Apnea obstructiva del sueño / OSA

Febrero 2, 2018. No. 2982

Apnea obstructiva del sueño y el paciente bariátrico OSA and the bariatric patient. De Silva S1. Author information Abstract J Perioper Pract. 2017 Jul;27(7-8):167-168. Mrs NH is a 49-year-old lady who presented for assessment prior to weight reduction surgery. KEYWORDS: Bariatric surgery; OSA; Obstructive sleep apnoea; Pre-assessment PDF Identificación de la apnea obstructiva del sueño significativa en el paciente obeso: desarrollo de la nueva puntuación "DX-AOS". Identification of significant obstructive sleep apnoea in the obese patient: development of the novel DX-OSA score. Godoroja DD1, Cioc DA2. Author information Rom J Anaesth Intensive Care. 2016 Oct;23(2):111-121. doi: 10.21454/rjaic.7518/232.dxo. Abstract BACKGROUND AND OBJECTIVES: There is a high prevalence of undiagnosed obstructive sleep apnoea (OSA) in obese surgical patients. We investigated the extent to which anthropometric measurements can be used to identify the presence of significant OSA (Apnoea/Hypopnoea Index (AHI) ≥ 20) in adult patients. MATERIALS AND METHODS: We prospectively studied 1357 adult patients scheduled for elective laparoscopic bariatric surgery. Prior to surgery, body mass index (BMI), gender, neck circumference, STOP-Bang score, SpO2, neck and trunk fat (by dual X-ray absorptiometry) were recorded. All patients with a STOP-Bang score ≥ 5 underwent polysomnography. Auto-titrated Positive Airway Pressure (APAP) therapy was instituted when AHI ≥ 20/h. Predictors of OSA were identified and their cut-off values determined. RESULTS: In total, 1357 patients were screened; 345 patients underwent preoperative polysomnography; 190 had AHI ≥ 20/h and received APAP treatment. The novel Dual X-Ray-Obstructive Sleep Apnoea (DX-OSA) score was derived from the data. The score included 6 items: the STOP-Bang score, BMI, neck fat, trunk fat, baseline SpO2, and Expiratory Reserve Volume (ERV), and its sensitivity, specificity, positive-predictive values, negative-predictive values, likelihood ratios, and post-test probabilities determined. At a cut-off of 3, the DX-OSA score had the same sensitivity as the STOP-bang score, but better specificity. The lowest likelihood ratio was found for STOP-Bang and the highest for the DX-OSA score (OSA probability > 83%). CONCLUSION: The DX-OSA score may be useful for identifying obese patients with significant OSA who require CPAP (continuous positive airway pressure) treatment, and CPAP could be commenced without the need for polysomnography, therefore, without delaying surgery. KEYWORDS: continuous positive airway pressure; obesity; obstructive sleep apnoea PDF La mejoría temprana en la apnea obstructiva del sueño y el aumento en los niveles de orexina después de la cirugía bariátrica en adolescentes y adultos jóvenes. Early improvement in obstructive sleep apnea and increase in orexin levels after bariatric surgery in adolescents and young adults. Amin R1, Simakajornboon N2, Szczesniak R3, Inge T4. Author information Surg Obes Relat Dis. 2017 Jan;13(1):95-100. doi: 10.1016/j.soard.2016.05.023. Epub 2016 May 30. Abstract BACKGROUND: Obstructive sleep apnea (OSA) associated with obesity is known to improve after bariatric surgery, but little is known about early changes in this condition after surgery. OBJECTIVES: To study the clinical course of OSA after bariatric surgery SETTING: Children's hospital in the United States METHODS: Adolescents and young adults with obstructive sleep apnea undergoing vertical sleeve gastrectomy (n = 6) or gastric bypass (n = 1) were enrolled in this prospective study. Participants underwent formal polysomnography before and at 3 and 5 weeks after bariatric surgery. Anthropometric measurements and assay for orexin and leptin were also performed at study visits. Thirty-one adolescents who underwent 2 polysomnography studies that were 4 weeks apart served as control patients. RESULTS: Baseline mean (range) age of participants was 17.8 (15.4-20.7) years, 71% were male, with body mass index of 55.2 (41.3-61.6) kg/m2 and had a median apnea hypopnea index (AHI) of 15.8 (7.1-23.8) events/hour. Differences in least-square means from longitudinal analysis did not show significant differences in AHI in the control group but showed significant postoperative decline in AHI relative to baseline. AHI declined postoperatively from baseline by 9.2 events/hour (95% confidence interval: 3.8 to 14.5) at 3 weeks (P = .002) and 9.1 events/hour (95% confidence interval: 3.8 to 14.5) at 5 weeks (P = .002); there was no significant change from 3 to 5 weeks in AHI. Leptin decreased and orexin levels increased significantly by 3 weeks postoperatively. CONCLUSIONS: These observations suggest that OSA responds early and out of proportion to weight loss after metabolic and or bariatric surgery, thus weight independent factors may at least in part be responsible for early improvement in OSA postoperatively. KEYWORDS: Leptin; Orexin; Polysomnography; Sleep apnea; Sleeve gastrectomy 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

