Anestesia en cirugía cardiaca / Cardiac anaesthesia

Septiembre 13, 2017. No. 2810

Ensayo clínico aleatorizado que compara las respuestas hemodinámicas a ketamina-propofol ón (Ketofol) versus etomidato durante la inducción de la anestesia en pacientes con disfunción ventricular izquierda sometidos a cirugía de bypass coronario. A randomized clinical trial comparing hemodynamic responses to ketamine-propofol combination (ketofol) versus etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery. Baradari AG1, Alipour A2, Habibi MR1, Rashidaei S3, Emami Zeydi A4,5. Author information Arch Med Sci. 2017 Aug;13(5):1102-1110. doi: 10.5114/aoms.2016.63193. Epub 2016 Oct 25. Abstract INTRODUCTION: Anesthesia induction is often accompanied by a period of hemodynamic instability, which could be a significant problem in patients with compromised ventricular function. The aim of this study is to compare the hemodynamic responses to etomidate versus a combination of ketamine and propofol (ketofol) for anesthetic induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS: In a double-blind randomized clinical study, a total of 84 patients with ischemic left ventricular dysfunction (EF < 40%) were randomly assigned to two groups (A and B). Patients in group A received etomidate 0.2 mg/kg and a placebo (normal saline); group B received a combination of ketamine (1 mg/kg) and propofol (1.5 mg/kg) at the induction of anesthesia. Two minutes after induction, hemodynamic variables, including systolic, diastolic, mean arterial pressure (SAP, DAP, MAP) and heart rate (HR), were measured immediately before and after the laryngoscopy, and before intubation and post-intubation at 1, 2, and 3 min. RESULTS: The decrease in all hemodynamic parameters (SBP, DBP, MAP and HR) from induction time to laryngoscopy was greater in the ketofol group (group B) than in the etomidate group (group A) (p < 0.05). The ephedrine prescription rate due to hemodynamic changes was 24.4% (10 patients) and 5% (2 patients) in group B and group A, respectively (p = 0.03). CONCLUSIONS: We found that etomidate provides superior hemodynamic stability as compared to ketofol in patients with left ventricular dysfunction undergoing CABG surgery under general anesthesia. KEYWORDS: etomidate; hemodynamics; ketamine; ketofol; propofol; ventricular dysfunction PDF Leucocitosis asintomática preoperatoria y evolución postoperatoria en pacientes con cirugía cardíaca. Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients. Mahmood E1,2, Knio ZO3, Mahmood F1, Amir R1, Shahul S1, Mahmood B1,4, Baribeau Y1, Mueller A1, Matyal R1. Author information PLoS One. 2017 Sep 5;12(9):e0182118. doi: 10.1371/journal.pone.0182118. eCollection 2017. Abstract BACKGROUND: Despite showing a prognostic value in general surgical patients, preoperative asymptomatic elevated white blood cell (WBC) count is not considered a risk factor for cardiac surgery. Whereas there is sporadic evidence of its value as a preoperative risk marker, it has not been looked at methodically as a specific index of outcome during cardiac surgery. Using a national database we sought to determine the relationship between preoperative WBC count and postoperative outcome in cardiac surgical patients. METHODS: Cardiac surgeries were extracted from the 2007-2013 American College of Surgeons National Surgical Quality Improvement Program database. Leukocytosis was defined by a preoperative WBC count greater than 11,000 cells/μL. A univariate analysis compared the incidence of adverse outcomes for patients with and without leukocytosis. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality. RESULTS: Out of a total of 10,979 cardiac surgery patients 863 (7.8%) had preoperative leukocytosis. On univariate analysis, patients with leukocytosis experienced greater incidences of 30-day mortality, wound complications, and medical complications. Wound complications included surgical site infection as well as wound dehiscence. The medical complications included all other non-surgical causes of increased morbidity and infection leading to urinary tract infection, pneumonia, ventilator dependence, sepsis and septic shock. After stepwise model adjustment, leukocytosis was a strong predictor of medical complications (OR 1.22, 95% CI: 1.09-1.36, p = 0.002) with c-statistic of 0.667. However, after stepwise model adjustment leukocytosis was not a significant predictor of 30-day mortality and wound complications. CONCLUSION: Preoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México).  Informes / Information

