Anestesia regional para cirugía de tórax y brazos / Regional anesthesia for thoracic surgery and upper extremities

Febrero 21, 2018. No. 3001

Analgesia epidural torácica para procedimientos oncológicos de mama: una mejor alternativa a la anestesia general Thoracic epidural analgesia for breast oncological procedures: A better alternative to general anesthesia Ravi PR, Jaiswal P. J Mar Med Soc 2017;19:91-5 Abstract Objective: The objective of the study was to compare the outcomes of the incidence of nausea/vomiting and other complications along with the time taken for discharged in patients undergoing Thoracic Epidural Analgesia (TEA) and General Anaesthesia (GA) for breast oncological surgeries. Background: GA with or without TEA or other postoperative pain-relieving strategies remains the traditional anesthetic technique used for breast oncological procedures. We initiated the use of high segmental TEA for patients undergoing these procedures in our hospital. Methods: Eighty patients undergoing breast oncological procedures performed by one surgical team were randomly allocated into two groups receiving TEA and GA. The Chi-square test and Fisher's exact test were used for categorical parameters, paired t-test and Student's t-test was used for continuous measurements. Results: In comparison with GA, TEA was associated with lesser incidence of complications of nausea/vomiting. In lumpectomy with axillary node dissection, 1 out of 18 patients (5.55%) in the TEA group had nausea/vomiting, while 11 out of 19 (57.8%) of the GA group had similar symptoms (P < 0.001). The discharge rate for the thoracic epidural group was 12 out of 18 by day 3 (66.6%) while all patients in the GA group required more than 3 days of hospitalization (P< 0.001). Conclusion: Thoracic epidural anesthesia is a safe technique and its use in breast oncological procedures could improve patients' recovery and facilitate their early discharge to home. Keywords: Bupivacaine, general anesthesia, postoperative nausea and vomiting, regional anesthesia, ropivacaine PDF El bloqueo retrolaminar guiado por ultrasonido: distribución de inyecciones dependiente del volumen. The ultrasound-guided retrolaminar block: volume-dependent injectate distribution. Damjanovska M1, Stopar Pintaric T1,2, Cvetko E2, Vlassakov K3. Author information J Pain Res. 2018 Feb 7;11:293-299. doi: 10.2147/JPR.S153660. eCollection 2018. Abstract PURPOSE: The ultrasound-guided retrolaminar block is one of the newer and simpler alternatives to the traditional, often technically challenging, paravertebral (PV) block. Its feasibility, safety, and efficacy have already been clinically demonstrated in patients with multiple rib fractures using higher volumes of local anesthetic, when compared with the traditional approach. The primary aim of this observational anatomical study was to assess the spread of local anesthetic from the retrolaminar injection point to the PV space and its volume dependence. Second, we assessed the incidence of epidural and contralateral PV spread in the both groups. METHODS: Ten fresh porcine cadavers were randomized into 2 groups (n=5 each) to receive ultrasound-guided retrolaminar injections at Th4-Th5 level with either 10 mL (low-volume group) or 30 mL (high-volume group) of 2% lidocaine and methylene blue mixture. After the procedure, the cadavers were dissected and frozen. Cross-section cuts (~1 cm thick) were performed to evaluate the injectate spread. RESULTS: In the high-volume group, injectate spread from the retrolaminar to the PV space was observed in all specimens (5 out of 5; 100%), while in the low-volume group, no apparent spread to the PV space was found (0 out of 5; 0%). No epidural or contralateral PV spread was observed in any of the specimens. CONCLUSION: Following ultrasound-guided retrolaminar injections in fresh porcine cadavers, injectate spread from the retrolaminar tissue plane to the PV space is strongly volume dependent, suggesting that, clinically, high local anesthetic volumes maybe critical for achieving regional anesthesia and analgesia consistent with traditional PV blockade. KEYWORDS: injections; local anesthetic; paravertebral space; vertebral lamina PDF Bloqueo cervical epidural continuo. Tratamiento del hipo intratable Continuous cervical epidural block: Treatment for intractable hiccups. Kim JE1, Lee MK, Lee DK, Choi SS, Park JS. Author information Medicine (Baltimore). 2018 Feb;97(6):e9444. doi: 10.1097/MD.0000000000009444. Abstract Intractable hiccups, although rare, may result in severe morbidity, including sleep deprivation, poor food intake, respiratory muscle fatigue, aspiration pneumonia, and death. Despite these potentially fatal complications, the etiology of intractable hiccups and definitive treatment are unknown.......Continuous C3-C5 level cervical epidural block has a successful remission rate. We suggest that continuous cervical epidural block is an effective treatment for intractable hiccups. PDF Bloqueo cervical epidural para manejo de cirugía de trauma de miembro superior Dra. Leslian Janet Mejía-Gómez Rev Mex Anestesiol Volumen 36, Suplemento 1, abril-junio 2013 INTRODUCCIÓN Según la Organización Mundial de la Salud (OMS), los accidentes de tránsito producen diez millones de heridos y 300,000 muertes por año (1). En los países con mayor población de personas menores de 45 años los accidentes automovilísticos y laborales son la primera causa de cirugía por traumatismo de miembro superior (2). La proporción hombre:mujer es de 3 a 1(1,6). El manejo clínico y las decisiones anestésicas y terapéuticas dependen del tipo y de la gravedad de la fractura (3). Actualmente el trauma de miembro superior ocupa el tercer lugar dentro de los traumatismos en general, después que el trauma abdominal. Grant J (4), refi ere la incidencia del 78% de trauma en el miembro superior. El mecanismo de lesión más frecuente es directo y en segundo lugar por mecanismo indirecto secundario a tracción flexión (4,5). Las más afectadas son personas jóvenes en edad productiva, recibiendo los hombres, más lesiones que las mujeres en una proporción de 3:1.1(1,6). PDF Bloqueo cervicotorácico en cirugía de mama Videoclip 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

