Indice de reserva de oxígeno y la presión parcial de oxígeno arterial / Reserve oxygen index and arterial oxygen partial pressure

Septiembre 4, 2016. No. 2438

Relación entre el índice de reserva de oxígeno y la presión parcial de oxígeno arterial durante cirugía The Relationship Between Oxygen Reserve Index and Arterial Partial Pressure of Oxygen During Surgery Applegate, Richard L. II MD; Dorotta, Ihab L. MD; Wells, Briana MS; Juma, David MPH; Applegate, Patricia M. MD Anesthesia & Analgesia September 2016 - Volume 123 - Issue 3 - p 626-633 doi: 10.1213/ANE.0000000000001262 Abstract BACKGROUND: The use of intraoperative pulse oximetry (SpO2) enhances hypoxia detection and is associated with fewer perioperative hypoxic events. However, SpO2 may be reported as 98% when arterial partial pressure of oxygen (PaO2) is as low as 70 mm Hg. Therefore, SpO2 may not provide advance warning of falling arterial oxygenation until PaO2approaches this level. Multiwave pulse co-oximetry can provide a calculated oxygen reserve index (ORI) that may add to information from pulse oximetry when SpO2 is >98%. This study evaluates the ORI to PaO2 relationship during surgery. METHODS: We studied patients undergoing scheduled surgery in which arterial catheterization and intraoperative arterial blood gas analysis were planned. Data from multiple pulse co-oximetry sensors on each patient were continuously collected and stored on a research computer. Regression analysis was used to compare ORI with PaO2 obtained from each arterial blood gas measurement and changes in ORI with changes in PaO2 from sequential measurements. Linear mixed-effects regression models for repeated measures were then used to account for within-subject correlation across the repeatedly measured PaO2 and ORI and for the unequal time intervals of PaO2 determination over elapsed surgical time. Regression plots were inspected for ORI values corresponding to PaO2 of 100 and 150 mm Hg. ORI and PaO2 were compared using mixed-effects models with a subject-specific random intercept. RESULTS: ORI values and PaO2 measurements were obtained from intraoperative data collected from 106 patients. Regression analysis showed that the ORI to PaO2 relationship was stronger for PaO2 to 240 mm Hg (r2 = 0.536) than for PaO2 over 240 mm Hg (r2 = 0.0016). Measured PaO2 was ≥100 mm Hg for all ORI over 0.24. Measured PaO2 was ≥150 mm Hg in 96.6% of samples when ORI was over 0.55. A random intercept variance component linear mixed-effects model for repeated measures indicated that PaO2 was significantly related to ORI (β[95% confidence interval] = 0.002 [0.0019-0.0022]; P < 0.0001). A similar analysis indicated a significant relationship between change in PaO2 and change in ORI (β [95% confidence interval] = 0.0044 [0.0040-0.0048]; P < 0.0001). CONCLUSIONS: These findings suggest that ORI >0.24 can distinguish PaO2 ≥100 mm Hg when SpO2 is over 98%. Similarly, ORI > 0.55 appears to be a threshold to distinguish PaO2≥150 mm Hg. The usefulness of these values should be evaluated prospectively. Decreases in ORI to near 0.24 may provide advance indication of falling PaO2 approaching 100 mm Hg when SpO2 is >98%. The clinical utility of interventions based on continuous ORI monitoring should be studied prospectively. PDF  XIII Congreso Virtual Mexicano de Anestesiología Octubre a Diciembre 2016 Información / Information 2017 Winter Anesthesia Conference in Maui California Society of Anesthesiologists Programa / Program  17h World Congress of Anaesthesiologists, WFSA Sep 6-11, 2020 Prague, Czech Republic Informes / Information

