Obesidad en UCI / Obesity in ICU

Agosto 4, 2016. No. 2407

Cuidados intensivos en los obesos durante y después de cirugía de columna Critical care of obese patients during and after spine surgery. Elgafy H1, Hamilton R1, Peters N1, Paull D1, Hassan A1. World J Crit Care Med. 2016 Feb 4;5(1):83-8. doi: 10.5492/wjccm.v5.i1.83. eCollection 2016.Abstract Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Post-operatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes. KEYWORDS: Critical care; Obesity; Spine sugary PDF Curso de Especialidad en Algología 2017-2018 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Universidad Nacional Autónoma de México Información / Information Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  Programa 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/

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

Bloqueo de la extremidad superior / Upper extremity nerve block

Agosto 1, 2016. No. 2404

Bloqueo neural de la extremidad superior. ¿Cómo se puede beneficiar, mejorar su duración y seguridad? Una actualización Upper extremity nerve block: how can benefit, duration, and safety be improved? An update. Brattwall M, Jildenstål P, Warrén Stomberg M, Jakobsson JG. F1000Res. 2016 May 18;5. pii: F1000 Faculty Rev-907. doi: 10.12688/f1000research.7292.1. eCollection 2016. Abstract Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effectivepostoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality. KEYWORDS: anaesthesia; axillary plexus; infraclavicular; interscalene; peripheral blocks; supraclavicular; ultra-sound guided; upper extremity block PDF  Curso de Especialidad en Algología 2017-2018 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Universidad Nacional Autónoma de México Información / Information Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  Programa 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/

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

Obesidad y cirugía bariátrica / Obesity and bariatric surgery

Agosto 1, 2016. No. 2404

¿Existe metabólicamente la obesidad sana? Does Metabolically Healthy Obesity Exist? Muñoz-Garach A1,2, Cornejo-Pareja I3, Tinahones FJ4,5. Nutrients. 2016 Jun 1;8(6). pii: E320. doi: 10.3390/nu8060320. Abstract The relationship between obesity and other metabolic diseases have been deeply studied. However, there are clinical inconsistencies, exceptions to the paradigm of "more fat means more metabolic disease", and the subjects in this condition are referred to as metabolically healthy obese (MHO).They have long-standing obesity and morbid obesity but can be considered healthy despite their high degree of obesity. We describe the variable definitions of MHO, the underlying mechanisms that can explain the existence of this phenotype caused by greater adipose tissue inflammation or the different capacity for adipose tissue expansion and functionality apart from other unknown mechanisms. We analyze whether these subjects improve after an intervention (traditional lifestyle recommendations or bariatric surgery) or if they stay healthy as the years pass. MHO is common among the obese population and constitutes a unique subset of characteristics that reduce metabolic and cardiovascular risk factors despite the presence of excessive fat mass. The protective factors that grant a healthier profile to individuals with MHO are being elucidated. KEYWORDS: adipose tissue; inflammation; metabolic syndrome; metabolically healthy obesity PDF Prescripción de actividad física antes de cirugía bariátrica. Viabilidad, impacto sobre la salud, y las implicaciones prácticas. Physical activity prescription before bariatric surgery: Feasibility, health impacts, and practical implications. Al-Hazzaa HM. Saudi J Obesity 2016;4:3-12 Abstract Obesity is a challenging health problem. For people with morbid obesity who cannot lose weight, using conventional weight loss methods, they may resort to bariatric surgery. However, despite increasing evidence that physical activity (PA) can reduce weight and improve postsurgical outcomes, most preoperative obese patients are inactive. Therefore, the aim of the present paper was to review the evidence for the feasibility and beneficial health impact of prebariatric surgery PA program for obese patients and to discuss the practical implications of PA counseling and exercise prescription to healthcare providers. A systematic electronic search was conducted utilizing keywords related to PA, exercise, and prebariatric surgery using MEDLINE databases. The findings of this review indicated that a presurgical intervention targeting PA among obese patients awaiting bariatric surgery is feasible and has the potential to increase patient's engagement in PA postoperatively. In addition, higher levels of preoperative PA or physical fitness were associated with lower postsurgical complications and a shorter length of stay in hospital. There is also evidence to support that higher levels of preoperative PA may improve weight loss outcomes following laparoscopic surgery. Research showed that the daily time spent being sedentary among obese patients was quite excessive. In adult population, the available evidence demonstrates a dose-response relationship between the amount of moderate-to-vigorous intensity PA and reduced weight loss and increased health benefits. It is recommended that healthcare providers to increase their use of the five A's (Assess, Advise, Agree, Assist, and Arrange) counseling model when counseling obese patients about PA and weight loss. Finally, the future studies must seek to make PA more effective and compliant for obese patients and focus on identifying major barriers that are preventing most patients from assuming active lifestyles. Keywords: Bariatric surgery, exercise, exercise counseling, obesity, physical activity, weight loss PDF  Fluoxetina, topiramato y su combinación para estabilizar la conducta alimenticia antes de cirugía bariátrica Fluoxetine, topiramate, and combination of both to stabilize eating behavior before bariatric surgery. Guisado-Macías JA1, Méndez-Sánchez F1, Baltasar-Tello I1, Zamora-Rodríguez FJ1, Escudero-Sánchez AB1, Vaz-Leal FJ1. Actas Esp Psiquiatr. 2016 May;44(3):93-6. Epub 2016 May 1. Abstract INTRODUCTION: Pharmacotherapy for the management of obesity is primarily aimed at weight loss, weight loss maintenance and risk reduction (reduction in body fat, risk factors for cardiovascular disease and the incidence of diabetes mellitus). Among drugs that have been evaluated for weight loss include antidepressants (fluoxetine) and antiepileptic (topiramate). MATERIAL AND METHODS: We analyzed eating behavior and weight loss in a sample of morbid obesity patients before bariatric surgery. The patients suffering eating disturbances symptoms were grouped into three groups: one group received 40 mg of flouxetine/day (Group A); another group received topiramate 200 mg/day (Group B); and the third group of patients were treated with fluoxetine 40 mg and 200 mg of topiramate/day (Group C). RESULTS: Patients treated with fluoxetine plus topiramate lost more weight at 3 and 6 months before surgery. CONCLUSIONS: The use of the psychopharmaceutical drug (fluoxetine and topiramate) in morbid obese patients with eating disorders could represent a new approach to the management of eating behavior before bariatric surgery. PDF Curso de Especialidad en Algología 2017-2018 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Universidad Nacional Autónoma de México Información / Information Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  Programa 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/

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015Obesidad y cirugía bariátrica / Obesity and bariatric surgery