Diagnóstico diferencial del dolor articular sacroiliaco

http://www.reemplazoprotesico.com.mx/academia/diagnostico-diferencial-del-dolor-articular-sacroiliaco/

Diagnóstico diferencial del dolor articular sacroiliaco 

Differential Diagnosis of SI Joint Pain

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https://nabilebraheim.wordpress.com/2018/02/02/differential-diagnosis-of-si-joint-pain/
https://youtu.be/5A1o5Q8hGkg



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Drogas psicodélicas / "Psychedelic drugs"

Febrero 1, 2018. No. 2981

Psiquiatría y las drogas psicodélicas. Pasado presente Futuro. Psychiatry & the psychedelic drugs. Past, present & future. Rucker JJH1, Iliff J2, Nutt DJ3. Author information Neuropharmacology. 2017 Dec 25. pii: S0028-3908(17)30638-X. doi: 10.1016/j.neuropharm.2017.12.040. [Epub ahead of print] Abstract The classical psychedelic drugs, including psilocybin, lysergic acid diethylamide and mescaline, were used extensively in psychiatry before they were placed in Schedule I of the UN Convention on Drugs in 1967. Experimentation and clinical trials undertaken prior to legal sanction suggest that they are not helpful for those with established psychotic disorders and should be avoided in those liable to develop them. However, those with so-called 'psychoneurotic' disorders sometimes benefited considerably from their tendency to 'loosen' otherwise fixed, maladaptive patterns of cognition and behaviour, particularly when given in a supportive, therapeutic setting. Pre-prohibition studies in this area were sub-optimal, although a recent systematic review in unipolar mood disorder and a meta-analysis in alcoholism have both suggested efficacy. The incidence of serious adverse events appears to be low. Since 2006, there have been several pilot trials and randomised controlled trials using psychedelics (mostly psilocybin) in various non-psychotic psychiatric disorders. These have provided encouraging results that provide initial evidence of safety and efficacy, however the regulatory and legal hurdles to licensing psychedelics as medicines are formidable. This paper summarises clinical trials using psychedelics pre and post prohibition, discusses the methodological challenges of performing good quality trials in this area and considers a strategic approach to the legal and regulatory barriers to licensing psychedelics as a treatment in mainstream psychiatry. KEYWORDS: Clinical trials; Psychedelics; Psychiatric disorders 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

Formulaciones de buprenorfina / Buprenorphine Formulations

Enero 30, 2018. No. 2979

Formulaciones de buprenorfina: recomendaciones de estrategias clínicas de mejores prácticas para el manejo perioperatorio de pacientes sometidos a procedimientos de dolor quirúrgico o intervencional. Buprenorphine Formulations: Clinical Best Practice Strategies Recommendations for Perioperative Management of Patients Undergoing Surgical or Interventional Pain Procedures. Jonan AB1, Kaye AD, Urman RD2. Author information Pain Physician. 2018 Jan;21(1):E1-E12. Abstract BACKGROUND: Starting with approval for clinical use in the treatment of opioid dependence in October 2002 by the Food and Drug Administration (FDA), buprenorphine has become an integral treatment option and in recent years, in chronic pain management. Buprenorphine possesses a unique pharmacodynamic and pharmacokinetic profile that can potentially make perioperative analgesiachallenging. OBJECTIVES: To date no unified guidelines or recommendations are available for buprenorphine product management during the perioperative period. The present investigation aims to review the literature and provide recommendations when encountering a patient on buprenorphine therapy who is scheduled for a surgical or interventional pain procedure. METHODS: Clinical studies and reviews were searched using the PubMed National Center for Biotechnology Information database using MeSH terms buprenorphine, buprenorphine and naloxone, suboxone, perioperative, and postoperative pain. RESULTS: PubMed National Center for Biotechnology Information database search resulted in one randomized control trial, one prospective case matched cohort, one retrospective cohort, 0 case series, 4 case reports, and 6 review articles. Key literature is reviewed and summarized. LIMITATIONS: Only 12 articles were included, which permits only limited recommendations drawn from this review. CONCLUSIONS: The perioperative management of buprenorphine and buprenorphine/naloxone are dependent on several key factors. The nature of the surgery, namely the postoperative opioid requirement, elective versus emergency surgery, patient characteristics, formulation of buprenorphine, and indication for buprenorphine or buprenorphine/naloxone therapy must be considered when devising a plan. Several options exist when formulating a plan for the perioperative management, including continuing buprenorphine therapy or holding buprenorphine therapy for a defined period of time with or without bridging to alternative opioids. Additionally, social support people and patient motivation should be addressed and optimized, as well as nonopioid adjuvant therapy should be maximized as applicable to each patient undergoing a surgical or interventional pain procedure. KEY WORDS: Buprenorphine, naloxone, surgery, pain management, anesthesia, suboxone, opioid abuse. 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