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

Apnea obstructiva del sueño en niños / Pediatric Obstructive Sleep Apnea

Septiembre 7, 2016. No. 2441

Detección preoperatoria de apnea obstructiva del sueño antes de cirugía ambulatoria en niños Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery. Ishman SL1,2,3, Tawfik KO3, Smith DF1, Cheung K4, Pringle LM5, Stephen MJ6, Everett TL6, Stierer TL4. J Clin Sleep Med. 2015 Jul 15;11(7):751-5. doi: 10.5664/jcsm.4852. Abstract PURPOSE: The American Society of Anesthesia practice guidelines recommend that pediatric and adult patients who undergo ambulatorysurgery be screened for obstructive sleep apnea (OSA). With this in mind, our objective was to assess the frequency of screening by anesthesiaproviders for the signs and symptoms of OSA in children undergoing surgery in an ambulatory setting. METHODS: Prospective single-blinded observational study of anesthesia providers' preoperative interview of caregivers of consecutive patients younger than age 18 who were scheduled for ambulatory surgery. RESULTS: One hundred one children (30 females) were identified, with a mean age of 6.9 ± 5.0 years; 54 were classified as white, 33 as black, and 14 as other. Total OSA-18 scores ranged from 18 to 97, with a mean of 33.1 ± 14.8. The mean score for adenotonsillectomy patients was higher than that for children who underwent procedures other than adenotonsillectomy. Thirty-one percent of children were screened for OSA, and snoring was the most common symptom recorded (28%). Patients who were screened for OSA were more likely to have snoring (p < 0.001), known OSA (p = 0.006), and a scheduled adenotonsillectomy (p = 0.02). CONCLUSION: OSA was not routinely screened for by anesthesia providers prior to ambulatory pediatric surgery. When screening did occur, "snoring" was the most commonly recorded symptom. Paradoxically, patients with undiagnosed OSA who would benefit the most from screening were the least likely to be screened. PDF Adenoidectomía. Abordajes actuales y revisión de la literatura Adenoidectomy: current approaches and review of the literature. Türkoğlu Babakurban S1, Aydın E. Kulak Burun Bogaz Ihtis Derg. 2016 May-Jun;26(3):181-90. doi: 10.5606/kbbihtisas.2016.32815. Abstract Adenoid is a secondary lymphoid organ located in the nasopharynx. Due to its location, it plays an important role in the host defense of the upper respiratory tract. Immunoglobulin G3 and immunoglobulin A1 antibodies are prevalent antibodies in the adenoid tissue. Adenoidal hypertrophy is a common condition in children causing symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech. It also plays a role in the pathogenesis of rhinosinusitis, recurrent otitis media, and otitis media with effusion. Currently, adenoidectomy is one of the most commonly performed pediatric surgical procedures worldwide. Although there is still poor evidence in the literature, recurrent upper respiratory infections, otitis media with effusion, and obstructive sleep apnea syndrome are considered to be the main indications of adenoidectomy. Adenoidectomy can be carried out with several techniques and instruments. Although rare, surgery possesses some risks and may cause emotional distress both for the patient and the family. Non-surgical treatments such as intranasal steroids are also used in the treatment of adenoid hypertrophy. In this review, we discuss the current literature on the adenoid function, adenoidectomy indications, and treatment of adenoid hypertrophy. PDF Mejora inmediata y sostenida en el comportamiento y la calidad de vida por Adenoamigdalectomía en niños con trastornos respiratorios del sueño. Immediate and Sustained Improvement in Behavior and Life Quality by Adenotonsillectomy in Children WithSleep-Disordered Breathing. Jeon YJ1, Song JJ2, Ahn JC3, Kong IG4, Kim JW5, Park GH6, Won TB1. Clin Exp Otorhinolaryngol. 2016 Jun;9(2):136-42. doi: 10.21053/ceo.2015.00584. Epub 2016 Apr 19. Abstract OBJECTIVES: To investigate longitudinal changes in behavior and quality-of-life (QoL) in children with sleep disordered breathing (SDB) after adenotonsillectomy (AT). METHODS: This study prospectively enrolled 148 children who underwent AT for SDB. Caregivers filled out Korean attention deficit hyperactivity disorder (ADHD) rating scale (K-ARS) and Korean version of the obstructive sleep apnea-18 (KOSA-18) at preoperative 1 day, postoperative 1 month, and postoperative 6 months. Longitudinal changes in K-ARS and KOSA-18 were evaluated and compared among subgroups. RESULTS: Both K-ARS and KOSA-18 scores improved immediately at postoperative 1 month and were maintained at postoperative 6 months. The mean preoperative K-ARS scores of the non-ADHD, ADHD-trait, and overt-ADHD groups showed uniformly immediate and sustained improvements. Also, the mean preoperative KOSA-18 scores of the small, moderate, and large impact groups were significantly improved both at postoperative 1 month and 6 months. The changes in behavior and QoL showed no significant differences with regard to the aforementioned factors. CONCLUSION: After AT, we may expect immediate and sustained improvements in behavior and QoL in children with SDB regardless of preoperative symptom severity. Moreover, by performing AT, improvements in behavior and QoL are expected regardless of sex, age, allergic trait, or concurrent coblation-assisted turbinoplasty. These findings may help our colleague physicians counselling pediatric SDB patients and their caregivers. KEYWORDS: Adenoidectomy; Attention Deficit Disorder with Hyperactivity; Quality of Life; Sleep Apnea Syndromes; Tonsillectomy PDF XIII Congreso Virtual Mexicano de Anestesiología Octubre a Diciembre 2016 Información / Information 2º Curso Internacional de Simulación en Vía Aérea FIDIVA Chile. Noviembre 7-8, 2016 Información / Information 17h World Congress of Anaesthesiologists, WFSA Sep 6-11, 2020 Prague, Czech Republic Informes / Information

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

TRAUMATOLOGÍA Y ORTOPEDIA F/SLAOT XXIV CONGRESO iNTERNACIONAL 2016, PUNTA CANA, REPÚBLICA DOMINICA. 12-16 DE OCTUBRE

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