Neurotoxicidad y anestesia / Anesthesia neurotoxicity

Enero 11, 2018. No. 2960

Neurotoxicidad anestésica en pacientes pediátricos Anesthetic Neurotoxicity in Pediatric Patients Ayse B. Ozer and Sibel Ozcan Current Topics in Anesthesiology book edited by Riza Hakan Erbay, ISBN 978-953-51-2918-9, Print ISBN 978-953-51-2917-2, Published: February 8, 2017 under CC BY 3.0 license. © The Author(s). http://dx.doi.org/10.5772/65921 Abstract In recent years, an increasing number of publications have shown the negative effects of anesthetics on the developing brain and have made inquiries about anesthesia for pediatric patients in practice. Anesthesia is applied to millions of children for surgery, imaging, and other invasive procedures; the issue is very serious and concerns. In this chapter, experimental and clinical studies about the issue have been summarized. As a result, anesthetic drugs except alpha-2 adrenergic agonist anesthetic (NMDA antagonist or a GABA agonist) used in pediatric patients (especially if there is no painful situation) have potential neurotoxicity. Particularly, if anesthesia exposure was applied in the fragile period (the first 4 years) and if used at higher concentrations or repeated anesthesia application, adverse effects of anesthesia exposure on the developing brain have been claimed. But, the issue is not fully clarified yet. Keywords: anesthesia, neurotoxicity, neonatal, developing brain PDF Un mecanismo celular reversible por presión de anestésicos generales capaz de alterar un posible mecanismo para la conciencia A pressure-reversible cellular mechanism of general anesthetics capable of altering a possible mechanism for consciousness Kunjumon I. Vadakkan Springerplus. 2015; 4: 485. Published online 2015 Sep 7. doi: 10.1186/s40064-015-1283-1 ASbstract Different anesthetics are known to modulate different types of membrane-bound receptors. Their common mechanism of action is expected to alter the mechanism for consciousness. Consciousness is hypothesized as the integral of all the units of internal sensations induced by reactivation of inter-postsynaptic membrane functional LINKs during mechanisms that lead to oscillating potentials. The thermodynamics of the spontaneous lateral curvature of lipid membranes induced by lipophilic anesthetics can lead to the formation of non-specific inter-postsynaptic membrane functional LINKs by different mechanisms. These include direct membrane contact by excluding the inter-membrane hydrophilic region and readily reversible partial membrane hemifusion. The constant reorganization of the lipid membranes at the lateral edges of the postsynaptic terminals (dendritic spines) resulting from AMPA receptor-subunit vesicle exocytosis and endocytosis can favor the effect of anesthetic molecules on lipid membranes at this location. Induction of a large number of non-specific LINKs can alter the conformation of the integral of the units of internal sensations that maintain consciousness. Anesthetic requirement is reduced in the presence of dopamine that causes enlargement of dendritic spines. Externally applied pressure can transduce from the middle ear through the perilymph, cerebrospinal fluid, and the recently discovered glymphatic pathway to the extracellular matrix space, and finally to the paravenular space. The pressure gradient reduce solubility and displace anesthetic molecules from the membranes into the paravenular space, explaining the pressure reversal of anesthesia. Changes in membrane composition and the conversion of membrane hemifusion to fusion due to defects in the checkpoint mechanisms can lead to cytoplasmic content mixing between neurons and cause neurodegenerative changes. The common mechanism of anesthetics presented here can operate along with the known specific actions of different anesthetics. Keywords: Consciousness, General anesthetics, Pressure reversal, Semblance hypothesis, Inter-membrane contact, Membrane hemifusion, Partial hemifusion, Complete hemifusion, Membrane fusion, Neurodegeneration PDF Una espada de doble filo: efectos anestésicos volátiles en el cerebro neonatal A Double-Edged Sword: Volatile Anesthetic Effects on the Neonatal Brain Sunny Chiao, Zhiyi Zuo Brain Sci. 2014 Jun; 4(2): 273-294. Published online 2014 Apr 16. doi: 10.3390/brainsci4020273 Abstract The use of volatile anesthetics, a group of general anesthetics, is an exceedingly common practice. These anesthetics may have neuroprotective effects. Over the last decade, anesthetic induced neurotoxicity in pediatric populations has gained a certain notoriety based on pre-clinical cell and animal studies demonstrating that general anesthetics may induce neurotoxicity, including neuroapoptosis, neurodegeneration, and long-term neurocognitive and behavioral deficits. With hundreds of millions of people having surgery under general anesthesia worldwide, and roughly six million children annually in the U.S. alone, the importance of clearly defining toxic or protective effects of general anesthetics cannot be overstated. Yet, with our expanding body of knowledge, we have come to learn that perhaps not all volatile anesthetics have the same pharmacological profiles; certain ones may have a more favorable neurotoxic profile and may actually exhibit neuroprotection in specific populations and situations. Thus far, very few clinical studies exist, and have not yet been convincing enough to alter our practice. This review will provide an update on current data regarding volatile anesthetic induced neurotoxicity and neuroprotection in neonatal and infant populations. In addition, this paper will discuss ongoing studies and the trajectory of further research over the coming years. Keywords: anesthesia, anesthetics, neuroprotection, neurotoxicity, pediatrics, volatile anesthetics, preconditioning, postconditioning, ischemic conditioning PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