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

Ketamina en suicidio / Ketamine for suicide

Septiembre 16, 2017. No. 2813

¿Es ketamina la nueva droga maravilla para tratar el suicidio? Is Ketamine the New Wonder Drug for Treating Suicide? Henry Boilini, MD; Madeleine Baldwin, LCSW; and Georgine Lamvu, MD Fed Pract. 2017 September;34(9):12-16 Although the initial findings involving the use of ketamine in suicidal patients are promising, further research is needed on the short - and long-term effects of this medication. In 2014 the suicide rate in the U.S. was 13/100,000, the highest recorded in 28 years.1 Suicide is now considered the 10th leading cause of death for all ages, and the rate has increased every year from 2000 to 2014 among both women and men and in every age group except those aged ≥ 75 years.1-3 For those aged 15 to 44 years, suicide is among the top 3 causes of death worldwide.4-6 PDF Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México).  Informes / Information XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017  Informes / Information

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

Anatomía en resonancia magnética de la cadera

http://www.artroscopiayreemplazos.com.mx/academia/anatomia-en-resonancia-magnetica-de-la-cadera/


MRI Anatomy of the HIP


Este artículo y/o video es originalmente publicado en:

https://youtu.be/Fm8VnKRdNL4


De y Todos los derechos reservados para:

Courtesy: Dr Jean Jose MD, Associate Chief, Musculoskeletal Radiology Section, Associate Professor of Clinical Radiology, University of Miami School of Medicine, Florida, USA





Radiology Residency UM/JMH


Publicado el 29 jul. 2015




Dr. Jean Jose reviews the detailed anatomy of the Hip/pelvis. Muscles, bones and joint structures are reviewed in detail with tidbits of key points required for the radiological diagnosis of important injuries. The covered material is critical to be able to begin interpreting Hip MRI and providing useful complete interpretations. It is recommended that you open up a case on your PACS to follow along with the video.


Categoría


Ciencia y tecnología
Licencia


Licencia de YouTube estándar

Defectos condrales de la articulación glenohumeral: Resultado a largo plazo después del microfracturado del hombro.

http://www.artroscopiayreemplazos.com.mx/academia/defectos-condrales-de-la-articulacion-glenohumeral-resultado-a-largo-plazo-despues-del-microfracturado-del-hombro/

Chondral defects of the glenohumeral joint: Long-term outcome after microfracturing of the shoulder.

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28868088

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579070/

https://link.springer.com/article/10.1007%2Fs11678-017-0415-3

De:

Hünnebeck SM1,Magosch P2,Habermeyer P2,Loew M2,Lichtenberg S2.

Obere Extrem.

2017;12(3):165-170. doi: 10.1007/s11678-017-0415-3. Epub 2017 Jun 29.

Todos los derechos reservados para:

Copyright and License information ▼

Copyright

© The Author(s) 2017Open Access. This 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.

Abstract

INTRODUCTION:

An increasing number of young patients are diagnosed with chondral lesions. Minimally invasive surgical techniques are important in order to delay progression of the early stages of osteoarthritis and the need for total joint replacement.

CONCLUSION:

Even though microfracturing does not prevent radiographic progression, microfracture of the glenohumeral joint might be worth considering as part of a treatment regimen for younger patients who may not yet be treated with arthroplasty.

KEYWORDS:

Arthroplasty; Arthroscopy; Omarthritis; Osteoarthritis; Pain

Resumen

INTRODUCCIÓN:
Un número cada vez mayor de pacientes jóvenes son diagnosticados con lesiones condrales. Técnicas quirúrgicas mínimamente invasivas son importantes para retrasar la progresión de las primeras etapas de la osteoartritis y la necesidad de reemplazo total de la articulación.

CONCLUSIÓN:
A pesar de que el microfracturado no previene la progresión radiográfica, la microfractura de la articulación glenohumeral podría ser considerada como parte de un régimen de tratamiento para pacientes más jóvenes que aún no pueden ser tratados con artroplastia.

PALABRAS CLAVE:
Artroplastia; Artroscopia; Omarthritis; Osteoartritis; Dolor

PMID: 28868088   PMCID:  

PMC5579070    

DOI:  

10.1007/s11678-017-0415-3

Free PMC Article

#Defectos condrales#inestabilidad glenohumeral#microfracturado#hombro#artroplastia#artroscopia#dolor