Más de bloqueos paravertebrales torácicos / More on thoracic paravertebral block

Marzo 26, 2018. No. 3034

Bloqueo paravertebral torácico de inyección única y analgesia postoperatoria después de la mastectomía: un estudio de cohorte retrospectivo. Single-injection thoracic paravertebral block and postoperative analgesia after mastectomy: a retrospective cohort study. Agarwal RR1, Wallace AM2, Madison SJ1, Morgan AC1, Mascha EJ3, Ilfeld BM4. Author information J Clin Anesth. 2015 Aug;27(5):371-4. doi: 10.1016/j.jclinane.2015.04.003. Epub 2015 May 6. Abstract BACKGROUND: The treatment of postoperative pain after mastectomy is an area of increasing interest, as this treatment option is now considered a standard of care for those affected by breast cancer. Thoracic paravertebral nerve block (tPVB) using local anesthetics administered before mastectomy can theoretically provide postoperative analgesia, thereby facilitating a more comfortable and shorter hospitalization. METHODS: In this retrospective cohort study, we aimed to determine the duration and degree to which tPVB provides postoperative analgesia in patients who underwent either unilateral or bilateral mastectomy (n = 182). We retrospectively examined the numeric rating scale (NRS) for pain scores recorded by nursing staff throughout individual patient hospitalizations, looking specifically at the following time points: arrival from the postanesthesia care unit to the surgical wards, noon on postoperative day 1 (POD1), and discharge. We also examined the number of days until patients were discharged from the hospital. RESULTS: Our results revealed a statistically significant decrease in NRS in pain scores for patients who had received a tPVB (n = 92) on arrival from the postanesthesia care unit to the surgical wards (mean NRS decrease of 1.9 points; 99% confidence interval [CI], -3.0 to -0.8; P < .001) but did not show statistically significant decreases in NRS for pain scores for patients at noon on POD1 (mean NRS decrease of 0.3 points at noon on POD1, P = .43) or at discharge (mean NRS decrease of 0.1 point at discharge, P = .65). Moreover, use of tPVB did not have an impact on time until discharge (average decrease of 0.5 hours; 95% CI, -6 to +5 hours, P = .87). CONCLUSIONS: Single-injection tPVB appears to provide meaningful postoperative analgesia in the immediate postoperative period after mastectomy but not after the first day of surgery. KEYWORDS: Peripheral nerve block; Postoperative analgesia; Postoperative pain; Regional analgesia; Regional anesthesia PDF BLOQUEO PARAVERTEBRAL TORÁCICO JULIÁN ALISTE M y FERNANDA BAEZA G Rev Chil Anest, 2011; 40: 263-271 INTRODUCCIÓN  Clásicamente se ha descrito al bloqueo epidural torácico como el gold standard de la analgesia en cirugía torácica y abdominal para dolor moderado a severo. Sabemos que el dolor a nivel torácico en general tiene un difícil manejo por su relación con la respiración o la tos, situaciones muchas veces inevitables en estos pacientes y donde el reposo y la inmovilización no son alternativas. Por otro lado, a pesar de lo importante que es otorgar una adecuada analgesia, en algunos pacientes está contraindicado o es cuestionable el uso del bloqueo epidural torácico, por ejemplo: sepsis, terapia anticoagulante, deformidades anatómicas importantes, traumatismo reciente, inestabilidad hemodinámica, etc PDF Aplicación clínica del bloqueo anestésico paravertebral torácico en operaciones de mama Sara Socorro Faria y Renato Santiago Gomez Brazilian Journal of Anesthesiology (Edicion en Espanol) Volume 65, Issue 2, March-April 2015, Pages 147-154 Resumen El adecuado tratamiento del dolor postoperatorio ha tenido una importancia fundamental en los cuidados con el paciente quirúrgico. Entre las técnicas de analgesia dirigidas a ese grupo de pacientes, el bloqueo paravertebral torácico combinado con la anestesia general se destaca por los buenos resultados y por la favorable relación riesgo-beneficio. Muchos anestésicos locales y otros fármacos adyuvantes están siendo investigados para el uso en esa técnica, con vistas a mejorar la calidad de la analgesia y reducir los efectos adversos. Objetivo: Evaluar la eficacia y la seguridad del bloqueo paravertebral en comparación con otros regímenes analgésicos y anestésicos en mujeres sometidas a cirugías para cáncer de mama. Métodos: Revisión integral de la literatura de 1966 a 2012, hecha por medio de términos específicos en las bases de datos informatizadas de artículos que investigaron las características clínicas y los efectos adversos y beneficiosos del bloqueo paravertebral torácico. Resultados: En el período seleccionado, fueron identificados 16 estudios aleatorizados que cumplían los criterios de selección establecidos para esa revisión bibliográfica. El bloqueo paravertebral torácico demostró una reducción significativa del dolor postoperatorio, también una disminución del dolor durante los movimientos del brazo después de la cirugía. Conclusión: El bloqueo paravertebral torácico redujo la necesidad postoperatoria de analgésicos cuando se le comparó con el grupo placebo, específicamente dentro de las primeras 24 h. El uso de esa técnica podría garantizar una analgesia posquirúrgica de relevancia clínica. Son necesarios nuevos estudios con mayores grupos poblacionales, puesto que el bloqueo paravertebral parece ser prometedor para la analgesia preventiva en la cirugía de cáncer de mama. PDF Curso Regional de Anestesiología en Obstetricia y Pediatría Colegio de Anestesiólogos de León AC y FMCA, AC Mayo 17-19, 2018. León Guanajuato, México Informes con el Dr. Enrique Hernández Cortez kikinhedz@gmail.com 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