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

5°Maratón del hombro y codo doloroso. Mi hombro y codo ¡Basta de sentir dolor!

www.mihombroycodo.com.mx/academia/mi-hombro-y-codo-basta-de-sentir-dolor/

¡Basta de sentir dolor!

Este 27 y 28 de enero del 2018, tendrás a un grupo de expertos en Traumatología y Ortopedia, entre ellos a un servidor, totalmente dispuestos a ayudarte para sanar tu hombro o codo doloroso en el Hospital de Especialidades Catalina, ubicado en la calle Pablo Valdez 719, Col. San Juan de Dios.

¿En qué consiste el Maratón del Hombro y Codo Doloroso?

Se trata de un fin de semana completo en el que los especialistas te ayudarán a diagnosticar con exactitud la causa de tu dolor. El paquete de diagnóstico consiste en:
Una radiografía
Un ultrasonido
Consulta especializada con doctor ortopedista
¿Tiene costo?

El paquete completo estará al precio especial de $1,350.00 MXN

¿Cómo puedes obtenerlo?

Llama y haz tu cita con el Dr. Carlos Cortés al tel. +52 (33) 1204 0143 o directamente al Hospital de Especialidades Catalina al +52 (33) 3883 1080.

¡Apunta la fecha!

27 y 28 de enero del 2018

Shock

Enero 7, 2018. No. 2956

El sangriento desastre de la transfusión de glóbulos rojos. The bloody mess of red blood cell transfusion. Chandra S1, Kulkarni H2, Westphal M3,4. Author information Crit Care. 2017 Dec 28;21(Suppl 3):310. doi: 10.1186/s13054-017-1912-x. Abstract Red blood cell (RBC) transfusion might be life-saving in settings with acute blood loss, especially uncontrolled haemorrhagic shock. However, there appears to be a catch-22 situation reflected by the facts that preoperative anaemia represents an independent risk factor for postoperative morbidity and mortality, and that RBC transfusion might also contribute to adverse clinical outcomes. This dilemma is further complicated by the difficulty to define the "best" transfusion trigger and strategy. Since one size does obviously not fit all, a personalised approach is merited. Attempts should thus be made to critically reflect on the pros and cons of RBC transfusion in each individual patient. Patient blood management concepts including preoperative, intraoperative and postoperative optimisation strategies involving the intensive care unit are warranted and are likely to provide benefits for the patients and the healthcare system. In this context, it is important to consider that "simply" increasing the haemoglobin content, and in proportion oxygen delivery, may not necessarily contribute to a better outcome but potentially the contrary in the long term. The difficulty lies in identification of the patients who might eventually profit from RBC transfusion and to determine in whom a transfusion might be withheld without inducing harm. More robust clinical data providing long-term outcome data are needed to better understand in which patients RBC transfusion might be life-saving vs life-limiting. PDF Una revisión sistemática de las estrategias neuroprotectoras durante la hipovolemia y el shock hemorrágico. A Systematic Review of Neuroprotective Strategies during Hypovolemia and Hemorrhagic Shock. Nistor M1, Behringer W2, Schmidt M3, Schiffner R4,5. Author information Int J Mol Sci. 2017 Oct 26;18(11). pii: E2247. doi: 10.3390/ijms18112247. Abstract Severe trauma constitutes a major cause of death and disability, especially in younger patients. The cerebral autoregulatory capacity only protects the brain to a certain extent in states of hypovolemia; thereafter, neurological deficits and apoptosis occurs. We therefore set out to investigate neuroprotective strategies during haemorrhagic shock. This review was performed in accordance to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Before the start of the search, a review protocol was entered into the PROSPERO database. A systematic literature search of Pubmed, Web of Science and CENTRAL was performed in August 2017. Results were screened and evaluated by two researchers based on a previously prepared inclusion protocol. Risk of bias was determined by use of SYRCLE's risk of bias tool. The retrieved results were qualitatively analysed. Of 9093 results, 119 were assessed in full-text form, 16 of them ultimately adhered to the inclusion criteria and were qualitatively analyzed. We identified three subsets of results: (1) hypothermia; (2) fluid therapy and/or vasopressors; and (3) other neuroprotective strategies (piracetam, NHE1-inhibition, aprotinin, human mesenchymal stem