Donador vivo renal / Live kidney donor

Mayo 9 2017. No. 2684

Función renal de donadores vivos programados para nefrectomía con sevorano o desflurano Kidney function in living donors undergoing nephrectomy by sevoflurane or desflurane anesthesia. Kim MS1, Lee JR, Kim MS, Ham SY, Choi SH. Yonsei Med J. 2013 Sep;54(5):1266-72. doi: 10.3349/ymj.2013.54.5.1266. Abstract PURPOSE: Although there is no clinical evidence of nephrotoxicity with the volatile anesthetics currently used in general anesthesia, a better agent should be needed in terms of preserving postoperative renal function in living kidney donors who have only single remaining kidney. The purpose of the current retrospective, single-center study was to evaluate and compare renal function of living kidney donors after nephrectomy under either sevoflurane or desflurane anesthesia. MATERIALS AND METHODS: From January 2006 through December 2011, a total of 228 donors undergoing video assisted minilaparotomy surgery nephrectomy for kidney donation were retrospectively enrolled in the current study. The donors were categorized into a sevoflurane group or desflurane group based on the type of volatile anesthetic used. We collected laboratory data from the patients preoperatively, immediately after the operation, on the first postoperative day and on the third postoperative day. We also compared renal function of the kidney donors after donor nephrectomy by comparing creatinine level and estimated glomerular filtration rate (eGFR). RESULTS: The decrease in renal function after surgery in both groups was the most prominent on the first postoperative day. There were no significant differences between the two groups in postoperative changes of creatinine or eGFR. CONCLUSION: Sevoflurane and desflurane can be used safely as volatile anesthetics in donors undergoing nephrectomy. KEYWORDS: Desflurane; living donors; nephrectomy; sevoflurane PDF ¿Podría el uso de un protocolo de recuperación mejorado en la nefrectomía del donante laparoscópico ser un incentivo para el donador vivo? Could the Use of an Enhanced Recovery Protocol in Laparoscopic Donor Nephrectomy be an Incentive for Live Kidney Donation? Rege A1, Leraas H2, Vikraman D3, Ravindra K3, Brennan T3, Miller T4, Thacker J1, Sudan D3. Cureus. 2016 Nov 22;8(11):e889. doi: 10.7759/cureus.889. Abstract INTRODUCTION AND BACKGROUND: Gastrointestinal (GI) recovery after major abdominal surgery can be delayed from an ongoing need for narcotic analgesia thereby prolonging hospitalization. Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to facilitate early recovery after major surgery by maintaining preoperative body composition and physiological organ function and modifying the stress response induced by surgical exposure. Enhanced recovery programs (ERPs) in colorectal surgery have decreased the duration of postoperative ileus and the hospital stay while showing equivalent morbidity, mortality, and readmission rates in comparison to the traditional standard of care. This study is a pilot trial to evaluate the benefits of ERAS protocols in living kidney donors undergoing laparoscopic nephrectomy. METHODS: This is a single-center, non-randomized, retrospective analysis comparing the outcomes of the first 40 live kidney donors subjected to laparoscopic nephrectomy under the ERAS protocol to 40 donors operated prior to ERAS with traditional standard of care. Our ERAS protocol includes reduced duration of fasting with preoperative carbohydrate loading, intraoperative fluid restriction to 3 ml/kg/hr, target urine output of 0.5 ml/kg/hr, use of subfascial Exparel injection (bupivacaine liposome suspension), and postoperative narcotic-free