Opioides / Opioids

Enero 13, 2017. No. 2568

Opioides en pacientes con enfermedades hepáticas. Revisión sistemática Opioid Drugs in Patients With Liver Disease: A Systematic Review. Soleimanpour H1, Safari S2, Shahsavari Nia K3, Sanaie S4, Alavian SM5. Hepat Mon. 2016 Mar 6;16(4):e32636. doi: 10.5812/hepatmon.32636. eCollection 2016. Abstract CONTEXT: The liver, one of the most important organs of the body, is known to be responsible for several functions. The functional contribution of the liver to the metabolism of carbohydrates, protein, drugs and toxins, fats and cholesterol and many other biological processes are still unknown. Liver disorders are classified into two types: acute and chronic. Different drugs are used in liver diseases to treat and control pain. Most pain relief medications such as opioids are metabolized via the liver; therefore, the adverse reactions of drugs are probably higher for patients with liver disease. The current study aimed to evaluate the effects of opioid drugs on patients with liver disease; therefore, it is necessary to select suitable opioids for such patients. EVIDENCE ACQUISITION: This review was written by referring to research literature including 70 articles and four textbooks published from 1958 to 2015 on various reputable sites. Searches were carried out on the key phrases of narcotic pain relievers (opioids), acute and chronic hepatic failure, opioid adverse drug reactions, drug-induced liver injury (DILI) and other similar keywords. References included a variety of research papers (descriptive and analytical), intervention and review articles. RESULTS: In patients with liver disease, administration of opioid analgesics should be observed, accurately. As a general rule, lower doses of drugs should be administered at regular intervals based on the signs of drug accumulation. Secondly, the interactions of opioid drugs with different levels of substrates of the P450 cytochrome enzyme should be considered. CONCLUSIONS: Pain management in patients with liver dysfunction is always challenging to physicians because of the adverse reactions of drugs, especially opioids. Opioids should be used cautiously since they can cause sedation, constipation and sudden encephalopathy effects. Since the clearance of these drugs in patients with hepatic insufficiency is decreased, the initial dose must be decreased, the intervals between doses should be increased and some patients need to be continuously assessed. KEYWORDS: Adverse Drug Reactions; Liver Disease; Opioids PDF Prevención de sobredosis de opioides y ¨kits¨ de rescate de naloxona: lo que sabemos y lo que no sabemos. Opioid overdose prevention and naloxone rescue kits: what we know and what we don't know. Kerensky T1, Walley AY2. Addict Sci Clin Pract. 2017 Jan 7;12(1):4. doi: 10.1186/s13722-016-0068-3. Abstract The opioid use and overdose crisis is persistent and dynamic. Opioid overdoses were initially driven in the 1990s and 2000s by the increasing availability and misuse of prescription opioids. More recently, opioid overdoses are increasing at alarming rates due to wider use of heroin, which in some places is mixed with fentanyl or fentanyl derivatives. Naloxone access for opioid overdose rescue is one of the US Department of Health and Human Services' three priority areas for responding to the opioid crisis. This article summarizes the known benefits of naloxone access and details unanswered questions about overdose education and naloxone rescue kits. Hopefully future research will address these knowledge gaps, improve the effectiveness of opioid overdose education and naloxone distribution programs, and unlock the full promise of naloxone rescue kits. KEYWORDS: Naloxone rescue kits; Opioid overdose education; Overdose prevention PDF  Neurobiología de la dependencia de opiáceos en la creación de vulnerabilidad a la adicción. Neurobiology of opioid dependence in creating addiction vulnerability. Evans CJ1, Cahill CM2. F1000Res. 2016 Jul 19;5. pii: F1000 Faculty Rev-1748. doi: 10.12688/f1000research.8369.1. eCollection 2016. Abstract Opioid drugs are potent modulators of many physiological and psychological processes. When given acutely, they can elicit the signature responses of euphoria and analgesia that societies have coveted for centuries. Repeated, or chronic, use of opioids induces adaptive or allostatic changes that modify neuronal circuitry and create an altered normality - the "drug-dependent" state. This state, at least that exhibited by those maintained