cells, remote ischemic preconditioning and sevoflurane). Overall, risk of bias according to SYRCLE's tool was medium; generally, animal experimental models require more rigorous adherence to the reporting of bias-free study design (randomization, etc.). While the individual study results are promising, the retrieved neuroprotective strategies have to be evaluated within the current scientific context-by doing so, it becomes clear that specific promising neuroprotective strategies during states of haemorrhagic shock remain sparse. This important topic therefore requires more in-depth research. KEYWORDS: bleeding; brain damage; haemorrhage; hypovolemia; neuroprotection; neuroprotective strategies; resuscitation; shock PDF Shock hemorrágico Shock, Hemorrhagic. Authors Hooper N1, Armstrong TJ2. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017-. 2017 Nov 27. Author information Excerpt Shock refers to the inadequate perfusion of tissues due to the imbalance between oxygen demand of tissues and the body's ability to supply it. Classically, there are four categories of shock: hypovolemic, cardiogenic, obstructive, and distributive shock. Hypovolemic shock occurs when there is decreased intravascular volume to the point of cardiovascular compromise. The hypovolemic shock could be due to severe dehydration through a variety of mechanisms or from blood loss. The pathophysiology, diagnosis, and treatment of hemorrhagic shock, a subset of hypovolemic shock, will be explored in this article. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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

Diabetes y embarazo / Diabetes and pregnancy

Enero 8, 2018. No. 2957

Manejo de la diabetes en el embarazo: Estándares del cuidado médico en diabetes : 2018 Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes: 2018 Diabetes Care 2018;41(Suppl. 1):S137-S143 | https://doi.org/10.2337/dc18-S013 The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. PDF Diabetes y embarazo: Manejo de la diabetes y sus complicaciones desde la preconcepción al periodo postnatal Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. Editors National Collaborating Centre for Women's and Children's Health (UK). Source London: National Institute for Health and Care Excellence (UK); 2015 Feb. National Institute for Health and Care Excellence: Clinical Guidelines . Excerpt Clinical guidelines have been defined as 'systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions'. This clinical guideline concerns the management of diabetes and its complications from preconception to the postnatal period. It has been developed with the aim of providing guidance on: preconception information; diagnosis and management of gestational diabetes; glycaemic control in the preconception, antenatal and intrapartum periods; changes to medications for diabetes and its complications before or during pregnancy; management of diabetic emergencies (for example, hypoglycaemia and ketoacidosis) and diabetic complications (such as retinopathy) during pregnancy; the timetable of antenatal appointments to be offered to women with diabetes; timing and mode of birth (including induction of labour, caesarean section, analgesia and anaesthesia, and the use of steroids for fetal lung maturation); initial care of the newborn baby; management of diabetes and its complications during the postnatal period. PDF Diabetes mellitus y el anestesiólogo, cuidados perioperatorios Elsa Elisa Jiménez Morales, Rogelio Sánchez García Revista de Investigación Médica Sur, México Vol. 15, núm. 1, Enero-Marzo 2008 Resumen La diabetes mellitus es uno de los padecimientos con mayor prevalencia, por lo que los médicos involucrados en su manejo antes, durante y después de un acto quirúrgico, deben conocer su terapéutica. Los criterios actuales de diagnóstico para diabetes son: síntomas de diabetes (poliuria, polidipsia, y pérdida de peso inexplicable) más el resultado de una muestra aleatoria mayor o igual a 200 mg/dL de glucosa, glucosa en ayuno (> 8 horas) de 126 mg/dL o mayor. Glucosa mayor o igual a 200 mg/dL 2 horas después de la administración oral de 75 g de glucosa. Los protocolos de manejo perioperatorio de pacientes diabéticos aceptados actualmente son tres y se conocen como; régimen clásico amplio, régimen estricto tipo I y escala móvil. Palabras clave: alabras clave: Diabetes mellitus, cuidados perioperatorios, anestesiología. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

