Revisiones_bibliográficas TyO

Int J Mol Sci. 2016 Dec 29;18(1). pii: E64. doi: 10.3390/ijms18010064.

Abstract

Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description dates back in the late 1970s, a new definition has recently been proposed. However, the definition remains based on clinical characteristic. In the present review, the diagnostic workup and the pathophysiology of the syndrome will be presented. Therapeutic approaches to ARDS, including lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids and recruitment manoeuvres will be reviewed. We will underline how a holistic framework of respiratory and hemodynamic support should be provided to patients with ARDS, aiming to ensure adequate gas exchange by promoting lung recruitment while minimizing the risk of ventilator-induced lung injury. To do so, lung recruitability should be considered, as well as the avoidance of lung overstress by monitoring transpulmonary pressure or airway driving pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extra-corporeal life support (alone or in combination) should be taken into account.

KEYWORDS: acute respiratory distress syndrome; critically ill patients; lung-protective ventilation; positive end-expiratory pressure

Manejo del síndrome de dificultad respiratoria aguda con posición prona

Treatment of ARDS With Prone Positioning.

Scholten EL1, Beitler JR2, Prisk GK3, Malhotra A2.

Chest. 2017 Jan;151(1):215-224. doi: 10.1016/j.chest.2016.06.032. Epub 2016 Jul 8.

Abstract

Prone positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiological mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proved challenging; several contemporary trials showed no major clinical benefits with prone positioning. By optimizing patient selection and treatment protocols, the recent Proning Severe ARDS Patients (PROSEVA) trial demonstrated a significant mortality benefit with prone ventilation. This trial, and subsequent meta-analyses, support the role of prone positioning as an effective therapy to reduce mortality in severe ARDS, particularly when applied early with other lung-protective strategies. This review discusses the physiological principles, clinical evidence, and practical application of prone ventilation in ARDS.

KEYWORDS: ARDS; critical care; hypoxemia; lung injury; ventilation

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Obstetricia / Obstetrics

Diciembre 22, 2017. No. 2940

Libro de Obstetricia

Obstetrics

Edited by Hassan Salah Abduljabbar, ISBN 978-953-51-3704-7, Print ISBN 978-953-51-3703-0, 198 pages, Publisher: InTech, Chapters published December 20, 2017 under CC BY 3.0 license
DOI: 10.5772/66054
Edited VolumeObstetrics is the field that deals with the well-being of the pregnant women as well as the labor and delivery of a healthy baby. Obstetricians work closely as neonatologists who deal with the care of the newborn baby to reduce chances of morbidity and mortality. The objective of obstetrics is to deal with diagnosis and treatment of pregnancy, antenatal care, and prevention of complication, collaborating with midwives to monitor pregnant women in labor, facilitating delivery and performing assisted procedures if needed as episiotomy, forceps delivery, vacuum extraction, and Cesarean section if indicated.

Libro / Book

Prevención de nausea y vomito en mujeres con anestesia regional en cesárea. Retos y soluciones

Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions.

Jelting Y1, Klein C1, Harlander T1, Eberhart L2, Roewer N1, Kranke P1.

Local Reg Anesth. 2017 Aug 9;10:83-90. doi: 10.2147/LRA.S111459. eCollection 2017.

Abstract

BACKGROUND:

Intraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids. METHODS: Given the high and even increasing rate of cesarean sections and the sparse information on the etiology, incidence and severity of nausea and vomiting and the impact of prophylactic measures on the incidence of PONV/IONV, this article aims to review the available information and provide pragmatic suggestions on how to prevent nausea and vomiting in this patient cohort. Current literature and guidelines were identified by electronic database searching (MEDLINE via PubMed and Cochrane database of systematic reviews) up to present, searching through reference lists of included literature and personal contact with experts. DISCUSSION AND CONCLUSION: Taking into account the current guidelines and literature as well as everyday clinical experience, the first step for decreasing the incidence of IONV and PONV is a comprehensive management of circulatory parameters. This management includes liberal perioperative fluid administration and the application of vasopressors as the circumstances require. By using low-dose local anesthetics, an additional application of intrathecal or spinal opioids or hyperbaric solutions for a sufficient controllability of neuraxial distribution, maternal hypotension might be reduced. Performing a combined spinal-epidural anesthesia or epidural anesthesia may be considered as an alternative to spinal anesthesia. Antiemetic drugs may be administered restrainedly due to off-label use in pregnant women for IONV or PONV prophylaxis and may be reserved for treatment.