continuously on long-acting opioid drugs such as methadone or buprenorphine, is generally indistinguishable from the drug-naïve state for most overt behaviors. The consequences of the allostatic changes (cellular, circuit, and system adaptations) that accompany the drug-dependent state are revealed during drug withdrawal. Drug cessation triggers a temporally orchestrated allostatic re-establishment of neuronal systems, which is manifested as opposing physiological and psychological effects to those exhibited by acute drug intoxication. Some withdrawal symptoms, such as physical symptoms (sweating, shaking, and diarrhea) resolve within days, whilst others, such as dysphoria, insomnia, and anxiety, can linger for months, and some adaptations, such as learned associations, may be established for life. We will briefly discuss the cellular mechanisms and neural circuitry that contribute to the opioid drug-dependent state, inferring an emerging role for neuroinflammation. We will argue that opioid addictive behaviors result from a learned relationship between opioids and relief from an existing or withdrawal-induced anxiogenic and/or dysphoric state. Furthermore, a future stressful life event can recall the memory that opioid drugs alleviate negative affect (despair, sadness, and anxiety) and thereby precipitate craving, resulting in relapse. A learned association of relief of aversive states would fuel drug craving in vulnerable people living in an increasingly stressful society. We suggest that this route to addiction is contributive to the current opioid epidemic in the USA. KEYWORDS: Learned Associative Model; aversive states; opioid epidemic; pass-forward allostasis; withdrawal relief PDF Uso de opioides en pacientes de cirugía ambulatoria. Prevalencia, manejo y resultados Opioid use among same-day surgery patients: Prevalence, management and outcomes. Wilson JL, Poulin PA, Sikorski R, Nathan HJ, Taljaard M, Smyth C. Pain Res Manag. 2015 Nov-Dec;20(6):300-4. Epub 2015 Sep 10. Abstract OBJECTIVES: To determine whether the prevalence of opioid use among patients requiring elective same-day admission (SDA) surgery is greater than the 2.5% prevalence found in the general population. Secondary objectives were to assess compliance with expert recommendations on acute pain management in opioid-tolerant patients and to examine clinical outcomes. METHODS: A retrospective review of 812 systematically sampled adult SDA surgical cases between April 1, 2008 and March 31, 2009 was conducted. RESULTS: Among 798 eligible patients, 148 (18.5% [95% CI 15.9% to 21.2%]) were prescribed opioids, with 4.4% prescribed long-acting opioids (95% CI 3.0% to 5.8%). Use of opioids was most prevalent among orthopedic and neurosurgery patients. Among the 35 patients on long-acting opioids who had a high likelihood of being tolerant, anesthesiologists correctly identified 33, but only 13 (37%) took their usual opioid preoperatively while 22 (63%) had opioids continued postoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and pregabalin were ordered preoperatively in 18 (51%), 15 (43%) and 18 (51%) cases, respectively, while ketamine was used in 15 (43%) patients intraoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and pregabalin were ordered postoperatively in 31 (89%), 15 (43%) and 17 (49%) of the cases, respectively. No differences in length of stay, readmissions and emergency room visits were found between opioid-tolerant and opioid-naive patients. CONCLUSION: Opioid use is more common in SDA surgical patients than in the general population and is most prevalent within orthopedic and neurosurgery patients. Uptake of expert opinion on the management of acute pain in the opioid tolerant patient population is lacking. PDF Muerte de celebridades relacionadas a las drogas. Estudio transversal Drug-related celebrity deaths: A cross-sectional study. Just JM1, Bleckwenn M2, Schnakenberg R2, Skatulla P2, Weckbecker K2. Subst Abuse Treat Prev Policy. 