Ketamina en dolor por anemia falciforme / Ketamine and sickle cell disease pain

Enero 28, 2018. No. 2977 La evaluación del uso de ketamina para el control del dolor con la crisis de células falciformes en el embarazo: un informe de 2 casos. Evaluating the Use of Ketamine for Pain Control With Sickle Cell Crisis in Pregnancy: A Report of 2 Cases. Gimovsky AC, Fritton K, Viscusi E, Roman A. A A Pract. 2018 Jan 1;10(1):20-22. doi: 10.1213/XAA.0000000000000624. Abstract Sickle cell crises occur frequently during pregnancy and are difficult to treat, even with high-dose opioids. Analgesia with ketamine has been suggested as an alternative, but its use during pregnancy is underreported. Two pregnant patients with uncontrolled sickle cell pain were treated with ketamine. Patient A reported no decrease in her pain, but her opioid requirements decreased. Patient B's pain resolved during ketamine administration. No serious maternal or neonatal adverse effects occurred. Ketamine may be considered as an adjunct analgesic in pregnant patients with sickle cell pain, although prospective clinical data are needed to fully assess its efficacy. PDF El papel de un régimen de dosis bajas de ketamina-midazolam en el tratamiento de la crisis dolorosa severa en pacientes con enfermedad de células falciformes. The role of a low-dose ketamine-midazolam regimen in the management of severe painful crisisin patients with sickle cell disease. Tawfic QA1, Faris AS2, Kausalya R3. Author information J Pain Symptom Manage. 2014 Feb;47(2):334-40. doi: 10.1016/j.jpainsymman.2013.03.012. Epub 2013 Jul 12 Abstract CONTEXT: Acute pain is one of the main causes of hospital admission in sickle cell disease, with variable intensity and unpredictable onset and duration. OBJECTIVES: We studied the role of a low-dose intravenous (IV) ketamine-midazolam combination in the management of severe painful sickle cell crisis. METHODS: A retrospective analysis was performed with data from nine adult patients who were admitted to the intensive care unit with severe painful sickle cell crises not responding to high doses of IV morphine and other adjuvant analgesics. A ketamine-midazolam regimen was added to the ongoing opioids as an initial bolus of ketamine 0.25mg/kg, followed by infusion of 0.2-0.25mg/kg/h. A midazolam bolus of 1mg followed by infusion of 0.5-1mg/h was added to reduce ketamine emergence reactions. Reduction in morphine daily requirements and improvement in pain scores were the determinants of ketamine-midazolam effect. The t-tests were used for statistical analysis. RESULTS: Nine patients were assessed, with mean age of 27±11 years. Morphine requirement was significantly lower after adding the IV ketamine-midazolam regimen. The mean±SD IV morphine requirement (milligram/day) in the pre-ketamine day (D0) was 145.6±16.5, and it was 112±12.2 on Day 1 (D1) of ketamine treatment (P=0.007). The Numeric Rating Scale scores on D0 ranged from eight to ten (mean 9.1), but improved to range from five to seven (mean 5.7) on D1. There was a significant improvement in pain scores after adding ketamine-midazolam regimen (P=0.01). CONCLUSION: Low-dose ketamine-midazolam IV infusion might be effective in reducing pain and opioid requirements in patients with sicklecell disease with severe painful crisis. Further controlled studies are required to prove this effect. Sickle cell disease; ketamine; midazolam; pain management; painful crisis PDF Crisis drepanocítica y tratamiento del dolor A. Rojas-Martínez, E. Calderón, M.A. Vidal, F. Arroyo, R. García-Hernández y L.M. Torres Rev Soc Esp Dolor 2015; 22(4): 165-167 RESUMEN La drepanocitosis incluye un grupo de desórdenes genéticamente heredados en los que a baja saturación de oxígeno ocurre la agregación de polímeros rígidos de hemoglobina S desoxigenada, otorgando forma de hoz al hematíe y dañando el endotelio vascular por medio de múltiples mecanismos, obstruyendo concomitantemente la microcirculación y produciendo una estimulación de nociceptores. Los pacientes con drepanocitosis pueden presentar múltiples tipos de dolor dependiendo de las estructuras lesionadas, siendo el de tipo músculo-esquelético el más frecuente. La base del manejo del dolor es el reconocimiento y la evaluación de la severidad, ya que de esta dependerá la prescripción del tratamiento analgésico. Las crisis vasooclusivas son la manifestación más característica de esta enfermedad. Una vez instaurado el dolor, el manejo inicial debe enfocarse en proveer control rápido del mismo, garantizándose dosis terapéuticas de los fármacos, y en la detección de complicaciones. Debe evitarse el uso no indicado de las terapias y el tratamiento infraterapéutico, acompañado de un seguimiento cuidadoso, prevención y tratamiento de los efectos adversos. El tratamiento del dolor crónico se hace de forma multidisciplinaria, considerando estrategias no farmacológicas. Palabras clave: Drepanocitosis. Células falciformes. Crisis veno-oclusivas. Opioides. Dolor intenso. 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