Conceptos actuales para alinear los implantes de rodilla: ¿específicos del paciente o sistemáticos?

http://www.artroscopiayreemplazos.com.mx/academia/conceptos-actuales-para-alinear-los-implantes-de-rodilla-especificos-del-paciente-o-sistematicos/

Current concepts for aligning knee implants: patient-specific or systematic?

Fuente

Este artículo es publicado originalmente en:

http://www.efortopenreviews.org/content/3/1/1

De:

Rivière, C., Lazic, S., Boughton, O., Wiart, Y., Vïllet, L., & Cobb, J. (2018). Current concepts for aligning knee implants: patient-specific or systematic?. EFORT Open Reviews, 3(1), 1-6. Accessed February 20, 2018. https://doi.org/10.1302/2058-5241.3.170021.

Todos los derechos reservados para:

http://creativecommons.org/licenses/by-nc/4.0/

Copyright © 2018 THE BRITISH EDITORIAL SOCIETY OF BONE & JOINT SURGERY and EFORT All Rights Reserved.

Abstract
Mechanical or anatomical alignment techniques create a supposedly ‘biomechanically friendly’ but often functionally limited prosthetic knee.

Alternative techniques for alignment in total knee arthroplasty (TKA) aim at being more anatomical and patient-specific, aiming to improve functional outcomes after TKA.

The kinematic alignment (KA) technique for TKA has shown good early clinical outcomes. Its role in extreme anatomical variation remains to be defined.

The restricted KA technique for TKA might be a reasonable option for patients with extreme anatomical variation.

While unicompartmental knee arthroplasty (UKA) has many advantages over TKA, the revision rate remains higher compared with TKA. One major explanation is the relative ease with which a UKA can be converted to a TKA, compared with revising a TKA. This can be considered as an additional advantage of UKA. Another reason is that surgeons favour revising a UKA to a TKA in cases of degeneration of the other femorotibial compartment rather than performing a relatively simple re-operation of the knee by doing an additional UKA (staged bi-UKA).

Cite this article: EFORT Open Rev 2018;3:1–6. DOI: 10.1302/2058-5241.3.170021

Key words

knee arthroplasty, kinematic alignment technique, mechanical alignment technique

Resumen

Las técnicas de alineación mecánica o anatómica crean una rodilla protésica supuestamente “amigable biomecánicamente” pero a menudo funcionalmente limitada.
Las técnicas alternativas para la alineación en la artroplastia total de rodilla (TKA) apuntan a ser más anatómicas y específicas del paciente, con el objetivo de mejorar los resultados funcionales después de la TKA.
La técnica de alineación cinemática (KA) para la TKA ha mostrado buenos resultados clínicos tempranos. Su papel en la variación anatómica extrema aún no se ha definido.
La técnica de KA restringida para TKA podría ser una opción razonable para pacientes con una variación anatómica extrema.
Si bien la artroplastia unicompartimental de rodilla (UKA) tiene muchas ventajas sobre la TKA, la tasa de revisión sigue siendo más alta en comparación con la TKA. Una explicación importante es la relativa facilidad con la que una UKA se puede convertir en una TKA, en comparación con la revisión de una TKA. Esto se puede considerar como una ventaja adicional de UKA. Otra razón es que los cirujanos están a favor de revisar una UKA a una TKA en casos de degeneración del otro compartimiento femorotibial en lugar de realizar una operación relativamente simple de la rodilla haciendo una UKA adicional (en escena bi-UKA).
Cita este artículo: EFORT Open Rev 2018; 3: 1-6. DOI: 10.1302 / 2058-5241.3.170021