2016 Dec 9;11(1):40. Abstract BACKGROUND: Celebrities are at risk for premature mortality as well as drug-related death. Despite being a vulnerable patient group, celebrities influence people's health behaviours through biological, psychological and social processes. Therefore, celebrity endorsement of the topic could be one way to challenge the current "opioid endemic". Our aim was to better understand the factors surrounding drug-related celebrity deaths by investigating the incidence as well as substances used between 1970 and 2015 using a cross-sectional study design. METHOD: We searched public databases for drug-related celebrity deaths between 1970 and 2015. They were categorized for sex, profession, age at death, year of death and substances involved. The main outcome measures are descriptive values including number of drug deaths per year and substances involved. Secondary outcome measures are analytical questions to examine whether and which factors influence age at death and year of death (e.g. type of substance use disorder). RESULTS: We identified 220 celebrities who died a drug-related death with a clear indication of involved substances between 1970 and 2015. The average age at death was 38.6 years; 75% were male. Most celebrities died between the age of 25 and 40. The number of drug-related deaths increased in the 21st century, with a significant increase in the use of prescription opioids. Deaths involving prescription opioids and heroin were associated with a significantly lower mean age at death compared to deaths where these substances were not involved. CONCLUSIONS: Compared to the 20th century, the total number of celebrities who died from a drug-related death in the 21st century increased, possibly due to an increased involvement of prescription opioids. Negative effects on individual health decisions of celebrity's followers could be the result. KEYWORDS: Addiction; Celebrity; Opioids PDF El impacto de la prescripción de opioides en todas las causas de muerte en Canadá The impact of prescription opioids on all-cause mortality in Canada. Imtiaz S1,2, Rehm J3,4,5,6,7,8. Subst Abuse Treat Prev Policy. 2016 Aug 1;11(1):27. doi: 10.1186/s13011-016-0071-4. Abstract An influential study from the United States generated considerable discussion and debate. This study documented rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century, with clear linkages of all-cause mortality to increasing rates of poisonings, suicides and chronic liver disease deaths. All of these causes of deaths are strongly related to the use of legal and illegal substances, but the study stressed the importance of prescription opioids. Given the similarities between the United States and Canada in prescription opioid use, the assessment of similar all-cause mortality trends is relevant for Canada. As this commentary highlights, the all-cause mortality shifts seen in the United States cannot be seen in Canada for either sex or age groups. The exact reasons for the differences between the two countries are not clear, but it is important for public health to further explore this question. KEYWORDS: All-cause mortality; Canada; Drug poisoning mortality; Opioid analgesics PDF Prescripción de opioides para dolor y la epidemia de muerte por sobredosis. ¿Puede la reducción dramática de la mortalidad por anestesia servir como un ejemplo? Opioid prescriptions for pain and epidemic of overdose death: can the dramatic reduction in anesthesia mortality serve as an example? Kissin I1. J Pain Res. 2016 Jun 28;9:453-6. doi: 10.2147/JPR.S108067. eCollection 2016. Abstract The annual number of US deaths from prescription-opioid overdose quadrupled between 1999 and 2010 and in 2010 alone reached 16,651. Deaths from opioid overdose have now surpassed the historic death toll from another drug-related epidemic - anesthesia mortality. In 1954, Beecher and Todd published reliable data on anesthesia-related mortality in the US, estimating the annual number of deaths to be nearly 5,000. Presently anesthesia/anesthetics are reported as the underlying cause in approximately 34 deaths in the US annually. This spectacular decline in anesthesia-related mortality could serve as an example for attempts to curb the epidemic of opioid overdose death. The main reason that led to the dramatic decline in anesthesia-related mortality is the context in which anesthetics are used. It includes training of the anesthesia providers, the introduction of specific standards of patient safety, and anesthesia monitoring. I suggest that the introduction of a similar multifactorial proper context for the use of opioids in the treatment of chronic nonmalignant pain might be the same "game changer" it was for safety in anesthesia. KEYWORDS: aberrant opioid-related behavior; addiction; apprenticeship; chronic pain; metrics of opioid effectiveness; opioid-use disorder; treatment compliance PDF 5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Ciudad de México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com  Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

