Complicaciones en anestesia regional / Regional anesthesia complications

Febrero 28, 2018. No. 3008

La anestesia general epidural combinada se asoció con un menor riesgo de complicaciones postoperatorias en pacientes sometidos a cirugía abdominal abierta por feocromocitoma: un estudio de cohortes retrospectivo. Combined epidural-general anesthesia was associated with lower risk of postoperative complications in patients undergoing open abdominal surgery for pheochromocytoma: A retrospective cohort study. Li N1, Kong H1, Li SL1, Zhu SN2, Wang DX1. Author information PLoS One. 2018 Feb 21;13(2):e0192924. doi: 10.1371/journal.pone.0192924. eCollection 2018. Abstract BACKGROUND: Current evidences show that regional anesthesia is associated with decreased risk of complications after major surgery. However, the effects of combined regional-general anesthesia remain controversial. The purpose of our study was to analyze the impact of anesthesia (combined epidural-general anesthesia vs. general anesthesia) on the risk of postoperative complications in patients undergoing open surgery for pheochromocytoma. METHODS: This was a retrospective cohort study. 146 patients who underwent open surgery for pheochromocytoma (100 received combined epidural-general anesthesia and 46 received general anesthesia) in Peking University First Hospital from January 1, 2002 to December 31, 2015 were enrolled. The primary outcome was the occurrence of postoperative complications during hospital stay after surgery. Multivariate Logistic regression models were used to analyze the association between the choice of anesthetic method and the risk of postoperative complications. RESULTS: 17 (11.6%) patients developed complications during postoperative hospital stay. The incidence of postoperative complications was lower in patients with combined epidural-general anesthesia than in those with general anesthesia (6% [6/100] vs. 23.9% [11/46], P = 0.006). Multivariate Logistic regression analysis showed that use of combined epidural-general anesthesia (OR 0.219, 95% CI 0.065-0.741; P = 0.015) was associated with lower risk, whereas male gender (OR 5.213, 95% CI 1.283-21.177; P = 0.021) and perioperative blood transfusion (OR 25.879; 95% CI 3.130-213.961; P = 0.003) were associated with higher risk of postoperative complications. CONCLUSIONS: For patients undergoing open surgery for pheochromocytoma, use of combined epidural-general anesthesia may decrease the occurrence of postoperative complications. PDF Tratamiento con emulsiones lipídicas para el mioclono posterior a la anestesia espinal Lipid Emulsion Treatment for Post Spinal Anesthesia Myoclonus Nguyen TA, Phan DV, Dang TT, Joseph Eldor. J Health Sci Development 2018; 1:1 (19-24). Abstract Two case reports of myoclonus of legs post spinal anesthesia treated successfully by IV lipid emulsion are first described in the medical literature. A review of cases of myoclonus post regional anesthesia (spinal or epidural) are discussed with the hypothesis that the Lipid Emulsion effects are on the mitochondria and the intracellular calcium. Keywords: Myoclonus; Post spinal anesthesia myoclonus; Post epidural anesthesia myoclonus; Intralipid; Lipidem; Fat emulsion; Mitochondria; Intracellular calcium PDF Fallas y complicaciones en la Anestesia Regional Obstétrica Dr. Francisco J Cisneros-Rivas,* Dr. Israel Chávez-Ruiz* Rev Mex Anestiol Vol. 40. Supl. 1 Abril-Junio 2017 pp S150-S154 Introducción La anestesia neuroaxial es la técnica preferida en la paciente embarazada debido a que reduce o inhibe el dolor en las diferentes fases del trabajo de parto, el alumbramiento, así como en caso de requerirse en la cesárea, además de disminuir el uso de medicamentos que atraviesen la barrera placentaria que pudieran afectar al producto. Como cualquier otro procedimiento, la anestesia regional no se encuentra libre de fallas y complicaciones, debiendo tener en cuenta alternativas como la anestesia general y en caso de complicaciones saber cuáles son, con qué frecuencia se presentan, cuál es su sintomatología, saber cómo prevenirlas y en su caso cómo tratarlas, para evitar lesiones permanentes que puedan ser causa de una acción legal en contra de nosotros, independientemente de la seguridad y calidad que brindemos a nuestros pacientes. PDF Evaluación de la seguridad y eficacia de la anestesia regional en comparación con la anestesia general en el procedimiento de biopsia pulmonar toracoscópica en pacientes con fibrosis pulmonar idiopática. Evaluation of safety and efficacy of regional anesthesia compared with general anesthesia in thoracoscopic lung biopsy procedure on patient with idiopathic pulmonary fibrosis. Hajjar WM1, Al-Nassar SA1, Al-Sugair GS1, Al-Oqail A1, Al-Mansour S1, Al-Haweel R1, Hajjar AW2. Author information Saudi J Anaesth. 