¿Todo listo para vacaciones de Semana Santa?

http://www.mihombroycodo.com.mx/me-divierto-actuando-trabajo-de-doctor/todo-listo-para-vacaciones-de-semana-santa/

Recuerda proteger tus articulaciones y no forzarlas si vas a hacer deporte o actividades recreativas.

¡Espero que disfrutes con tu familia y amigos!

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Dr. Carlos Cortés / Hombro y Codo

http://www.mihombroycodo.com.mx/academia/dr-carlos-cortes-hombro-y-codo/

Hola, soy el Dr. Carlos Cortés, traumatólogo ortopedista con maestría en Medicina del Deporte.

Me especialicé en hombro y codo para ayudarte a retomar tus actividades favoritas, sin dolor y sin molestias.

Si me necesitas, ingresa a hombroycodo.com.mx para agendar tu consulta.

#HombroYCodo #EspecialistaEnHombro #TraumatologíaYOrtopedia

¡El dolor no debe limitar tu pasión! / Dr Carlos Cortés – Testimonio Marco Alberto Pérez Corona

www.mihombroycodo.com.mx/uncategorized/el-dolor-no-debe-limitar-tu-pasion-dr-carlos-cortes-testimonio-marco-alberto-perez-corona/

Les comparto el caso del basquetbolista Marco Pérez, quien recuperó la funcionalidad completa de su hombro gracias a una artroscopía exitosa con rehabilitación.
Visítame en hombroycodo.com.mx para conocer los tratamientos con los que puedo ayudarte a continuar tu vida deportiva.

Si deseas agendar tu cita, puedes llamar a mi consultorio: +52 (33) 1204 0143

¡Te esperamos!

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Protesis de rodilla y tienes dolor

http://www.ortotrauma.xyz/academia/protesis-de-rodilla-y-tienes-dolor/

Si te han colocado una protesis de rodilla y tienes dolor.Necesitas una revision clinica y revalorar la funcion de tu rodilla..
Dr. Jorge Negrete Corona.
Cirugia articular y artroscopia.
Tel.52645458.