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

Estudio observacional longitudinal de la artroplastia total reversa de hombro para la disfunción irreparable del manguito de los rotadores: resultados después de 15 años

http://www.lesionesdeportivas.com.mx/academia/estudio-observacional-longitudinal-de-la-artroplastia-total-reversa-de-hombro-para-la-disfuncion-irreparable-del-manguito-de-los-rotadores-resultados-despues-de-15-anos/

Longitudinal observational study of reverse total shoulderarthroplasty for irreparable rotator cuff dysfunction: results after 15 years


Fuente


Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29305102
http://www.jshoulderelbow.org/article/S1058-2746(17)30697-3/fulltext

De:
Gerber C1, Canonica S1, Catanzaro S1, Ernstbrunner L2.
J Shoulder Elbow Surg. 2018 Jan 3. pii: S1058-2746(17)30697-3. doi: 10.1016/j.jse.2017.10.037. [Epub ahead of print]


Todos los derechos reservados para:




Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.









Abstract

HYPOTHESIS:


This study investigated the hypothesis that functional outcome remains significantly improved over the preoperative state beyond 15 years of reverse total shoulder arthroplasty (RTSA) for irreparable rotator cuff dysfunction.




CONCLUSIONS:


This early series of RTSA shows a substantial complication and failure rate. If, however, complications can be treated without removal of the implants, outcome is not compromised. Overall shoulder function and subjective outcome remained significantly improved and highly satisfactory during the entire study period.


KEYWORDS:


Reverse total shoulder arthroplasty; cuff tear arthropathy; irreparable rotator cuff tear; long-term; pseudoparalysis; shoulder dysfunction








Resumen




HIPÓTESIS:


Este estudio investigó la hipótesis de que el resultado funcional sigue mejorando significativamente con respecto al estado preoperatorio más allá de los 15 años de artroplastia total reversa de hombro (RTSA) para la disfunción irreparable del manguito rotador.



CONCLUSIONES:


Esta serie temprana de RTSA muestra una complicación sustancial y una tasa de fracaso. Sin embargo, si las complicaciones se pueden tratar sin quitar los implantes, el resultado no se verá comprometido. La función general del hombro y el resultado subjetivo se mantuvieron significativamente mejorados y altamente satisfactorios durante todo el período de estudio.



PALABRAS CLAVE:


Artroplastia total reversa de hombro; artropatía por desgarro del manguito; rotura irreparable del manguito rotador; a largo plazo; pseudoparalisis; disfunción del hombro






Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
PMID: 29305102 DOI: 10.1016/j.jse.2017.10.037

Resultados de la artroplastia reversa de hombro en pacientes de estatura pequeña y grande

http://www.lesionesdeportivas.com.mx/academia/resultados-de-la-artroplastia-reversa-de-hombro-en-pacientes-de-estatura-pequena-y-grande/

Outcomes of reverse shoulder arthroplasty in small- and large-stature patients

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29292034

http://www.jshoulderelbow.org/article/S1058-2746(17)30757-7/fulltext

De:

Matsuki K1, King JJ2, Wright TW2, Schoch BS3.

J Shoulder Elbow Surg. 2017 Dec 29. pii: S1058-2746(17)30757-7. doi: 10.1016/j.jse.2017.11.011. [Epub ahead of print]

Todos los derechos reservados para:

Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Abstract

BACKGROUND:

As the worldwide use of reverse shoulder arthroplasty (RSA) increases, a range of implant sizes may be required to match regional and ethnic variation in patients’ stature. Size-mismatched implants may possibly result in poorer surgical outcomes. The purpose of this study was to compare the outcomes of primary RSA in patients at the extreme ends of the growth curve with those in average-stature patients in the United States.

METHODS:

A multicenter shoulder arthroplasty database was retrospectively reviewed to identify all primary RSAs using a single implant system with a minimum 2-year follow-up. Small patients were defined as the height of <155 cm, tall as >183 cm, and average as 162-178 cm. Active range of motion (ROM), visual analog scale pain score, and patient-reported outcomes (PROs) were compared among the 3 groups.