2018 Jan-Mar;12(1):46-51. doi: 10.4103/sja.SJA_265_17. Abstract BACKGROUND: Interstitial lung diseases are diseases that need histology diagnosis or obtaining a lung biopsy to establish the diagnosis. Surgical biopsies are performed usually using the thoracoscopy technique under general anesthesia (GA) although this procedure is still associated with morbidity rate. The aim of this study is to determine the effectiveness and safety of regional anesthesia (RA) compared with GA in thoracoscopic lung biopsy procedures done on patients with idiopathic pulmonary fibrosis (IPF). SUBJECTS AND METHODS: This is a retrospective qualitative study based on adult cases of video-assisted thoracoscopy (VAT) lung biopsy on patients with IPF admitted in the division of Thoracic Surgery, Department of General Surgery, King Khalid University Hospital, Riyadh, KSA. We included 67 patients with IPF, 26 with RA, and 41 with GA, who underwent this procedure from January 2008 to December 2015. Procedures performed under RA were done using three different approaches, intercostal nerve blocks, extrapleural infusion, and paravertebral block while GA was performed using double-lumen endotracheal tube placement. For statistical analysis, SPSS program, version 21.0. Software used to analyze the obtained data. The statistical significance was defined as P < 0.05. RESULTS: Sixty-seven patients underwent the procedure of thoracoscopic lung biopsy. Twenty-six of them (38.8%) underwent the procedure under RA and 41 (61.2%) under GA. The cross tabulation of the intercostal chest tube duration showed that it was significantly longer in GA group (6.23 ± 5.1 days) compared to RA group (3.12 ± 1.5 days), P = 0.004. Furthermore, for the Intensive Care Unit (ICU) stay, it was significantly longer in GA group (3.38 ± 2.1 days) compared to RA group (1.09 ± 0.7 days), P = 0.019. Regarding the relation between the number of biopsies taken and type of anesthesia performed, the probability values for GA group as well as RA group come out to be >0.05 (statistically independent) and the results of risk estimate also show that there was no significant association found between them. The cross tabulation of the representation of biopsies taken by the two methods showed that all biopsies taken under both settings were representative of the disease. Of 41 procedures done under GA, 16 of the total showed a number of complications. Likewise, of 26 procedures under RA, five cases showed complications. The significant (two-sided) value was (P = 0.110), there was no statistical significance between the risks of complications and the two types of anesthesia. CONCLUSION: There was a significant decrease in chest tube duration and ICU stay in RA group compared to the GA group. There was no statistical difference between both types of anesthesia in the number of biopsy, representation, and postoperative complications although the rate of these complications was much less in the RA group. Based on this outcome, we can conclude that VAT lung biopsy procedure on patients with IPF under RA is safe, representative, and effective operation. In addition, high-risk patients for GA can go through this procedure under RA as an alternative and safe option with no added complications. KEYWORDS: General anesthesia; idiopathic pulmonary fibrosis; regional anesthesia; thoracoscopic lung biopsy PDF Simposio Internacional de Emergencias Médicas y Paciente Crítico Santiago de Chile 31 de Mayo al 1 de Junio, 2018 Informes / Information 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

