Revisiones_bibliográficas TyO

jueves, 23 de febrero de 2017

Confiabilidad y seguridad de un nuevo algoritmo de tratamiento para lesiones de columna cervical alta.

http://www.columnavertebralpediatricaygeriatrica.com.mx/academia/confiabilidad-y-seguridad-de-un-nuevo-algoritmo-de-tratamiento-para-lesiones-de-columna-cervical-alta/

Reliability and safety of a new upper cervical spine injury treatment algorithm

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28226080

http://www.scielo.br/scielo.php?script=sci_abstract&pid=S0004-282X2017000200007&lng=en&nrm=iso&tlng=en

De:

Joaquim AF1,²,Brock RS1,Guirado VM1,Sandon LH1,Silva OT2,Taricco MA1,

Teixeira MJ1,Figueiredo EG1.

Arq Neuropsiquiatr.

2017 Feb;75(2):107-113. doi: 10.1590/0004-282X20160200.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

METHODS:

Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer) using the Kappa index.

RESULTS:

The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons’ personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases.

CONCLUSION:

The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.

Resumen

MÉTODOS:
Treinta casos, previamente tratados de acuerdo con el nuevo algoritmo, se presentaron a cuatro cirujanos de columna que fueron interrogados acerca de su sugerencia personal para el tratamiento, y el tratamiento sugerido de acuerdo a la aplicación del algoritmo. Después de cuatro semanas, se volvió a hacer las mismas preguntas para evaluar la fiabilidad (intra e interobservador) usando el índice Kappa.

RESULTADOS:
La fiabilidad del tratamiento sugerido por la aplicación del algoritmo fue superior a la fiabilidad de la sugerencia personal de los cirujanos para el tratamiento. Al aplicar el algoritmo de tratamiento de lesiones cervicales superiores, se obtuvo un acuerdo con el tratamiento efectivamente realizado en más del 89% de los casos.

CONCLUSIÓN:
El sistema es seguro y confiable para tratar lesiones traumáticas de la columna cervical superior. El algoritmo se puede utilizar para ayudar a los cirujanos en la decisión entre el tratamiento conservador versus quirúrgico de estas lesiones.

PMID: 28226080 DOI:

10.1590/0004-282X20160200

[PubMed – in process]

#algoritmo #lesiones cervicales #columna cervical

Vía aérea / Airway

Febrero 23, 2017. No. 2609

Manejo de la vía aérea en pacientes de cirugía cardiaca. Perspectivas actuales

Airway management of the cardiac surgical patients: Current perspective.

Choudhury A1, Gupta N2, Magoon R1, Kapoor PM1.

Ann Card Anaesth. 2017 Jan;20(Supplement):S26-S35. doi: 10.4103/0971-9784.197794.Abstract

The difficult airway (DA) is a common problem encountered in patients undergoing cardiac surgery. However, the challenge is not only just establishment of airway but also maintaining a definitive airway for the safe conduct of cardiopulmonary bypass from initiation to weaning after surgical correction or palliation, de-airing of cardiac chambers. This review describes the management of the DA in a cardiac theater environment. The primary aims are recognition of DA both anatomical and physiological, necessary preparations for (and management of) difficult intubation and extubation. All patients undergoing cardiac surgery should initially be considered as having potentially DA as many of them have poor physiologic reserve. Making the cardiac surgical theater environment conducive to DA management is as essential as it is to deal with low cardiac output syndrome or acute heart failure. Tube obstruction and/or displacement should be suspected in case of a new onset ventilation problem, especially in the recovery unit. Cardiac anesthesiologists are often challenged with DA while inducing general endotracheal anesthesia. They ought to be familiar with the DA algorithms and possess skill for using the latest airway adjuncts.

PDF

El anestesiólogo y la vía aérea difícil. ¿Dónde estamos actualmente?

Anesthesiology and the difficult airway - Where do we currently stand?

Richtsfeld M1, Belani KG2.

Ann Card Anaesth. 2017 Jan-Mar;20(1):4-7. doi: 10.4103/0971-9784.197814.

PDF

Comparación de i-gel con otros supraglóticos en maniquíes de adultos. Revisión sistemática y meta-análisis

Comparison of the i-gel and other supraglottic airways in adult manikin studies: Systematic review and meta-analysis.

An J1, Nam SB, Lee JS, Lee J, Yoo H, Lee HM, Kim MS.

Medicine (Baltimore). 2017 Jan;96(1):e5801. doi: 10.1097/MD.0000000000005801.

Abstract

BACKGROUND: The i-gel has a gel-like cuff composed of thermoplastic elastomer that does not require cuff inflation. As the elimination of cuff inflation may shorten insertion time, the i-gel might be a useful tool in emergency situations requiring prompt airway care. This systematic review and meta-analysis of previous adult manikin studies for inexperienced personnel was performed to compare the i-gel with other supraglottic airways. METHODS: We searched PubMed, the Cochrane Library, and EMBASE for eligible randomized controlled trials (RCTs) published before June 2015, including with a crossover design, using the following search terms: "i-gel," "igel," "simulation," "manikin," "manikins," "mannequin," and "mannequins." The primary outcomes of this review were device insertion time and the first-attempt success rate of insertion. RESULTS: A total of 14 RCTs were included. At the initial assessment without difficult circumstances, the i-gel had a significantly shorter insertion time than the LMA Classic, LMA Fastrach, LMA Proseal, LMA Unique, laryngeal tube, Combitube, and EasyTube. However, a faster insertion time of the i-gel was not observed in comparisons with the LMA Supreme, aura-i, and air-Q. In addition, the i-gel did not show the better results for the insertion success rate when compared to other devices. CONCLUSION: The findings of this meta-analysis indicated that inexperienced volunteers placed the i-gel more rapidly than other supraglottic airways with the exception of the LMA Supreme, aura-i, and air-Q in manikin studies. However, the quicker insertion time is clinically not relevant. The unapparent advantage regarding the insertion success rate and the inherent limitations of the simulation setting indicated that additional evidence is necessary to confirm these advantages of the i-gel in an emergency setting.

PDF

Entendiendo la vía aérea.

Understanding Airways

Keith Greenland MD

Video