Palabras clave

artroplastia de rodilla, técnica de alineación cinemática, técnica de alineación mecánica

Retorno al trabajo después de la artroplastia total anatómica del hombro para pacientes de 55 años o menos a un promedio de seguimiento de 5 años.

http://www.mihombroycodo.com.mx/academia/retorno-al-trabajo-despues-de-la-artroplastia-total-anatomica-del-hombro-para-pacientes-de-55-anos-o-menos-a-un-promedio-de-seguimiento-de-5-anos/

Return to Work After Anatomic Total Shoulder Arthroplasty for Patients 55 Years and Younger at Average 5-Year Follow-up.

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29451941

https://www.healio.com/orthopedics/journals/ortho/%7Bd2e50a59-cade-4718-a067-cedeb3892b9e%7D/return-to-work-after-anatomic-total-shoulder-arthroplasty-for-patients-55-years-and-younger-at-average-5-year-follow-up

De:

Liu JN, Garcia GH, Wong AC, Sinatro A, Wu HH, Dines DM, Warren RF, Gulotta LV.

Orthopedics. 2018 Feb 16:1-6. doi: 10.3928/01477447-20180213-08. [Epub ahead of print]

Todos los derechos reservados para:

Copyright 2018, SLACK Incorporated

Abstract

As the number of anatomic total shoulder arthroplasties performed on younger patients continues to grow, return to work after surgery becomes increasingly important. The purpose of this study was to evaluate the ability of anatomic total shoulder arthroplasty to return patients 55 years or younger to work postoperatively. A retrospective review was performed of consecutive anatomic total shoulderarthroplasty patients. Inclusion criteria were age 55 years or younger at surgery, greater than 2 years of follow-up, and employment within 3 years of surgery. Employment was stratified by intensity of work (sedentary, light, moderate, or heavy). Return to work status and time out of work were also evaluated. Fifty-two patients worked before surgery. Average age was 48.4 years, with average follow-up of 5.4 years. Seventy-three percent were male, and average body mass index was 28.0 kg/m2. Average visual analog scale score improved from 5.5 to 0.9 (P<.0001) and American Shoulder and Elbow Society score improved from 39.9 to 88.3 (P<.0001). Forty-eight (92%) of 52 returned to work postoperatively after an average of 2.1 months. When stratified by intensity, all patients with sedentary, light, or moderate work returned, whereas 64% returned to heavy work (P<.01). Eighty-seven percent were satisfied to very satisfied after surgery. In summary, most patients (92%) who undergo anatomic total shoulder arthroplasty at 55 years or younger return to work, on average, 2.1 months after surgery.

Resumen:

A medida que el número de artroplastias totales anatómicas del hombro realizadas en pacientes más jóvenes continúa creciendo, el regreso al trabajo después de la cirugía se vuelve cada vez más importante. El objetivo de este estudio fue evaluar la capacidad de la artroplastia total anatómica del hombro para devolver a los pacientes de 55 años o menos al trabajo postoperatorio. Se realizó una revisión retrospectiva de pacientes consecutivos anatomopatológicos totales con osteoplastia. Los criterios de inclusión fueron de 55 años o menos en la cirugía, más de 2 años de seguimiento y empleo dentro de los 3 años posteriores a la cirugía. El empleo fue estratificado por la intensidad del trabajo (sedentario, ligero, moderado o pesado). El estado de vuelta al trabajo y el tiempo fuera del trabajo también fueron evaluados. Cincuenta y dos pacientes trabajaron antes de la cirugía. La edad promedio fue de 48.4 años, con un seguimiento promedio de 5.4 años. Setenta y tres por ciento eran hombres, y el índice de masa corporal promedio fue de 28.0 kg / m2. El puntaje de escala analógica visual promedio mejoró de 5.5 a 0.9 (P <.0001) y el puntaje de la Sociedad Americana de Hombro y Codo mejoró de 39.9 a 88.3 (P <.0001). Cuarenta y ocho (92%) de 52 regresaron al trabajo después de la operación después de un promedio de 2.1 meses. Cuando se estratificó por intensidad, todos los pacientes con trabajo sedentario, liviano o moderado regresaron, mientras que el 64% regresaron al trabajo pesado (P <.01). Ochenta y siete por ciento estaban satisfechos o muy satisfechos después de la cirugía. En resumen, la mayoría de los pacientes (92%) que se someten a una artroplastia total anatómica del hombro a los 55 años o más vuelven al trabajo, en promedio, 2,1 meses después de la cirugía.

