Revisiones_bibliográficas TyO

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miércoles, 1 de marzo de 2017

Más de videolaringoscopios / More on videolaryngoscopes

Febrero 25, 2017. No. 2611

Videolaringoscopios difieren sustancialmente en la iluminación de la cavidad oral: Un estudio de maniquí.

Videolaryngoscopes differ substantially in illumination of the oral cavity: A manikin study.

Pieters BM1, van Zundert AA2.

Indian J Anaesth. 2016 May;60(5):325-9. doi: 10.4103/0019-5049.181593.

Abstract

BACKGROUND AND AIMS: Insufficient illumination of the oral cavity during endotracheal intubation may result in suboptimal conditions. Consequently, suboptimal illumination and laryngoscopy may lead to potential unwanted trauma to soft tissues of the pharyngeal mucosa. We investigated illumination of the oral cavity by different videolaryngoscopes (VLS) in a manikin model. METHODS: We measured light intensity from the mouth opening of a Laerdal intubation trainer comparing different direct and indirect VLS at three occasions, resembling optimal to less-than-optimal intubation conditions; at the photographer's dark room, in an operating theatre and outdoors in bright sunlight. RESULTS: Substantial differences in luminance were detected between VLS. The use of LED light significantly improved light production. All VLS produced substantial higher luminance values in a well-luminated environment compared to the dark photographer's room. The experiments outside-in bright sunlight-were interfered with by direct sunlight penetration through the synthetic material of the manikin, making correct measurement of luminance in the oropharynx invalid. CONCLUSION: Illumination of the oral cavity differs widely among direct and indirect VLS. The clinician should be aware of the possibility of suboptimal illumination of the oral cavity and the potential risk this poses for the patient.

KEYWORDS: Airway; anaesthetic techniques-laryngoscopy; equipment-laryngoscopes; intubation

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Comparación de los videolaringoscopios C-MAC (®) y GlideScope (®) en pacientes con trastornos de la columna cervical e inmovilización.

Comparison of the C-MAC(®) and GlideScope(®) videolaryngoscopes in patients with cervical spine disorders and immobilisation.

Brück S1, Trautner H, Wolff A, Hain J, Mols G, Pakos P, Roewer N, Lange M.

Anaesthesia. 2015 Feb;70(2):160-5. doi: 10.1111/anae.12858. Epub 2014 Sep 29.

Abstract

In-line stabilisation of the neck can increase the difficulty of tracheal intubation with direct laryngoscopy. We randomly assigned 56 patients with cervical spine pathology scheduled for elective surgery to tracheal intubation using either the C-MAC(®) (n = 26) or GlideScope(®) (n = 30), when the head and neck were stabilised in-line. There was no significant difference in the median (IQR [range]) intubation times between the C-MAC (19 (14-35 [9-90]) s and the GlideScope (23, (15-32 [8-65]) s. The first-attempt failure rate for the C-MAC was 42% (95% CI 23-63%) compared with 7% (95% CI 1-22%) for the GlideScope, p = 0.002. The laryngeal view was excellent and comparable with both devices, with the C-MAC requiring significantly more attempts and optimising manoeuvers (11 vs 5, respectively, p = 0.04). There were no significant differences in postoperative complaints e.g. sore throat, hoarseness and dysphagia. Both devices provided an excellent glottic view in patients with cervical spine immobilisation, but tracheal intubation was more often successful on the first attempt with the GlideScope.

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Limitaciones de la vídeolaringoscopía. Una realidad del manejo anestésico

Limitations of the Videolaryngoscope: An Anesthetic Management Reality

Ahmed A. Treki, Tracey Straker.

INTERNATIONAL ANESTHESIOLOGY CLINICS 2017;Volume 55, Number 1, 97-104

Securing the airway has always been a challenging task. It requires the development of the nesthesiologist's psychomotor skills and continuous assessment of existing equipment due to technologic advances. Endotracheal intubation has evolved since the introduction of the Macintosh and Miller blades in the 1940s. The technique has changed from the classic concept of obtaining a line of sight by aligning oral, laryngeal, and pharyngeal axes using conventional direct laryngoscopy (DL) to development of alternative indirect tools that capture the glottic view through a small camera at the tip of the blade, transmitting it to a video screen independent of the line of sight. Because of a large array of videolaryngoscope (VL) designs available in practice, one cannot generalize regarding the similarities of these videoscopes. Each VL has its own design features, specifications, and indications.

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5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.

Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.

Committee for European Education in Anaesthesiology (CEEA)

y el Colegio de Anestesiólogos de León A.C.