pain regimen with acetaminophen, ketorolac, or tramadol. Short-term patient outcomes were compared using Pearsons's Chi-Squared test for categorical variables and the Kruskal-Wallis test for continuous variables. Additionally, a multivariate analysis was conducted to evaluate factors influencing patient length of stay and likelihood of readmission. RESULTS: ERAS protocol reduced the postoperative median length of stay decreased from 2.0 to 1.0 days (p=0.001). Overall pain scores were significantly lower in the ERAS group (peak pain score 6.0 vs. 8.00, p< 0.001; morning after surgery pain score 3.0 vs. 7.0, p=0.001; lowest pain score 0.0 vs. 2.0, p=0.016) despite the absence of postoperative narcotics. The average duration of surgery was shorter in the ERAS group (248 vs. 304 minutes, p<0.001). The average amount of intraoperative fluid used was significantly lower in the ERAS group (2500 ml vs. 3525 ml, p<0.001) without affecting the donor renal function. The incidence of delayed graft function was similar in the two groups (p=0.541). A trend toward lower readmission was noted with the ERAS protocol (12.8% vs. 27.5%, p=0.105). GI dysfunction was the most common reason for readmission. CONCLUSION: Application of an ERAS protocol in a laparoscopic living donor nephrectomy was associated with reduced length of hospitalization and improved pain scores related likely to intraoperative use of subfascial Exparel and a shorter duration of ileus. Restricted use of intraoperative fluids prevents excessive third spacing and bowel edema, enhancing gut recovery without adversely impacting recipient graft function. This study suggests that ERAS has the potential to enhance the advantages of laparoscopic surgery for live kidney donation through optimizing donor outcomes and perioperative patient satisfaction. KEYWORDS: donor readmission rates; enhanced recovery after surgery (eras); enhanced recovery programs (erps); laparoscopic living donor nephrectomy; length of stay (los); postoperative pain scores PDF El estudio del donador vivo para trasplante renal Carlos Arroyo,* Fernando Gabilondo,* Bernardo Gabilondo* Rev. invest. clín. vol.57 no.2 México mar./abr. 2005 Resumen Actualmente, por la falta de órganos para trasplante renal provenientes de cadáveres, y debido al largo tiempo de espera por un riñón, existe una tendencia a realizar trasplantes renales utilizando riñones procedentes de donadores vivos. La mayoría de los donadores son familiares del receptor. La donación de órganos debe considerarse como un regalo con un valor extraordinario y debe facilitarse a los candidatos a donación. En todo el mundo se ha observado un aumento en el número de personas en la lista de espera para un trasplante renal. El trasplante renal de donador vivo se considera actualmente como el mejor método de tratamiento en pacientes con insuficiencia renal terminal, debido a que ofrece la mayor supervivencia a corto y largo plazos. En vista de que existen diferencias significativas en los criterios de selección y evaluación de donadores renales, en especial en un grupo selecto de pacientes añosos o con enfermedades asociadas, es indispensable establecer criterios mínimos de selección. Todos los donadores deberán contar con una historia clínica completa y exámenes de laboratorio y gabinete que permitan su evaluación integral. Estos estudios se describen con detalle en este artículo. También se discuten los criterios para donadores renales con ciertas comorbilidades (obesos, hipertensos, hiperglucémicos, con litiasis y neoplasias) que previamente se descartaban como candidatos para donación. Palabras clave. Donador renal. Trasplante renal. Donador vivo renal. PDF