PMID:  29451941   DOI:   10.3928/01477447-20180213-08

La artrosis de hombro o daño al cartílago de la articulación

http://www.mihombroycodo.com.mx/academia/la-artrosis-de-hombro-o-dano-al-cartilago-de-la-articulacion/

La artrosis de hombro o daño al cartílago de la articulación generalmente se presenta después de los 50 años, pero cada vez hay más casos en personas menores de 40, debido a malas prácticas deportivas.

Si reconoces los síntomas, ingresa a hombroycodo.com.mx/citas para agendar tu consulta de valoración.

Manejo de defectos anatómicos del Tórax

Conferencia por el Dr.. José Refugio Mora Fol, Cirujano Pediatra con un gran historial, pionero del manejo de defectos anatómicos del Tórax. Describe que es un fenómeno frecuente en USA pero también en México. Afecta mucho la autoestima pero da origen a muchos problemas. restrictivos en órganos intra-torácicos, el mas importante en la función cardiaca. La edad ideal para abordarlos es la adolescencia o pre-adolescencia. El manejo quirúrgico es variado pero los mejores resultados se obtienen con la corrección utilizando las barras de Nuss, sin embargo no deja de tener complicaciones la mas común es el desplazamiento de las barras y lesiones cardiacas

Ciberpeds: http://bit.ly/2g6Teaj
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Combo sobre ketamina / Combo on ketamine

