the mechanisms underlying the RIC could be impairing the design of clinical trials and the interpretation of their results. In the present review we summarize current knowledge about RIC pathophysiology and the data about its cardioprotective efficacy. KEYWORDS: Atherosclerosis; Cardiac surgery; Ischemic heart disease; Percutaneous coronary intervention; Remote ischemic conditioning PDF Condicionamiento isquémico: Tropiezos en el camino hacia el uso clínico Ischaemic conditioning: pitfalls on the path to clinical translation. Przyklenk K1. Br J Pharmacol. 2015 Apr;172(8):1961-73. doi: 10.1111/bph.13064. Epub 2015 Feb 27. Abstract The development of novel adjuvant strategies capable of attenuating myocardial ischaemia-reperfusion injury and reducing infarct size remains a major, unmet clinical need. A wealth of preclinical evidence has established that ischaemic 'conditioning' is profoundly cardioprotective, and has positioned the phenomenon (in particular, the paradigms of postconditioning and remote conditioning) as the most promising and potent candidate for clinical translation identified to date. However, despite this preclinical consensus, current phase II trials have been plagued by heterogeneity, and the outcomes of recent meta-analyses have largely failed to confirm significant benefit. As a result, the path to clinical application has been perceived as 'disappointing' and 'frustrating'. The goal of the current review is to discuss the pitfalls that may be stalling the successful clinical translation of ischaemic conditioning, with an emphasis on concerns regarding: (i) appropriate clinical study design and (ii) the choice of the 'right' preclinical models to facilitate clinical translation. PDF  Condicionamiento isquémico: El reto de proteger el corazón diabético Ischemic conditioning: the challenge of protecting the diabetic heart. Wider J1, Przyklenk K1. Cardiovasc Diagn Ther. 2014 Oct;4(5):383-96. doi: 10.3978/j.issn.2223-3652.2014.10.05. Abstract The successful clinical translation of novel therapeutic strategies to attenuate lethal myocardial ischemia-reperfusion injury and limit infarct size has been identified as a major unmet need, and is of particular importance in patients with type-2 diabetes. There is a wealth of preclinical evidence that ischemic conditioning (encompassing the three paradigms of preconditioning, postconditioning and remote conditioning) is profoundly cardioprotective and, via up-regulation of endogenous signaling cascades, renders the heart resistant to infarction. However, current phase II trials aimed at exploiting ischemic conditioning for the clinical treatment of myocardial ischemia-reperfusion injury have yielded mixed results, possibly reflecting the emerging concern that the efficacy of conditioning-induced cardioprotection may be compromised in the diabetic heart. Our goal in this review is to provide a summary of our present understanding of the effect of type-2 diabetes on the infarct-sparing effect of ischemic conditioning, and the challenges of limiting ischemia-reperfusion injury in the diabetic heart. KEYWORDS: Myocardial infarction; diabetes; postconditioning; preconditioning; remote conditioning PDF  VIII Foro Internacional de Medicina del Dolor y Paliativa  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Junio 9-11, Ciudad de México Dra. Argelia Lara Solares Tel. 5513 3782  www.dolorypaliativos.org  Cursos de Anestesiología en Chile, 2016 Facultad de Medicina. Pontificia Universidad Católica de Chile Información

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

Bibliotecas. Noticias

bibliotecas
Notificaciones diarias ⋅ 1 de junio de 2016
NOTICIAS


ABC.es
¿Una política de Estado en Bibliotecas Públicas?
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Programas medioambientales, deportivos, de comunicación, artísticos y de biblioteca dirigidos a escolares de la red pública. Todos están riesgo de ...
¿Importa la educación pública de calidad? - eldiario.es
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WEB

La evolución de la BNE en tiempos difíciles
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Hipnosis Usos Médicos y Alcances Terapéuticos

Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 15 de Junio 2016 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Hipnosis Usos Médicos y Alcances Terapéuticos”, por el “Dra. Elena Aguilar Sánchez”, Cirujano Pediatra de la Cd. Paris Fr. 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/hipnosis/