Sedación en niños / Pediatirc sedation

Marzo 10, 2018. No. 3018 Protocolo de sedación durante la inyección intravítrea de bevacizumab en recién nacidos prematuros con retinopatía de la prematuridad. Sedation Protocol During Bevacizumab Intravitreal Injection in Preterm Infants With Retinopathy of Prematurity. Miller JL, Johnson PN, Harkey K, Siatkowski RM. J Pediatr Pharmacol Ther. 2018 Jan-Feb;23(1):34-40. doi: 10.5863/1551-6776-23.1.3 4Abstract OBJECTIVES: This study describes outcomes of intravenous (IV) analgesics and sedatives for bedside intravitreal bevacizumab injections for retinopathy of prematurity. METHODS: This retrospective study included infants receiving intravitreal bevacizumab injections between January 2012 and May 2016. Infants were excluded if bevacizumab was administered under general anesthesia or for incomplete records. Data collection included demographics, sedation and analgesia regimen, and cardiopulmonary adverse events (AEs). The primary objective was to identify the median doses of the IV analgesics and sedatives. The secondary objectives included the number of patients with cardiopulmonary AEs and those with procedure success, defined as procedure completion without interruption and absence of interventions. RESULTS: Fifteen infants were included. Fourteen (93.3%) were initiated on a fentanyl infusion at a median of 2 mcg/kg/hr (IQR, 2-3.6), and 12 (80%) received midazolam infusions at a median of 0.06 mg/kg/hr. All patients received at least 1 IV neuromuscular blocker dose just prior to the procedure. Only 2 patients (13.3%) required an increase in their fentanyl or midazolam infusions. Procedure success was achieved in 13 patients (86.7%). Five patients (33.3%) experienced 1 cardiopulmonary AE. One patient (6.7%) had a delay in the procedure, and 1 patient (6.7%) required naloxone. Despite this, the procedure was completed in all patients. CONCLUSIONS: Most received fentanyl and midazolam infusions with a dose of vecuronium just prior to the procedure. Thirteen (86.7%) met the criteria for procedure success. One-third experienced a cardiopulmonary AE. Future studies are needed to identify the optimal agents and route of administration for this procedure. KEYWORDS: bevacizumab; fentanyl; midazolam; neonatal intensive care unit; retinopathy of prematurity PDF Resultados del tratamiento del uso de sedación por inhalación para la atención dental integral. Treatment outcomes of using inhalation sedation for comprehensive dental care. Madouh M1, BaniHani A2, Tahmassebi JF2. Author information Eur Arch Paediatr Dent. 2018 Feb;19(1):33-37. doi: 10.1007/s40368-017-0318-4. Epub 2018 Jan 11. Abstract AIM: To assess the outcomes of dental treatment under inhalation sedation within a UK specialist hospital setting. METHODS: This was a retrospective cohort study of the case notes of patients under 17 years of age who received dental treatment using inhalation sedation at a UK specialist setting during the period 2006-2011. Treatment outcomes were categorised into five groups: (1) treatment completed as planned, (2) modified treatment completed, (3) treatment abandoned in sedation unit and patient referred for treatment under general analgesia (GA), (4) treatment abandoned in sedation unit and patient referred for treatment under local analgesia(LA), (5) child failed to return to complete treatment. RESULTS: In total, the case notes of 453 patients were evaluated. The mean age of the patients was 10.3 ± 2.9 years. Treatment was completed successfully in 63.6% of the cases, 15.9% were referred for treatment under GA, 11.2% failed to return to complete the treatment, 7.1% received modified treatment completed, and only 2.2% were referred for treatment under LA. Treatment outcomes were significantly associated with patient`s age (p = 0.002). The treatment outcome "treatment abandoned and child referred to be treated under GA" had significantly lower mean patient ages than the other outcomes. CONCLUSIONS: The majority of children referred for inhalation sedation, completed their course of treatment. A significantly higher proportion of those in the younger age group required GA to complete their treatment. KEYWORDS: Children; General analgesia; Inhalation sedation; Treatment outcomes PDF Remifentanil para sedación y analgesia durante la división despierta de colgajo de lengua en niños: un informe de dos casos. Remifentanil for sedation and analgesia during awake division of tongue flap in children: a report of two cases. Kuroiwa KK1, Nishizawa M1, Kondo N1, Nakazawa H1, Hirabayashi T1. Author information JA Clin Rep. 2017;3(1):43. doi: 10.1186/s40981-017-0114-5. Epub 2017 Aug 23. Abstract BACKGROUND: The tongue flap is an accepted treatment method for cleft palate repair. Orotracheal or nasotracheal intubation using a fiberoptic scope is preferred for the division of the tongue flap. We report two cases of tongue flap division in which the patients received adequate sedation and analgesia without tracheal intubation. CASE PRESENTATION: Twelve- and 13-year-old male patients were treated at our hospital for tongue flap division, performed as part of a cleft palate repair. We planned to divide the tongue flap under sedation with remifentanil (1 μg/kg/min continuous infusion) and local anesthesia, followed by induction of general anesthesia, and orotracheal intubation after the tongue flap was divided. During the procedure, patients were breathing spontaneously and were cooperative. Patients were able to follow the surgeons' verbal cues to thrust out the tongue during the procedure, so that the surgeons could easily insert the sutures. CONCLUSIONS: During the division of the tongue flap in two children, excellent sedative and analgesic effects were achieved using continuous remifentanil infusion. KEYWORDS: Cleft palate; Remifentanil; Tongue flap PDF Curso Regional de Anestesiología en Obstetricia y Pediatría Colegio de Anestesiólogos de León AC y FMCA, AC Mayo 17-19, 2018. León Guanajuato, México Informes con el Dr. Enrique Hernández Cortez kikinhedz@gmail.com Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