Cuidados paliativos / Palliative care

Marzo 1, 2018. No. 3009

Cuidado y cuidado domiciliario Caregiving and Home Care Edited by Mukadder Mollaoglu, ISBN 978-953-51-3779-5, Print ISBN 978-953-51-3778-8, 238 pages, Publisher: InTech, Chapters published February 14, 2018 under CC BY 3.0 license DOI: 10.5772/66261 Edited Volume The management of chronic diseases is one of the tasks of all members of the health team, and different models need to be applied in the practice of chronic care management. One of these models is home care services. There are two main sections in this book. In the first part of the section, the concept of caregiving and care at home is explained. In the second part, the responsibilities of caregivers at home and the responsibilities of caregivers of people who have health problems that occur during different periods of life are discussed. In the second section, the problems of caregivers are also included. I would like to think that what is quoted in this book, which contains examples from different cultures of the world for home care approaches, will contribute to the development of home care services. This book is presented to all health professionals working in the field of health services as well as health politics professionals and students trained in these areas. Libro / Book / Livre Cuidados paliativos en el hospital: ¿Deberíamos reconsiderar qué función deberían tener los hospitales en pacientes con enfermedad en etapa terminal o cáncer avanzado? In-Hospital Palliative Care: Should We Need to Reconsider What Role Hospitals Should Have in Patients with End-Stage Disease or Advanced Cancer? Cotogni P1, Saini A1, De Luca A1. Author information J Clin Med. 2018 Jan 30;7(2). pii: E18. doi: 10.3390/jcm7020018. Abstract Traditionally, palliative care (PC) systems focused on the needs of advanced cancer patients, but most patients needing PC have end-stage organ diseases. Similarly, PC models focus on the needs of patients in hospices or at home; however, in most cases PC is provided in acute hospitals. Indeed, the symptom burden that these patients experience in the last year of life frequently forces them to seek care in emergency departments. The majority of them are admitted to the hospital and many die. This issue poses important concerns. Despite the efforts of attending healthcare professionals, in-hospital patients do not receive optimal care near the end-of-life. Also, evidence is emerging that delay in identifying patients needing PC have a detrimental impact on their quality of life (QoL). Therefore, there is an urgent need to identify, early and properly, these patients among those hospitalized. Several trials reported the efficacy of PC in improving the QoL in these patients. Each hospital should ensure that a multidisciplinary PC team is available to support attending physicians to achieve the best QoL for both PC patients and their families. This review discusses the role and the impact of in-hospital PC in patients with end-stage disease or advanced cancer. KEYWORDS: acute palliative care unit; cost savings; end-of-life; palliative care team; quality of life; seriously ill patients; symptom relief PDF Traducción de un modelo de cuidados paliativos precoces de EE. UU. Para Turquía y Singapur. Translating a US Early Palliative Care Model for Turkey and Singapore. Akyar I1, Dionne-Odom JN2, Yang GM3, Bakitas MA2,4. Author information Asia Pac J Oncol Nurs. 2018 Jan-Mar;5(1):33-39. doi: 10.4103/apjon.apjon_73_17. Abstract The field of palliative care is growing in acceptance and sophistication globally. No longer considered just for patients at end-of-life, palliative care is now being incorporated early in the disease trajectory. Despite professional guidelines supporting early palliative care, there are few models that have been created that can be translated into practice cross-culturally. In the United States, the Educate, Nurture, Advise, Before, Life Ends (ENABLE) early palliative care telehealth model has demonstrated effectiveness in improving quality of life, mood, symptom relief, and survival for patients with cancer and is now being tested in patients with heart failure. Family caregivers of patients who have received ENABLE concurrent with their care recipients have also demonstrated positive outcomes in quality of life and caregiver burden. Internationally, a number of investigators are culturally adapting ENABLE for patients and family caregivers. While some elements of ENABLE, such as symptom management and self-care, and the caregiving role are relevant cross-culturally, others have been built on Western principles of self-determination or represent concepts such as advance care planning which will require more cultural adaptation. In addition, ENABLE was initially an in-person approach that was converted to telehealth to accommodate a rural population-it will be important to understand cultural norms related to receiving care by phone or if an in-person approach will be more culturally acceptable. This paper describes efforts in Turkey and Singapore to culturally adapt the ENABLE early palliative care principles for their countries. KEYWORDS: Advise; Before Life Ends; Educate; Nurture; oncology patients; palliative care PDF Hospicio y cuidados paliativos en China: desarrollo y desafíos. Hospice and Palliative Care in China: Development and Challenges. Lu Y1, Gu Y1, Yu W2. Author information Asia Pac J Oncol Nurs. 2018 Jan-Mar;5(1):26-32. doi: 10.4103/apjon.apjon_72_17. Abstract Hospice and palliative care have been demonstrated to improve quality of life, shorten hospital stays, and save costs. As a developing country, faced with a rapidly aging population and an increasing number of patients with life-threatening illnesses such as cancer, China has made great progress in promoting hospice and palliative care during the past few decades. A trained nurse can play a significant role in promoting quality hospice and palliative care by providing care, coordinating a multidisciplinary team, calling for policy support, and raising public awareness. It is critical for nurses to clearly understand the development and challenges that currently exist in the country. With this awareness, nurses will improve their ability to recognize and address patients' and families' needs, resulting in quality, dignified, and individualized end-of-life care. KEYWORDS: Challenge; China; development; hospice and palliative care; nurses 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