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

El running disminuye la citoquina intraarticular de la rodilla y las concentraciones de la matriz oligomérica del cartílago: un estudio piloto

El running disminuye la citoquina intraarticular de la rodilla y las concentraciones de la matriz oligomérica del cartílago: un estudio piloto





http://www.lesionesdeportivas.com.mx/academia/el-running-disminuye-la-citoquina-intraarticular-de-la-rodilla-y-las-concentraciones-de-la-matriz-oligomerica-del-cartilago-un-estudio-piloto/



Running decreases knee intra-articular cytokine and cartilage oligomeric matrix concentrations: a pilot study


Fuente

Este artículo es originalmente publicado en:


https://www.ncbi.nlm.nih.gov/pubmed/27699484
http://link.springer.com/article/10.1007%2Fs00421-016-3474-z


De:

Hyldahl RD1, Evans A2, Kwon S2, Ridge ST2, Robinson E3, Hopkins JT2, Seeley MK2


Todos los derechos reservados para:

© 2017 Springer International Publishing AG. Part of Springer Nature.





Abstract

INTRODUCTION:


Regular exercise protects against degenerative joint disorders, yet the mechanisms that underlie these benefits are poorly understood. Chronic, low-grade inflammation is widely implicated in the onset and progression of degenerative joint disease.
PURPOSE:


To examine the effect of running on knee intra-articular and circulating markers of inflammation and cartilage turnover in healthy men and women.

CONCLUSIONS:


Running appears to decrease knee intra-articular pro-inflammatory cytokine concentration and facilitates the movement of COMP from the joint space to the serum.

KEYWORDS:


Biomarker; COMP; Exercise; GM-CSF; Ground reaction force; IL-15; IL-6; Inflammation; Knee joint; Osteoarthritis; Synovial fluid








Resumen



INTRODUCCIÓN:

El ejercicio regular protege contra los trastornos degenerativos de las articulaciones, pero los mecanismos que subyacen a estos beneficios son poco conocidos. La inflamación crónica de bajo grado está ampliamente implicada en el inicio y la progresión de la enfermedad degenerativa de las articulaciones.


PROPÓSITO:

Examinar el efecto de correr sobre los marcadores intraarticulares y circulantes de la rodilla de la inflamación y la rotación del cartílago en hombres y mujeres sanos.



CONCLUSIONES:

El funcionamiento parece disminuir la concentración de citoquinas pro-inflamatorias intraarticulares en la rodilla y facilita el movimiento de COMP desde el espacio articular hasta el suero.


PALABRAS CLAVE:

Biomarcador; COMP; Ejercicio; GM – CSF; Fuerza de reacción del suelo; IL – 15; IL – 6; Inflamación; Articulación de la rodilla; Osteoartritis; Líquido sinovial




PMID: 27699484 DOI: 10.1007/s00421-016-3474-z





[PubMed – in process]

Nuevas técnicas quirúrgicas permiten una recuperación más rápida tras un reemplazo de rodilla

Nuevas técnicas quirúrgicas permiten una recuperación más rápida tras un reemplazo de rodilla





http://www.bibliomanazteca.com.mx/academia/nuevas-tecnicas-quirurgicas-permiten-una-recuperacion-mas-rapida-tras-un-reemplazo-de-rodilla/

Nuevas técnicas quirúrgicas permiten una recuperación más rápida tras un reemplazo de rodilla

 admin

 enero 12, 2017

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Fuente
Este artículo es originalmente publicado en:

http://www.condroprotectores.es/nuevas-tecnicas-quirurgicas-permiten-una-recuperacion-mas-rapida-tras-reemplazo-rodilla/?utm_source=suscription

De y Todos los derechos reservados para:

BIOIBERICA COPYRIGHT © 2012

Las operaciones de reemplazo de rodilla resultan cada vez menos invasivas y requieren de posoperatorios menos prolongados gracias a una combinación de factores: nuevas técnicas quirúrgicas, protocolos hospitalarios mejorados, y fármacos antifibrinolíticos que reducen la tasa de transfusión en artroplastias de rodilla.

Lea el artículo completo AQUÍ

¿Cuál es el papel de la cirugía mínimamente invasiva en una vía rápida de reemplazo de cadera y rodilla?



http://www.reemplazoprotesico.com.mx/academia/cual-es-el-papel-de-la-cirugia-minimamente-invasiva-en-una-via-rapida-de-reemplazo-de-cadera-y-rodilla/

¿Cuál es el papel de la cirugía mínimamente invasiva en una vía rápida de reemplazo de cadera y rodilla?

academia

Por admin

What is the role of minimally invasive surgery in a fast track hip and knee replacement pathway?

