Sedación en urgencias / Sedation in emergency department

Diciembre 4, 2017. No. 2922

Incidencia de eventos adversos en adultos sometidos a sedación para procedimientos en el servicio de urgencias: revisión sistemática y metaanálisis. Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Bellolio MF1,2, Gilani WI1, Barrionuevo P3,2, Murad MH3,2, Erwin PJ4, Anderson JR1, Miner JR5,6, Hess EP1,2. Acad Emerg Med. 2016 Feb;23(2):119-34. doi: 10.1111/acem.12875. Epub 2016 Jan 22. Author information Abstract OBJECTIVES: This was a systematic review and meta-analysis to evaluate the incidence of adverse events in adults undergoing procedural sedation in the emergency department (ED). METHODS: Eight electronic databases were searched, including MEDLINE, EMBASE, EBSCO, CINAHL, CENTRAL, Cochrane Database of Systematic Reviews, Web of Science, and Scopus, from January 2005 through 2015. Randomized controlled trials and observational studies of adults undergoing procedural sedation in the ED that reported a priori selected outcomes and adverse events were included. Meta-analysis was performed using a random-effects model and reported as incidence rates with 95% confidence intervals (CIs). RESULTS: The search yielded 2,046 titles for review. Fifty-five articles were eligible, including 9,652 procedural sedations. The most common adverse event was hypoxia, with an incidence of 40.2 per 1,000 sedations (95% CI = 32.5 to 47.9), followed by vomiting with 16.4 per 1,000 sedations (95% CI = 9.7 to 23.0) and hypotension with 15.2 per 1,000 sedations (95% CI = 10.7 to 19.7). Severe adverse events requiring emergent medical intervention were rare, with one case of aspiration in 2,370 sedations (1.2 per 1,000), one case of laryngospasm in 883 sedations (4.2 per 1,000), and two intubations in 3,636 sedations (1.6 per 1,000). The incidence of agitation and vomiting were higher with ketamine (164.1 per 1,000 and 170.0 per 1,000, respectively). Apnea was more frequent with midazolam (51.4 per 1,000), and hypoxia was less frequent in patients who received ketamine/propofol compared to other combinations. The case of laryngospasm was in a patient who received ketamine, and the aspiration and intubations were in patients who received propofol. When propofol and ketamine are combined, the incidences of agitation, apnea, hypoxia, bradycardia, hypotension, and vomiting were lower compared to each medication separately. CONCLUSIONS: Serious adverse events during procedural sedation like laryngospasm, aspiration, and intubation are exceedingly rare. Quantitative risk estimates are provided to facilitate shared decision-making, risk communication, and informed consent. PDF Ketamina-Propofol versus propofol para la sedación de procedimiento en el servicio de urgencias: una revisión sistemática y metanálisis. Ketamine-Propofol Versus Propofol Alone for Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Yan JW1,2, McLeod SL1,2, Iansavitchene A2. Author information Acad Emerg Med. 2015 Sep;22(9):1003-13. doi: 10.1111/acem.12737. Epub 2015 Aug 20. Abstract OBJECTIVES: Propofol is an agent commonly used for procedural sedation and analgesia (PSA) in the emergency department (ED), but it can cause respiratory depression and hypotension. The combination of ketamine-propofol (K-P) is an alternative that theoretically provides a reduction in adverse events compared to propofol. The primary objective of this review was to determine if K-P has a lower frequency of adverse respiratory events in patients undergoing PSA in the ED than propofol alone. Secondary objectives were to compare the proportion of overall adverse events, sedation time, procedure time, and recovery time between K-P and propofol. METHODS: Electronic searches of Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL were conducted and reference lists were hand-searched. Randomized controlled trials (RCTs) published in English comparing the use of K-P to propofol alone for PSA in the ED were included. RESULTS: Six RCTs were included with a combined total of 932 patients (K-P = 520, propofol = 412). Five RCTs reported the proportion of adverse respiratory events; the pooled estimate revealed fewer adverse respiratory events with K-P compared to propofol (29.0% vs. 35.4%; risk ratio [RR] = 0.82; 95% confidence interval [CI] = 0.68 to 0.99). There was no significant difference with respect to the proportion of overall adverse events (38.8% vs. 42.5%; RR = 0.88; 95% CI = 0.75 to 1.04). Procedure time was similar when the groups were compared. CONCLUSIONS: The premise of combining ketamine with propofol is based on the many synergies that theoretically exist between these two agents. In this study, K-P had a lower frequency of adverse respiratory events in patients undergoing PSA in the ED compared to propofol alone. PDF Jornadas de Trabajo Social y Psicología en los Cuidados Paliativos Dicienbre 7-8, 2017. Guadalajara, México Informes en tszoquipan@hotmail.com XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo International Anesthesia Research Society Annuals Meetings USA Informes / Information