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 de hipotermia / More on hypothermia

Junio 12, 2016. No. 2355

Hipotermia intraoperatoria no planeada Inadvertent intraoperative hypothermia. Horosz B1, Malec-Milewska M. Anaesthesiol Intensive Ther. 2013 Jan-Mar;45(1):38-43. doi: 10.5603/AIT.2013.0009. Abstract Inadvertent perioperative hypothermia complicates a large percentage of surgical procedures and is related to multiple factors. Strictly regulated in normal conditions (± 0.2°C), the core body temperature of an anaesthetised patient may fall by as much as 6°C, while a 2°C decrease is very common. This is due to a combination of anaesthesia-related impairment of the central thermoregulatory control and a cool operating room temperature, which, when superimposed on insufficient insulation and a failure to actively warm the patient, may result in profound temperature disturbances. As a result, prolonged wound healing, increased risk of wound infection, a higher rate of cardiac morbidity, and greater intraoperative blood loss and postoperative blood transfusion requirements may occur. The reasons for this are said to include underlying changes in microcirculation, coagulation, immunology and an increase in the duration of action of most anaesthesia medications. As effective methods have been available for a number of years now, it is currently indicated to maintain intraoperative normothermia in order to minimise procedure-related risk and improve patient comfort. PDF Manejo de la hipotermia perioperatoria no planeada en adultos The Management of Inadvertent Perioperative Hypothermia in Adults [Internet]. Editors; National Collaborating Centre for Nursing and Supportive Care (UK). London: Royal College of Nursing (UK); 2008 Apr.  National Institute for Health and Clinical Excellence: Guidance . Excerpt Inadvertent perioperative hypothermia is a common but preventable complication of perioperative procedures, which is associated with poor outcomes for patients. Inadvertent perioperative hypothermia should be distinguished from the deliberate induction of hypothermia for medical reasons, which is not covered by this guideline. In this guideline, hypothermia is defined as a patient core temperature of below 36.0°C. Hereafter, 'temperature' is used to denote core temperature. Adult surgical patients are at risk of developing hypothermia at any stage of the perioperative pathway. In the guideline, the perioperative pathway is divided into three phases: the preoperative phase is defined as the 1 hour before induction of anaesthesia (when the patient is prepared for surgery on the ward or in the emergency department), the intraoperative phase is defined as totalanaesthesia time, and the postoperative phase is defined as the 24 hours after entry into the recovery area in the theatre suite (which will include transfer to and time spent on the ward). The phrase 'comfortably warm' is used in recommendations relating to both the preoperative and postoperative phases, and refers to the expected normal temperature range of adult patients (between 36.5°C and 37.5°C). PDF  Monitoreo de la temperatura y termorregulación perioperatoria Temperature monitoring and perioperative thermoregulation. Sessler DI1. Anesthesiology. 2008 Aug;109(2):318-38. doi: 10.1097/ALN.0b013e31817f6d76. Abstract Most clinically available thermometers accurately report the temperature of whatever tissue is being measured. The difficulty is that no reliably core-temperature-measuring sites are completely noninvasive and easy to use-especially in patients not undergoing general anesthesia. Nonetheless, temperature can be reliably measured in most patients. Body temperature should be measured in patients undergoing generalanesthesia exceeding 30 min in duration and in patients undergoing major operations during neuraxial anesthesia. Core body temperature is normally tightly regulated. All general anesthetics produce a profound dose-dependent reduction in the core temperature, triggering cold defenses, including arteriovenous shunt vasoconstriction and shivering. Anesthetic-induced impairment of normal thermoregulatory control, with the resulting core-to-peripheral redistribution of body heat, is the primary cause of hypothermia in most patients. Neuraxial anesthesia also impairs thermoregulatory control, although to a lesser extent than does general anesthesia. Prolonged epidural analgesia is associated with hyperthermia whose cause remains unknown. PDF 16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/  Cursos de Anestesiología en Chile, 2016 Facultad de Medicina. Pontificia Universidad Católica de Chile Información

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