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/22507716/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705225/

http://publishing.rcseng.ac.uk/doi/abs/10.1308/003588412X13171221590214?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&

De:

Lloyd JM¹, Wainwright T, Middleton RG.

Todos los derechos reservados para:

Copyright and License information ▼

Copyright © 2012 by the Annals of The Royal College of Surgeons of England

Abstract

INTRODUCTION:

Minimally invasive hip and knee replacement surgery (MIS) continues to receive coverage in both the popular press and scientific literature. The cited benefits include a smaller scar, less soft tissue trauma, faster recovery, reduced hospital stay, decreased blood loss and reduced post-operative pain. These outcomes are highly desirable and consistent with the aims of fast track hip and knee pathways. This paper evaluates the literature and discusses whether performing MIS over conventional surgical techniques offers advantages in a fast track hip and knee pathway.

CONCLUSIONS:

There is insufficient evidence to indicate that surgical technique alone makes a significant difference to recovery or reduces soft tissue trauma. No consensus on whether to use MIS techniques in fast track hip and knee replacement pathways can therefore be drawn. This is especially important given that the complication rates of MIS in the low to medium volume surgeon appear unacceptably high compared with standard approaches. It is also too early to assess the long-term effects of MIS on implant survival.

Resumen

INTRODUCCIÓN:
La cirugía mínimamente invasiva de reemplazo de cadera y rodilla (MIS) sigue recibiendo cobertura tanto en la prensa popular como en la literatura científica. Los beneficios citados incluyen una cicatriz más pequeña, menos traumatismos de tejidos blandos, recuperación más rápida, menor estancia hospitalaria, disminución de la pérdida de sangre y reducción del dolor postoperatorio. Estos resultados son altamente deseables y consistentes con los objetivos de las vías rápidas de cadera y rodilla. Este artículo evalúa la literatura y discute si la realización de MIS sobre técnicas quirúrgicas convencionales ofrece ventajas en una vía rápida de cadera y vía de rodilla.

CONCLUSIONES:
No hay evidencia suficiente para indicar que la técnica quirúrgica sola hace una diferencia significativa en la recuperación o reduce el traumatismo de los tejidos blandos. Por lo tanto, no se puede llegar a un consenso sobre si se deben usar las técnicas MIS en las vías rápidas de reemplazo de cadera y rodilla. Esto es especialmente importante dado que las tasas de complicaciones de MIS en el cirujano de bajo a medio volumen parecen inaceptablemente altas en comparación con los enfoques estándar. También es demasiado pronto para evaluar los efectos a largo plazo de MIS en la supervivencia del implante.

PMID: 22507716   PMCID:  PMC3705225DOI:  10.1308/003588412X13171221590214

[PubMed – indexed for MEDLINE]