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

Si buscas en Google: artroplastia reversa de hombro….

http://www.lesionesdeportivas.com.mx/academia/si-buscas-en-google-artroplastia-reversa-de-hombro/

Sale esto…

#artroplastia reversa de hombro

EXPOSICION DEL GLENOIDES EN LA ARTROPLASTIA TOTAL DEL HOMBRO

http://www.lesionesdeportivas.com.mx/academia/exposicion-del-glenoides-en-la-artroplastia-total-del-hombro/

GLENOID EXPOSURE IN TOTAL SHOULDER ARTHROPLASTY

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29155311

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1877056817303237?returnurl=http:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1877056817303237%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F29155311

De:

Nové-Josserand L1,Clavert P2.

Orthop Traumatol Surg Res.

2017 Nov 16. pii: S1877-0568(17)30323-7. doi: 10.1016/j.otsr.2017.10.008. [Epub ahead of print]

Todos los derechos reservados para:

Orthopaedics & Traumatology: Surgery & Research, Copyright © 2017

Copyright © 2017 Elsevier, Inc. All rights reserved.

Abstract

Glenoid exposure is agreed to be a difficult step, but is also a key step in total shoulderarthroplasty, both anatomic and reverse. It conditions unhindered use of the ancillary instrumentation and thus correct glenoid component positioning. The main stages comprise arthrotomy, by opening the rotator cuff, humeral head cut, and inferior glenohumeral release, enabling shifting of the humerus and good exposure of the glenoid cavity. The two main approaches are deltopectoral and anterosuperior transdeltoid. Using the deltopectoral approach, arthrotomy is performed through the subscapularis muscle, by various techniques. This approach enables extensive inferior glenohumeral release and thus an approach to the inferior apex of the glenoid cavity, which is a key area for glenoid implant positioning. The main drawbacks are postoperative shoulder instability and limited access to the posterior part of the glenoid in case of significant retroversion. Moreover, subscapularis healing is uncertain, which can impair the clinical outcomes, with risk of glenoid component loosening. Advantages, on the other hand, include the fact that it can be implemented in all cases, even the most difficult ones, and that the deltoid muscle is respected. The transdeltoid approach has the advantage of being simple, providing direct exposure of the glenoid cavity through a rotator cuff tear after passing through the deltoid. It is therefore especially indicated for reverse prosthesis in case of rotator cuff tear, and in traumatology. However, the approach to the inferior part of the glenoid cavity can be restricted, with insufficient exposure and a risk of glenoid component malpositioning (superior tilt). The preoperative assessment is essential, to detect at-risk situations such as severe stiffness and anticipate difficulties in glenoid exposure.

