Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
Anaesthesia. 2016 Dec 20. doi: 10.1111/anae.13773. [Epub ahead of print]
Abstract
Despite current recommendations on the management of pre-operative anaemia, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in surgical patients. A number of experienced researchers and clinicians took part in an expert workshop and developed the following consensus statement. After presentation of our own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best-practice and evidence-based statements to advise on patient care with respect to anaemia and iron deficiency in the peri-operative period. These statements include: a diagnostic approach for anaemia and iron deficiency in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up. We urge anaesthetists and peri-operative physicians to embrace these recommendations, and hospital administrators to enable implementation of these concepts by allocating adequate resources.
Allogeneic blood remains a scarce and expensive resource, even as the risks of disease transmission and other complications associated with blood transfusion are well known. Blood conservation, however, is a quality-of-care concept that transcends these and other known and unknown complications of transfusion, to involve a gamut of strategies meant to prevent exposure of patients to allogeneic blood. In urging a halt to incessant allogeneic blood transfusion, we report three cases to highlight the benefits of multimodal multidisciplinary collaboration in blood conservation. The three patients were chosen on account of either religious objection to any blood transfusion or the likelihood of exposure to several units of allogeneic blood. The blood conservation plan proposed for each patient was discussed with the respective surgeon and patient. Multimodal multidisciplinary approach to blood conservation utilising combination of strategies best suited for each individual patient will remarkably reduce the exposure of patients to allogeneic blood thereby ensuring better use of the scarce resource, and and preventing potential clinical complications and spiritual trespass of Jehovah's Witnesses.
BACKGROUND: Cell salvage is commonly used as part of a blood conservation strategy. However concerns among clinicians exist about the efficacy of transfusion of washed cell salvage. CONCLUSIONS: Washed cell salvage is efficacious in reducing the need for allogeneic RBC transfusion and risk of infection in surgery.
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ESPECIAL CARDIOLOGÍA
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El equipo de editorial de Medwave le desea una muy felíz Navidad.
To compare clinical and functional outcomes of surgically treated medial and lateral knee dislocations.
CONCLUSIONS:
In patients undergoing multiligament knee reconstruction, our data suggest that those who undergo medial repair for knee dislocations are not as likely to achieve positive results as those who undergo reconstruction or lateral reconstruction/repair, regardless of the status of the peroneal nerve. In addition, medial reconstruction had comparable outcomes to those in patients treated with lateral reconstruction/repair. Lastly, female patients showed less favorable clinical outcomes than male patients.
Resumen
PROPÓSITO: Comparar los resultados clínicos y funcionales de luxaciones mediales y laterales de rodilla tratadas quirúrgicamente. CONCLUSIONES: En los pacientes sometidos a reconstrucción de rodilla multiligamento, nuestros datos sugieren que aquellos que se someten a reparación medial para las luxaciones de rodilla no son tan probables para lograr resultados positivos como aquellos que se someten a reconstrucción o reconstrucción / reparación lateral, independientemente del estado del nervio peroneo. Además, la reconstrucción medial tuvo resultados comparables a los de los pacientes tratados con reconstrucción / reparación lateral. Por último, las mujeres presentan resultados clínicos menos favorables que los varones.