KEYWORDS: PONV; antiemetics; hypotension; neuraxial anesthesia; obstetrics

Comparación de fenilefrina y efedrina en el manejo de la hipotensión inducida por raquia en embarazo de alto riesgo. Revisión narrativa

Comparison of Phenylephrine and Ephedrine in Treatment of Spinal-Induced Hypotension in High-Risk Pregnancies: A Narrative Review.

Dusitkasem S1, Herndon BH2, Somjit M3, Stahl DL2, Bitticker E4, Coffman JC2.

Front Med (Lausanne). 2017 Jan 20;4:2. doi: 10.3389/fmed.2017.00002. eCollection 2017.

Abstract

PURPOSE: To compare maternal and fetal effects of intravenous phenylephrine and ephedrine administration during spinal anesthesia for cesarean delivery in high-risk pregnancies. SOURCE: An extensive literature search was conducted using the US National Library of Medicine, MEDLINE search engine, Cochrane review, and Google Scholar using search terms "ephedrine and phenylephrine," "preterm and term and spinal hypotension," "preeclampsia and healthy parturients," or "multiple and singleton gestation and vasopressor." PRINCIPLE FINDINGS: Both phenylephrine and ephedrine can be safely used to counteract hypotension after spinal anesthesia in patients with uteroplacental insufficiency, pregnancy-induced hypertension, and in non-elective cesarean deliveries. Vasopressor requirements before delivery in high-risk cesarean sections are reduced compared to healthy parturients. Among the articles reviewed, there were no statistically significant differences in umbilical arterial pH, umbilical venous pH, incidence of fetal acidosis, Apgar scores, or maternal hypotension when comparing maternal phenylephrine and ephedrine use. CONCLUSION: From the limited existing data, phenylephrine and ephedrine are both appropriate selections for treating or preventing hypotension induced by neuraxial blockade in high-risk pregnancies. There is no clear evidence that either medication is more effective at maintaining maternal blood pressure or has a superior safety profile in this setting. Further investigations are required to determine the efficacy, ideal dosing regimens, and overall safety of phenylephrine and ephedrine administration in high-risk obstetric patients, especially in the presence uteroplacental insufficiency.

KEYWORDS: ephedrine; fetal compromise; hypotension; phenylephrine; preeclampsia; uteroplacental insufficiency

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Anestesiología y Medicina del Dolor

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Congreso IberoLatinoamericano de Cirugía de Mano, del 12 al 14 de abril del 2018 Hotel Barceló Maya Caribe

http://www.clinicademano.com.mx/academia/congreso-iberolatinoamericano-de-cirugia-de-mano/

martes, 19 de diciembre de 2017

Una masa muscular tonificada preserva la función articular en rodillas y caderas con artrosis

http://www.cirugiarticular.com.mx/academia/una-masa-muscular-tonificada-preserva-la-funcion-articular-en-rodillas-y-caderas-con-artrosis/

Body composition and clinical symptoms in patients with hip or knee osteoarthritis: Results from the KHOALA cohort.

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29224976
http://www.semarthritisrheumatism.com/article/S0049-0172(17)30138-5/fulltext

De:

Jeanmaire C1, Mazières B2, Verrouil E2, Bernard L3, Guillemin F4, Rat AC5.
Semin Arthritis Rheum. 2017 Oct 18. pii: S0049-0172(17)30138-5. doi: 10.1016/j.semarthrit.2017.10.012. [Epub ahead of print]

Todos los derechos reservados para:

Copyright © 2017 Elsevier Inc. All rights reserved.

Abstract

OBJECTIVE:

To analyze the associations between body composition, notably low lean mass, and clinicalsymptoms [pain, physical function, quality of life (QoL)] in patients with symptomatic hip and/or knee OA.
METHODS:

Cross-sectional study using data from the 3-year follow-up visit of the Knee and HipOsteoArthritis Long-term assessment (KHOALA) cohort. Skeletal muscle and fat mass were measured by dual X-ray absorptiometry (DXA). Fat mass index (FMI) was defined as total fat mass/height2. Appendicular lean mass was adjusted on body mass index (ALM/BMI), and low lean mass was defined according to the definition of FNIH Sarcopenia Project recommendations. Pain and function were measured by the WOMAC index and QoL by the SF-36.
RESULTS:

In total, 358 patients underwent DXA (67% women, mean [SD] age 63.4 [8.4] years, mean BMI 29.5 [5.6]kg/m2). The visual analog scale (0-100) pain score was 38.0 [24.7] and 25.4% had hipand 74.6% knee OA. Low lean mass and ALM/BMI were associated with impaired QoL and WOMAC scores on bivariate analysis (all p ≤ 0.001) but not on multivariate analysis after adjustment for FMI. For patients with normal BMI, mean [SD] WOMAC scores were higher (greater impairment) with low lean mass than normal body composition (WOMAC function 33.4 [23.3] and 24.0 [17.4], p = 0.02), and mean SF-36 physical component score was lower (greater impairment) 40.3 [10.2] and (44.3 [8.4], p = 0.04). Among patients with obesity, low lean mass had no additional effect.
CONCLUSION:

For patients with OA and normal BMI, QoL and function were more impaired for those with than without low lean mass. Conserving muscle mass in people with OA could have functional and antalgic benefits especially for those with normal BMI.

Copyright © 2017 Elsevier Inc. All rights reserved.

KEYWORDS:

Body composition; Dual X-ray absorptiometry; Knee osteoarthritis; Low lean mass

Resumen

OBJETIVO:

Analizar las asociaciones entre la composición corporal, notablemente la baja masa magra y los síntomas clínicos [dolor, función física, calidad de vida (CdV)] en pacientes con OA de cadera y / o rodilla sintomática.

MÉTODOS:

Estudio transversal con datos de la visita de seguimiento de 3 años de la cohorte de evaluación de la rodilla y la osteoartritis de la cadera a largo plazo (KHOALA). El músculo esquelético y la masa de grasa se midieron mediante absorciometría doble de rayos X (DXA). El índice de masa grasa (FMI) se definió como la masa grasa total / altura2. La masa magra apendicular se ajustó en el índice de masa corporal (ALM / IMC), y la baja masa magra se definió de acuerdo con la definición de las recomendaciones del Proyecto de Sarcopenia FNIH. El dolor y la función se midieron mediante el índice WOMAC y la CdV por el SF-36.

RESULTADOS:

En total, 358 pacientes se sometieron a DXA (67% mujeres, media [DE] edad 63,4 [8,4] años, IMC medio 29,5 [5,6] kg / m2). La escala de la escala analógica visual (0-100) fue de 38.0 [24.7] y el 25.4% tenía cadera y el 74.6% de rodilla OA. La baja masa magra y la ALM / IMC se asociaron con puntuaciones de QoL y WOMAC dañadas en el análisis bivariado (todos p ≤ 0.001) pero no en el análisis multivariado después del ajuste para FMI. Para pacientes con IMC normal, las puntuaciones medias [SD] WOMAC fueron más altas (mayor deterioro) con baja masa magra que la composición corporal normal (función WOMAC 33.4 [23.3] y 24.0 [17.4], p = 0.02) y media SF-36 física el puntaje del componente fue menor (mayor deterioro) 40.3 [10.2] y (44.3 [8.4], p = 0.04). Entre los pacientes con obesidad, la baja masa magra no tuvo ningún efecto adicional.

CONCLUSIÓN:

Para los pacientes con OA y el IMC normal, la CdV y la función fueron más perjudicadas para los que tenían una masa magra baja. La conservación de la masa muscular en personas con OA podría tener beneficios funcionales y antálgicos especialmente para aquellos con un IMC normal.

Copyright © 2017 Elsevier Inc. Todos los derechos reservados.

PALABRAS CLAVE:

Composición corporal; Absorciometría dual de rayos X, Osteoartritis de rodilla; Baja masa magra
PMID: 29224976 DOI: 10.1016/j.semarthrit.2017.10.012

Cuidado respiratorio perioperatorio del obeso / Perioperative respiratory care of obesity

Diciembre 18, 2017. No. 2936

Manejo respiratorio perioperatorio de los pacientes obesos

Respiratory Management of Perioperative Obese Patients.

Imber DA1,2, Pirrone M1,3, Zhang C1,4, Fisher DF5, Kacmarek RM6, Berra L7,8.

Respir Care. 2016 Dec;61(12):1681-1692. Epub 2016 Sep 13.

Abstract

With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia.

KEYWORDS: PEEP; atelectasis; mechanical ventilation; noninvasive ventilation; obesity; recruitment maneuver

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