RESULTS:

The study included 552 shoulders (130 small, 384 average, and 38 tall stature). Preoperatively, the average height group had significantly less ROM than the other groups, but there were no significant differences in postoperative ROM. This resulted in poorer improvements in postoperative ROM in the small and tall groups, with the small-stature patients having significantly less ROM improvement compared with average-stature patients. However, these differences did not result in poorer PROs between groups.

DISCUSSION:

Small- and large-stature patients showed inferior improvements in ROM after RSA compared with average-stature patients. Our results suggest that current implants optimize ROM gains for average-stature patients and improve PROs independently of patient stature at a minimum 2-year follow-up.

Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

KEYWORDS:

Reverse shoulder arthroplasty; complications; implant size; outcomes; scapular notching; stature

Resumen

ANTECEDENTES:

A medida que aumenta el uso de la artroplastia reversa de hombro (RSA) en todo el mundo, es posible que se necesite una variedad de tamaños de implantes para que coincida con la variación regional y étnica en la estatura de los pacientes. Los implantes que no coinciden con el tamaño pueden dar como resultado resultados quirúrgicos más pobres. El propósito de este estudio fue comparar los resultados de RSA primaria en pacientes en los extremos de la curva de crecimiento con aquellos en pacientes de estatura promedio en los Estados Unidos.

MÉTODOS:

Se revisó retrospectivamente una base de datos de artroplastia de hombro multicéntrica para identificar todos los RSA primarios utilizando un solo sistema de implante con un mínimo de 2 años de seguimiento. Los pacientes pequeños se definieron como la altura de <155 cm, altura> 183 cm y una media de 162-178 cm. Se comparó el rango de movimiento activo (ROM), el puntaje de dolor visual en escala analógica y los resultados informados por el paciente (PRO) entre los 3 grupos.

RESULTADOS:

El estudio incluyó 552 hombros (130 pequeños, 384 de promedio y 38 de estatura alta). Preoperatoriamente, el grupo de estatura promedio tuvo significativamente menos ROM que los otros grupos, pero no hubo diferencias significativas en el ROM postoperatorio. Esto dio como resultado mejoras más pobres en el ROM postoperatorio en los grupos pequeños y altos, con los pacientes de estatura pequeña que tenían una mejora de ROM significativamente menor en comparación con los pacientes de estatura media. Sin embargo, estas diferencias no dieron como resultado PRO más pobres entre los grupos.

DISCUSIÓN:

Los pacientes de estatura pequeña y grande mostraron una mejoría inferior en la ROM después del RSA en comparación con los pacientes de estatura media. Nuestros resultados sugieren que los implantes actuales optimizan las ganancias de ROM para pacientes de estatura media y mejoran las PRO independientemente de la estatura del paciente con un mínimo de 2 años de seguimiento.

PALABRAS CLAVE:
Artroplastia reversa de hombro ; complicaciones; tamaño del implante; resultados; muescas escapulares; estatura

Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

PMID:  29292034  DOI:  10.1016/j.jse.2017.11.011

Inestabilidad de la columna cervical, radiografía de la flexión extensión

http://www.columnavertebralpediatricaygeriatrica.com.mx/academia/inestabilidad-de-la-columna-cervical-radiografia-de-la-flexion-extension/

Cervical Spine Instability, Flexion Extension X-rays

Fuente

Este artículo y/o video es originalmente publicado en:

https://medium.com/@Dr_nabil_ebraheim/cervical-spine-instability-flexion-extension-x-rays-b3a408d23b7e

https://youtu.be/HzGyMpSzosU

De y todos los derechos reservados para:

Nabil Ebraheim

Dr. Ebraheim is the Chairman of Orthopaedics and the Director of the Orthopaedic Surgery Residency Program at the University of Toledo

nabil ebraheim

SUSCRIBIRSE 188 K

Dr. Ebraheim’s educational animated video describes flexion / extension xrays of the cervical spine.

Flexion/extension views detect subtle ligamentous injuries that are not apparent on routine neutral static views. It is done to avoid missing an unstable injury in the cervical spine. It is one of the many tactics that improve understanding of the extent and personality of the neck injury.

Comparte esto:

www.columnavertebralpediatricaygeriatrica.com.mx/academia/inestabilidad-de-la-columna-cervical-radiografia-de-la-flexion-extension/

www.columnavertebralpediatricaygeriatrica.com.mx