KEYWORDS:

Arthroplasty; Deltopectoral; Glenoid cavity; Shoulder; Transdeltoid

Resumen

La exposición glenoidea se considera un paso difícil, pero también es un paso clave en la artroplastia total del hombro, tanto anatómica como reversa. Condiciona el uso sin obstáculos de la instrumentación auxiliar y, por lo tanto, corrige el posicionamiento del componente glenoideo. Las etapas principales comprenden la artrotomía, al abrir el manguito de los rotadores, el corte de la cabeza del húmero y la liberación glenohumeral inferior, lo que permite el desplazamiento del húmero y una buena exposición de la cavidad glenoidea. Los dos abordajes principales son deltopectoral y anterosuperior transdeltoide. Usando el abordaje deltopectoral, la artrotomía se realiza a través del músculo subescapular, por diversas técnicas. Este abordaje permite una liberación glenohumeral inferior extensa y, por lo tanto, un acercamiento al ápice inferior de la cavidad glenoidea, que es un área clave para el posicionamiento de los implantes glenoideos. Los principales inconvenientes son la inestabilidad postoperatoria del hombro y el acceso limitado a la parte posterior de la cavidad glenoidea en caso de retroversión significativa. Además, la cicatrización del subescapular es incierta, lo que puede perjudicar los resultados clínicos, con riesgo de aflojamiento del componente glenoideo. Las ventajas, por otro lado, incluyen el hecho de que puede implementarse en todos los casos, incluso los más difíciles, y que se respeta el músculo deltoides. El abordaje transdeltoide tiene la ventaja de ser simple y proporciona una exposición directa de la cavidad glenoidea a través de una rotura del manguito rotador después de atravesar el deltoides. Por lo tanto, está especialmente indicado para prótesis reversas en caso de rotura del manguito de los rotadores y en traumatología. Sin embargo, el acceso a la parte inferior de la cavidad glenoidea puede restringirse, con una exposición insuficiente y un riesgo de mala posición del componente glenoideo (inclinación superior). La evaluación preoperatoria es esencial para detectar situaciones de riesgo como rigidez severa y anticipar dificultades en la exposición glenoidea.

PALABRAS CLAVE:

Artroplastia; Deltopectoral; Cavidad glenoidea; Hombro; Transdeltoide

PMID:  29155311   DOI:  10.1016/j.otsr.2017.10.008

#artroplastia#deltopectoral#cavidad glenoidea#hombro#transdeltoide

Bloqueo epidural para ciática / The epidural block of sciatica

Noviembre 29, 2017. No. 2917

Tratamiento epidural de la ciática. Su origen y evolución Resumen La inyección epidural con corticosteroides es una opción de tratamiento común para pacientes con dolor lumbar o ciática. En este artículo revisamos su origen y evolución. Las primeras inyecciones fueron dadas alrededor de 1900 en París por Jean Sicard (1872-1929) y Fernand Cathelin (1873-1945), que trabajaban de forma independiente. Ambos inyectaron pequeños volúmenes de cocaína en el hiato sacro. Después de un comienzo lento, el tratamiento epidural del dolor de espalda y la ciática se extendió gradualmente a otras partes de Europa y América del Norte. A principios de la década de 1950, se introdujeron corticosteroides para uso epidural. Desde la década de 1970, se han realizado numerosos ensayos clínicos que muestran un efecto significativo, aunque pequeño, de las inyecciones de corticosteroides epidurales en comparación con el placebo para el dolor en las piernas a corto plazo. A pesar de un debate continuo sobre la efectividad y la seguridad, las inyecciones epidurales siguen siendo populares. The Epidural Treatment of Sciatica: Its Origin and Evolution. Ter Meulen BC1, Weinstein H, Ostelo R, Koehler PJ. Author information Eur Neurol. 2016;75(1-2):58-64. doi: 10.1159/000443729. Epub 2016 Jan 28. Abstract Epidural injection with corticosteroids is a common treatment option for patients with lower back pain or sciatica. In this paper we review its origin and evolution. The first injections were given around 1900 in Paris by Jean Sicard (1872-1929) and Fernand Cathelin (1873-1945), who worked independently. They both injected small volumes of cocaine into the sacral hiatus. After a slow start, the epidural treatment of back pain and sciatica gradually spread to other parts of Europe and Northern America. In the early 1950s, corticosteroids were introduced for epidural use. Since the 1970s, there have been numerous clinical trials that show a significant, although small, effect of epidural corticosteroid injections compared with placebo for leg pain in the short term. Despite an ongoing debate about effectiveness and safety, epidural injections remain popular. PDF Jornadas de Trabajo Social y Psicología en los Cuidados Paliativos Dicienbre 7-8, 2017. Guadalajara, México Informes en tszoquipan@hotmail.com XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo International Anesthesia Research Society Annuals Meetings USA Informes / Information