Dr Carlos Cortés - 6to maratón de hombro y codo

Médico Mediático

Publicado el 27 feb. 2018

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Poder en el tobillo y el mediopié durante la marcha y el ascenso en escalera en adultos sanos.

http://www.cirugiadepieytobillo.com.mx/academia/poder-en-el-tobillo-y-el-mediopie-durante-la-marcha-y-el-ascenso-en-escalera-en-adultos-sanos/

Ankle and Midfoot Power During Walking and Stair Ascent in Healthy Adults.

Fuente

Este artículo es publicado originalmente en:

https://www.ncbi.nlm.nih.gov/pubmed/29485306

https://journals.humankinetics.com/doi/10.1123/jab.2017-0095

De:

DiLiberto FE1, Nawoczenski DA2, Houck J3.

J Appl Biomech. 2018 Feb 27:1-28. doi: 10.1123/jab.2017-0095. [Epub ahead of print]

Todos los derechos reservados para:

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Abstract

Ankle power dominates forward propulsion of gait, but midfoot power generation is also important for successful push off. However, it is unclear if midfoot power generation increases or stays the same in response to propulsive activities that induce larger external loads and require greater ankle power. The purpose of this study was to examine ankle and midfoot power in healthy adults during progressively more demanding functional tasks. Multi-segment foot motion (tibia, calcaneus, forefoot) and ground reaction forces were recorded as participants (N=12) walked, ascended a standard step, and ascended a high step. Ankle and midfoot positive peak power and total power, and the proportion of midfoot to ankle total power were calculated. One-way repeated measures ANOVAs were conducted to evaluate differences across tasks. Main effects were found for ankle and midfoot peak and total powers (all p < .001), but not for the proportion of midfoot to ankletotal power (p = .331). Ankle and midfoot power significantly increased across each task. Midfoot power increased in proportion to anklepower and in congruence to the external load of a task. Study findings may serve to inform multi-segment foot modeling applications and internal mechanistic theories of normal and pathological foot function.

KEYWORDS:

foot biomechanics; kinetics; multi-segment foot model

Resumen

El poder del tobillo domina la propulsión hacia adelante de la marcha, pero la generación de energía en el mediopié también es importante para un empuje exitoso. Sin embargo, no está claro si la generación de energía en el mediopié aumenta o permanece igual en respuesta a las actividades de propulsión que inducen cargas externas más grandes y requieren una mayor potencia en el tobillo. El propósito de este estudio fue examinar el poder del tobillo y el mediopié en adultos sanos durante tareas funcionales progresivamente más exigentes. Múltiples segmentos del movimiento del pie (tibia, calcáneo, antepié) y las fuerzas de reacción del suelo se registraron cuando los participantes (N = 12) caminaron, ascendieron un paso estándar y ascendieron a un paso alto. Se calculó la potencia máxima positiva y la potencia total del tobillo y el mediopié, y la proporción de potencia total desde el mediopié hasta el tobillo. Se realizaron ANOVA de medidas repetidas en un sentido para evaluar las diferencias entre tareas. Los principales efectos se encontraron para el tobillo y el mediopié del pico y las potencias totales (todos p <.001), pero no para la proporción de la energía del mediopié al tobillo (p = .331). El poder del tobillo y el mediopié aumentó significativamente en cada tarea. La potencia del mediopié aumentó en proporción a la fuerza del tobillo y en congruencia con la carga externa de una tarea. Los hallazgos del estudio pueden servir para informar las aplicaciones de modelado de pie multisegmento y las teorías mecanicistas internas de la función del pie normal y patológica.

PALABRAS CLAVE:

biomecánica del pie; cinética; modelo de pie multi-segmento

PMID:  29485306   DOI:   10.1123/jab.2017-0095