LIbro sobre trombocitopenia / Book on thrombocytopenia

Marzo 12, 2018. No. 3020

Trombocitopenia Thrombocytopenia Edited by Pankaj Abrol, ISBN 978-953-51-3876-1, Print ISBN 978-953-51-3875-4, 104 pages, Publisher: InTech, Chapters published March 07, 2018 under CC BY 3.0 license DOI: 10.5772/intechopen.69080 Edited Volume The book "Thrombocytopenia" certainly raises some important issues in its pathogenesis and management. The authors have done a lot of hard work to write state-of-the-art chapters. Each and every chapter is peer-reviewed, evidence-based, and remarkably excellent. Some of the causes of thrombocytopenia are well explained in textbooks, but the topics included in this book are not usually so well described. The chapters are written in such a manner so as to stimulate and keep the reader well-informed. Such an approach is certainly beneficial when aiming to motivate discussion, interaction, innovation, and research. Chapters like "Interferon-Induced Thrombotic Microangiopathy" have been included with the aim to help in understanding the immune pathogenesis of thrombocytopenia. Others have also been selected to keep an eye on the future. Libro / Book / Buchen La fisiopatología de las plaquetas sanguíneas y la sepsis: ¿una nueva perspectiva terapéutica en pacientes críticos? Blood platelets and sepsis pathophysiology: A new therapeutic prospect in critical ill patients? Dewitte A1,2, Lepreux S3,4, Villeneuve J5, Rigothier C3,6, Combe C3,6, Ouattara A7,8, Ripoche J3. Author information Erratum in Correction to: Blood platelets and sepsis pathophysiology: A new therapeutic prospect in critically ill patients? [Ann Intensive Care. 2018] Ann Intensive Care. 2017 Dec 1;7(1):115. doi: 10.1186/s13613-017-0337-7. Abstract Beyond haemostasis, platelets have emerged as versatile effectors of the immune response. The contribution of platelets in inflammation, tissue integrity and defence against infections has considerably widened the spectrum of their role in health and disease. Here, we propose a narrative review that first describes these new platelet attributes. We then examine their relevance to microcirculatory alterations in multi-organ dysfunction, a major sepsis complication. Rapid progresses that are made on the knowledge of novel platelet functions should improve the understanding of thrombocytopenia, a common condition and a predictor of adverse outcome in sepsis, and may provide potential avenues for management and therapy. KEYWORDS: Inflammation; Intensive care; Platelets; Sepsis PDF Curso Regional de Anestesiología en Obstetricia y Pediatría Colegio de Anestesiólogos de León AC y FMCA, AC Mayo 17-19, 2018. León Guanajuato, México Informes con el Dr. Enrique Hernández Cortez kikinhedz@gmail.com 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