Febrero 16, 2018. No. 2996

Special K sin licencia para matar: sobredosis accidental de ketamina en la inducción de anestesia general. Special K with No License to Kill: Accidental Ketamine Overdose on Induction of General Anesthesia. Warner LL1, Smischney N1. Author information Am J Case Rep. 2018 Jan 3;19:10-12. Abstract BACKGROUND. Ketamine is used as an induction and sedation agent in emergency departments and operating rooms throughout the country. Despite its widespread clinical use, there are few cases of significant morbidity and mortality attributed to ketamine overdose in the clinical setting. CASE REPORT; The anesthesia provider in the room was an oral maxillofacial surgeon who inadvertently took out a more highly concentrated bottle of ketamine that is typically used for pediatric patients. The patient received 950 mg (100 mg/ml concentration) of intravenous ketamine instead of the intended 95 mg (10 mg/ml concentration). After the ketamine was given, there were no signs to any involved provider that a mistake had occurred until the wake-up appeared to be unusually prolonged. CONCLUSIONS; Despite this, the patient did not demonstrate any systemic effects such as hemodynamic or CNS perturbations other than prolonged awakening. This case highlights one (drug overdose) of many causes of delayed emergence from anesthesia and reminds the provider caring for the patient to be mindful of drug concentrations used when preparing to sedate a patient, as relying on effects of the parent drug is not always adequate. PDF Experiencia en el uso de ketamina para controlar la abstinencia de opiáceos en una mujer adicta: informe de un caso. Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman: a case report. Lalanne L1,2, Nicot C3, Lang JP3, Bertschy G3,4, Salvat E5,6. Author information BMC Psychiatry. 2016 Nov 10;16(1):395. Abstract BACKGROUND: Opioids are good painkillers, but many patients treated with opioids as painkillers developed a secondary addiction. These patients need to stop misusing opioids, but the mild-to-severe clinical symptoms associated with opioid withdrawal risk increasing their existing pain. In such cases, ketamine, which is used by anaesthetists and pain physicians to reduce opioid medication, may be an effective agent for managing opioid withdrawal. CASE PRESENTATION: We describe the case of a woman who developed a severe secondary addiction to opioids in the context of lombo-sciatic pain. She presented a severe opioid addiction, and her physicians refused to prescribe such high doses of opioid treatment (oxycontin® extended-release 120 mg daily, oxycodone 60 mg daily, and acetaminophen/codeine 300 mg/25 mg 6 times per day). To assist her with her opioid withdrawal which risked increasing her existing pain, she received 1 mg/kg ketamine oral solution, and two days after ketamine initiation her opioid treatment was gradually reduced. The patient dramatically reduced the dosage of opioid painkillers and ketamine was withdrawn without any withdrawal symptoms. CONCLUSION: Ketamine displays many interesting qualities for dealing with all symptoms relating to opioid withdrawal. Accordingly, it could be used instead of many psychotropic treatments, which interact with each other, to help with opioid withdrawal. However, the literature describes addiction to ketamine. All in all, although potentially addictive, ketamine could be a good candidate for the pharmacological management of opioid withdrawal. KEYWORDS: Ketamine; Opioid addiction; Opioid withdrawal; Painkillers PDF Tratamiento exitoso del prurito asociado al nevo epidérmico con ketamina-amitriptilina-lidocaína tópicas. Successful Treatment of Epidermal Nevus-associated Pruritus with Topical Ketamine-Amitriptyline-Lidocaine. Jaller JA1, Yosipovitch G. Acta Derm Venereol. 2018 Jan 12;98(1):121-122. doi: 10.2340/00015555-2811. Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare, linear, unilateral, pruritic eruption that usually presents during childhood. It is more commonly seen on an extremity, although cases on the head and neck area have been reported in the past (1). It is considered a variant of keratinocytic epidermal nevus; however, it has a significant histological similarity with psoriasis. Patients who have this condition usually complain of intense pruritus (2). Treatments that are regularly effective in psoriasis have shown low efficacy on the management of these lesions, as well as their related symptoms (3). We present here a case of successful treatment of pruritus associated with an epidermal nevus with the use of topical Ketamine 10% - Amitriptyline 5% - Lidocaine 5% in lipoderm base (TKAL). The preparation is widely used in the US for nociceptive pain and is prepared by a compounding pharmacy. All ingredients are FDA approved PDF Combinación de ketamina/bupivacaína tópica versus caudal para la analgesia postoperatoria en niños sometidos a herniotomía inguinal. Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy. Abdel-Ghaffar HS1, Moeen SM1, Moeen AM2. Author information Saudi J Anaesth. 2017 Jan-Mar;11(1):41-48. doi: 10.4103/1658-354X.197338. Abstract BACKGROUND: Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. PATIENTS AND METHODS: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topicalgroup). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative. RESULTS: Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P = 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6th till 48th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. CONCLUSION: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair. KEYWORDS: Analgesia; caudal; day-case anesthetic techniques; ketamine; pediatrics; postoperative; topical PDF Modulación de la Actividad del Receptor NMDA en la Fibromialgia. Modulation of NMDA Receptor Activity in Fibromyalgia. Littlejohn G1, Guymer E2. Author information Biomedicines. 2017 Apr 11;5(2). pii: E15. doi: 10.3390/biomedicines5020015. Abstract Activation of the N-methyl-d-aspartate receptor (NMDAR) results in increased sensitivity of spinal cord and brain pathways that process sensory information, particularly those which relate to pain. The NMDAR shows increased activity in fibromyalgia and hence modulation of the NMDAR is a target for therapeutic intervention. A literature review of interventions impacting on the NMDAR shows a number of drugs to be active on the NMDAR mechanism in fibromyalgia patients, with variable clinical effects. Low-dose intravenous ketamine and oral memantine both show clinically useful benefit in fibromyalgia. However, consideration of side-effects, logistics and cost need to be factored into management decisions regarding use of these drugs in this clinical setting. Overall benefits with current NMDAR antagonists appear modest and there is a need for better strategy trials to clarify optimal dose schedules and to delineate potential longer-term adverse events. Further investigation of the role of the NMDAR in fibromyalgia and the effect of other molecules that modulate this receptor appear important to enhance treatment targets in fibromyalgia. KEYWORDS: NMDA receptor; drugs; fibromyalgia; ketamine; memantine PDF La ketamina en el tratamiento del dolor crónico según medicina basada en la evidencia F. Neira Reina y J. L. Ortega García Rev Soc Esp Dolor 2016; 23(6): 292-306. Resumen: La ketamina es un antagonista no competitivo de los receptores NMDA y tiene un amplio mecanismo de acción que involucra, además, a los receptores AMPA, kainato, ácido gamma-aminobutírico, opioides, monoaminérgicos, muscarínicos y nicotínicos. Actúa sobre los canales de calcio y sodio voltaje-dependientes, interviene en la síntesis y liberación del óxido nítrico e inhibe la recaptación de serotonina. La interacción con todos estos mecanismos de acción hace que tenga una importante participación sobre mecanismos del dolor, inflamación, neuroprotección y tolerancia de opioides .... 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