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El ultrasonido de hombro realizado por cirujanos ortopédicos aumenta la eficiencia en el diagnóstico de los desgarres del manguito rotador.

http://www.mihombroycodo.com.mx/academia/el-ultrasonido-de-hombro-realizado-por-cirujanos-ortopedicos-aumenta-la-eficiencia-en-el-diagnostico-de-los-desgarres-del-manguito-rotador/

Shoulder ultrasonography performed by orthopedic surgeons increases efficiency in diagnosis of rotator cuff tears.

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28427416

https://josr-online.biomedcentral.com/articles/10.1186/s13018-017-0565-4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399436/

De:

Chiu CH1,2,Chen P3,Chen AC4,5,Hsu KY6,2,Chang SS1,2,Chan YS6,2,

Chen YJ6,2.

J Orthop Surg Res.

2017 Apr 20;12(1):63. doi: 10.1186/s13018-017-0565-4.

Todos los derechos reservados para:

Copyright and License information ▼

Copyright

© The Author(s). 2017Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Abstract

BACKGROUND:

Rotator cuff tears are very common and their incidence increases with age. Shoulder ultrasonography has recently gained popularity in detecting rotator cuff tears because of its efficiency, cost-effectiveness, time-saving, and real-time nature of the procedure. Well-trained orthopedic surgeons may utilize shoulder ultrasonography to diagnose rotator cuff tears. The wait time of patients planned to have shoulder MRI (magnetic resonance imaging) to rule in rotator cuff tears may decrease after orthopedic surgeon start doing shoulder ultrasonography as a screening tool for that. Patients with rotator cuff tears may be detected earlier by ultrasonography and have expedited surgical repair. The efficacy in determination of rotator cuff tears will also increase.

CONCLUSIONS:

Office-based shoulder ultrasound examination can reduce the wait time for a shoulder MRI. The efficacy of determination of rotator cuff tears will also increase after the introduction of shoulder ultrasonography.

KEYWORDS:

Diagnosis; Efficiency; Rotator cuff; Shoulder; Ultrasonography

Resumen

ANTECEDENTES:
Los desgarres del manguito rotador son muy comunes y su incidencia aumenta con la edad. La ultrasonografía de hombro ha ganado recientemente popularidad en la detección de los desgarres del manguito rotador debido a su eficiencia, rentabilidad, ahorro de tiempo, y en tiempo real la naturaleza del procedimiento. Los cirujanos ortopédicos bien entrenados pueden utilizar la ecografía o ultrasonido del hombro para diagnosticar los desgarros del manguito rotador. El tiempo de espera de los pacientes proyectados para someterse a RM del hombro (resonancia magnética) para descartar los desgarres del manguito rotador puede disminuir después de que el cirujano ortopédico comience a hacer ultrasonografía en el hombro como una herramienta de detección para eso. Los pacientes con desgarramiento del manguito rotador pueden ser detectados antes por ultrasonografía y han acelerado la reparación quirúrgica. La eficacia en la determinación de los desgarres del manguito rotador también aumentará.

CONCLUSIONES:
El examen de ultrasonido de hombro basado en la oficina puede reducir el tiempo de espera para una RM de hombro. La eficacia de la determinación de los desgarres del manguito rotador también aumentará después de la introducción de la ecografía del hombro.

PALABRAS CLAVE:
Diagnóstico; Eficiencia; Manguito rotador; Hombro; Ultrasonografía

PMID:  28427416   PMCID:  

PMC5399436

  DOI:  

10.1186/s13018-017-0565-4

Free PMC Article

#diagnóstico#eficiencia#manguito rotador#hombro#ultrasonografia

Libro sobre pediatría / Book on pediatrics

Mayo 7, 2017. No. 2682

Cirugía pediátrica y neonatal Pediatric and Neonatal Surgery Edited by Joanne Baerg, ISBN 978-953-51-3136-6, Print ISBN 978-953-51-3135-9, 168 pages, Publisher: InTech, Chapters published May 03, 2017 under CC BY 3.0 license Edited Volume Neonatal and Pediatric Surgery is a broad field with many challenges. The aim of this short book is to provide the reader with several informative chapters in the field of neonatal and pediatric surgery. Each chapter provides details on a specific area of this changing field. The scope of this book focuses on a few areas that are rare and challenging. For example, it covers preoperative and postoperative care of neonates. Important anesthesia considerations, including anesthesia for neonates and regional anesthesia, are discussed. A unique chapter on neonatal tumors is presented. The book provides an overview of the recent recommendations for care of infants and children that undergo cardiac surgery. The challenging aspects of caustic ingestion are explained. Each chapter stands alone as a detailed source of information for the reader. This book brings updated information with structured headings that will allow the reader to remain focused as the material is reviewed. Libro / Book

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