Free PMC Article

Analgésicos / Analgesics

Enero 12, 2017. No. 2567

Reacciones de hipersensibilidad a AINES en niños y adolescentes: reacciones selectivas Hypersensitivity Reactions to Nonsteroidal Anti-inflammatory Drugs in Children and Adolescents: Selective Reactions. Blanca-López N, Cornejo-García JA, Pérez-Alzate D, Pérez-Sánchez N, Plaza-Serón MC, Doña I, Torres MJ, Canto G, Kidon M, Perkins JR, Blanca M. Abstract Nonsteroidal anti-inflammatory drugs (NSAIDs) are used throughout the world to treat pain and inflammation; however, they can trigger several types of drug hypersensitivity reactions (DHRs) in all age groups. Although most such reactions occur through activation of the leukotriene pathway without specific immunological recognition (cross-intolerance), a significant number of DHRs to NSAIDs are due to immunological mechanisms (selective reactions [SRs]). SRs are thought to be induced by specific IgE antibodies or by T cells. In this manuscript, we focus on SRs, which are of great concern in children and adolescents and comprise a heterogeneous set of clinical pictures ranging from mild entities such as urticaria/angioedema to potentially life-threatening conditions such as Stevens-Johnson syndrome/toxic epidermal necrolysis. Paracetamol and ibuprofen are the most frequent elicitors of IgE-mediated SRs, although pyrazolones have also been implicated. T cell-mediated reactions are infrequent in children but have been associated with ibuprofen, naproxen, and dipyrone. In this review, we analyze the available literature on SRs in children and adolescents, with emphasis on epidemiological data, mechanisms, and drugs involved, as well as on diagnostic procedures. PDF  Aspectos de seguridad de los analgésicos actuales: una actualización. Safety issues of current analgesics: an update. Cazacu I1, Mogosan C1, Loghin F2. Clujul Med. 2015;88(2):128-36. doi: 10.15386/cjmed-413. Epub 2015 Apr 15. Abstract Pain represents a complex experience which can be approached by various medicines. Non-opioid and opioid analgesics are the most common drugs used to manage different types of pain. The increased attention nowadays to pain management entailed concomitantly more frequent adverse drug reactions (ADRs) related to analgesic use. Drug-drug interactions can be sometimes responsible for the adverse effects. However, a significant proportion of analgesic ADRs are preventable, which would avoid patient suffering. In order to draw the attention to analgesics risks and to minimize the negative consequences related to their use, the present review comprises a synthesis of the most important safety issues described in the scientific literature. It highlights the potential risks of the most frequently used analgesic medicines: non-opioid (paracetamol, metamizole, non-steroidal anti-inflammatory drugs) and opioid analgesics. Even if there is a wide experience in their use, they continue to capture attention with safety concerns and with potential risks recently revealed. Acknowledging potential safety problems represents the first step for health professionals in assuring a safe and efficient analgesic treatment with minimum risks to patients. Taking into consideration all medical and environmental factors and carefully monitoring the patients are also essential in preventing and early detecting analgesic ADRs. KEYWORDS: adverse drug reactions; analgesics; drug-drug interactions PDF Farmacología de los analgésicos no opiáceos (AINES) PDF El uso de aspirina y AINES reduce el riesgo de cáncer gástrico. Meta-análisis de dosis respuesta Aspirin and non-steroidal anti-inflammatory drugs use reduce gastric cancer risk: A dose-response meta-analysis. Huang XZ1, Chen Y2, Wu J1, Zhang X1, Wu CC1, Zhang CY1, Sun SS1, Chen WJ1. Oncotarget. 2016 Nov 25. doi: 10.18632/oncotarget.13591. [Epub ahead of print] Abstract BACKGROUND: The association between non-steroidal anti-inflammatory drugs (NSAIDs) and gastric cancer (GC) risk is controversial. The aim of this study is to evaluate the chemopreventive effect of NSAIDs for GC. METHODS: A literature search was performed for relevant studies using the PubMed and Embase database (up to March 2016). Risk ratios (RRs) and 95% confidence intervals (CIs) were used as the effect measures. The dose-response analysis and subgroup analysis were also performed. RESULTS: Twenty-four studies were included. Our results indicated that NSAIDs could reduce GC risk (any NSAIDs: RR=0.78, 96%CI=0.72-0.85; aspirin: RR=0.70, 95%CI=0.62-0.80; non-aspirin NSAIDs: RR=0.86, 95%CI=0.80-0.94), especially for non-cardia GC risk. Moreover, the dose-response analysis indicated the risk of GC decreased by 11% and 5% for 2 years increment of any NSAIDs and aspirin use, respectively. There were nonlinear relationships between the frequency of any NSAIDs use and aspirin use and GC risk (P for non-linearity<0.01), with a threshold effect of 5 times/week. A monotonically decreasing trend was observed only for the frequency of less than 5 times/week. CONCLUSIONS: Our results indicate that NSAIDs is inversely associated with GC risk, especially for non-cardia GC risk. NSAIDs use may become a feasible approach to prevent GC. KEYWORDS: aspirin; chemoprevention; gastric cancer; meta-analysis; non-steroidal anti-inflammatory drugs PDF 5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Ciudad de México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com  Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information