Abril 7-9, 2017, León Guanajuato, México

Informes (477) 716 06 16, kikinhedz@gmail.com

4° Congreso Internacional de Control Total de la Vía Aérea

Asociación Mexicana de Vía Aérea Difícil, AC

Ciudad de México 21, 22 y 23 de Abril 2017
Informes: amvadmexico@gmail.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

Anestesiología y Medicina del Dolor

52 664 6848905

vwhizar@anestesia-dolor.org

anestesia-dolor.org

La regeneración ósea en la era de las células madre: ¿juego seguro para el paciente?

http://www.traumaysiniestros.com.mx/academia/la-regeneracion-osea-en-la-era-de-las-celulas-madre-juego-seguro-para-el-paciente/

Bone regeneration in the stem cell era: safe play for the patient?

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28238087

https://link.springer.com/article/10.1007%2Fs10067-017-3581-1

De:

Musacchio E1,Veronese N2

Clin Rheumatol.

2017 Feb 25. doi: 10.1007/s10067-017-3581-1. [Epub ahead of print]

Abstract

The past decade has seen outstanding scientific progress in the field of stem cell (SC) research and clinical application. SCs are convenient both technically and biologically: they are easy to find and to culture and they can differentiate in virtually all tissues and even in whole organs. Induced pluripotent stem cells (iPSs) are a type of pluripotent SC generated in vitro directly from mature cells through the introduction of key transcription factors. The use of iPSs, however tantalizing, poses serious safety concerns because of their genomic instability. Recently, it has been suggested that the main mechanism of SC action relies on paracrine signals. Therefore, the secretome would be primarily responsible for SC effects. The therapeutical use of secretome is safer and more reliable and offers manufacturing, handling and transportation advantages. The authors discuss current applications of SCs with particular respect to bone regeneration stressing the possible risks that may arise from incautious employments of SCs-particularly when associated with stimulating factors. Safety issues hamper the advancement of SC-based innovative therapies and raise the need for novel standards to adequately address and rule out inconsistency and other concerns, considering the permanent nature of SC treatments. Many biological aspects concerning dose, time and site of administration are still to be elucidated. Solid clinical data and trials with long-term follow-ups are highly recommended as a means to evaluate the risk/benefit ratio of each potential intervention and to provide patients with clear and accurate information.

KEYWORDS:

Cell differentiation; Growth factor; Induced pluripotent stem cell; Risk; Safety; Transformation; Tumourigenesis

Resumen

La última década ha sido testigo de un progreso científico sobresaliente en el campo de la investigación con células madre (CS) y la aplicación clínica. Los SC son convenientes tanto técnica como biológicamente: son fáciles de encontrar y de cultivar y pueden diferenciarse en prácticamente todos los tejidos e incluso en órganos enteros. Las células madre pluripotentes inducidas (iPSs) son un tipo de SC pluripotencial generado in vitro directamente a partir de células maduras mediante la introducción de factores clave de transcripción. El uso de iPSs, aunque tentador, plantea serias preocupaciones de seguridad debido a su inestabilidad genómica. Recientemente, se ha sugerido que el mecanismo principal de la acción SC se basa en las señales parácrinas. Por lo tanto, el secretome sería el principal responsable de los efectos de SC. El uso terapéutico de secretome es más seguro y más confiable y ofrece ventajas de fabricación, manipulación y transporte. Los autores analizan las aplicaciones actuales de SCs con particular respeto a la regeneración ósea enfatizando los posibles riesgos que pueden derivarse de los empleos incumplidos de SCs, particularmente cuando están asociados con factores estimulantes. Las cuestiones de seguridad dificultan el avance de las terapias innovadoras basadas en SC y plantean la necesidad de nuevas normas para abordar y descartar adecuadamente la inconsistencia y otras preocupaciones, teniendo en cuenta la naturaleza permanente de los tratamientos SC. Todavía hay que dilucidar muchos aspectos biológicos relativos a la dosis, el tiempo y el lugar de administración. Los sólidos datos clínicos y los ensayos con seguimiento a largo plazo son altamente recomendados como un medio para evaluar la relación riesgo / beneficio de cada intervención potencial y proporcionar a los pacientes información clara y precisa.
PALABRAS CLAVE:
Diferenciación celular; Factor de crecimiento; Células madre pluripotentes inducidas; Riesgo; La seguridad; Transformación; Tumourigénesis

PMID: 28238087 DOI:

10.1007/s10067-017-3581-1

[PubMed – as supplied by publisher]

#regeneración ósea #células madre #Diferenciación celular #Factor de crecimiento #Células madre pluripotentes inducidas

Courtesy:
Saqib Rehman MD
Director of Orthopaedic Trauma
Temple University
Philadelphia
Pennsylvania
USA
www.orthoclips.com

Narrated, annotated lecture 1 of 3 on general principles of wound coverage and skin grafts from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com.