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

Hepatitis viral y embarazo / Viral hepatitis in pregnancy. Yahoo / Buzón

Noviembre 28, 2017. No. 2916

Actualización sobre hepatitis viral y embarazo Update on viral hepatitis in pregnancy. Shao Z1, Al Tibi M2, Wakim-Fleming J3. Author information Cleve Clin J Med. 2017 Mar;84(3):202-206. doi: 10.3949/ccjm.84a.15139. Abstract Pregnant women with acute viral hepatitis are at higher risk of morbidity and death than pregnant women with chronic viral hepatitis. The risk of death is highest with acute viral hepatitis E, and the rate of transmission to the baby may be highest with hepatitis B virus (HBV) infection. Managing viral hepatitis in pregnancy requires assessing the risk of transmission to the baby, determining the gestational age at the time of infection and the mother's risk of decompensation, and understanding the side effects of antiviral drugs. PDF Conocimiento, educación y prácticas de obstetras y ginecólogos con respecto a la hepatitis B crónica en el embarazo. Obstetricians' and gynecologists' knowledge, education, and practices regarding chronic hepatitis B in pregnancy. Niu B1, Marzio DH2, Fenkel JM2, Herrine SK2. Author information Abstract BACKGROUND: In pregnant women with high viral loads, third-trimester initiation of antiviral agents can reduce the risk of vertical transmission. We aimed to assess obstetricians' and gynecologists' (OB-GYN) knowledge and clinical practice when treating pregnant women with chronic hepatitis B virus (HBV). METHODS: All program directors (PDs) from 250 US OB-GYN residency programs were invited to anonymously complete an 18-item questionnaire. Descriptive statistics were calculated and analyzed. RESULTS: A total of 323 participants responded, including both PDs (n=51, response rate 21%) and residents (n=272, response rate 11%). Responding PDs (62% university-based vs. 32% community-based) came from various practice types. All PDs and 95.2% of residents reported screening for chronic HBV in pregnant patients on the first prenatal visit. A majority of PDs (85.5%) and residents (85%) correctly interpreted HBV serologies. Referral patterns showed that 66.7% of PDs and 65.5% of residents refer to a specialist regardless of viral load. A minority of respondents (19.6% PDs and 12.6% residents) knew that third-trimester antiviral therapy is recommended for women with high viral loads (>200,000 IU/mL). Few respondents had prescribed HBV antivirals (9.8% PDs and 6.0% residents), with residents more commonly prescribing tenofovir and less frequently lamivudine. Half the PDs believed trainees from their programs were comfortable managing HBV in pregnancy, but only 41.8% of residents reported being comfortable managing pregnant patients with HBV. CONCLUSION: OB-GYNs report screening almost all pregnant patients for chronic HBV, though significant gaps still exist in practitioner comfort and training regarding the management of HBV during pregnancy. KEYWORDS: Hepatitis B virus; education; obstetricians and gynecologists; practice; pregnancy; survey PDF Hepatitis vitral aguda durante el embarazo Enrique Valdés R., Alvaro Sepúlveda M., Paula Candia P., Karina Lattes A. Rev Chil Infect 2010; 27 (6): 505-512 PDF Jornadas de Trabajo Social y Psicología en los Cuidados Paliativos Dicienbre 7-8, 2017. Guadalajara, México Informes en tszoquipan@hotmail.com XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo International Anesthesia Research Society Annuals Meetings USA Informes / Information

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