Revisiones_bibliográficas TyO

Int J Mol Sci. 2017 Apr 3;18(4). pii: E759. doi: 10.3390/ijms18040759.

Abstract

In this study, the aim was to test the biochemical effects of melatonin supplementation in Intensive Care Unit (ICU) patients, since their blood levels are decreased. Sixty-four patients were enrolled in the study. From the evening of the 3rd ICU day, patients were randomized to receive oral melatonin (3 mg, group M) or placebo (group P) twice daily, at 20:00 and 24:00, until discharged. Blood was taken (at 00:00 and 14:00), on the 3rd ICU day to assess basal nocturnal melatonin values, and then during the treatment period on the 4th and 8th ICU days. Melatonin, total antioxidant capacity, and oxidative stress were evaluated in serum. Melatonin circadian rhythm before treatment was similar in the two groups, with a partial preservation of the cycle. Four hours from the 1st administration (4th ICU day, 00:00), melatonin levels increased to 2514 (982.3; 7148) pg·mL-1 in group M vs. 20.3 (14.7; 62.3) pg·mL-1 in group P (p < 0.001). After five treatment days (8th ICU day), melatonin absorption showed a repetitive trend in group M, while in group P nocturnal secretion (00:00) was impaired: 20 (11.5; 34.5) pg·mL-1 vs. 33.8 (25.0; 62.2) on the 3rd day (p = 0.029). Immediately from the beginning of treatment, the total antioxidant capacity was significantly higher in melatonin treated subjects at 00:00; a significant correlation was found between total antioxidant capacity and blood melatonin values (ρ = 0.328; p < 0.001). The proposed enteral administration protocol was adequate, even in the early phase, to enhance melatonin blood levels and to protect the patients from oxidative stress. The antioxidant effect of melatonin could play a meaningful role in the care and well-being of these patients.

KEYWORDS: antioxidants; critical illness; dietary supplements; melatonin; oxidative stress

Melatonina profiláctica para el delirio en cuidados intensivos (Pro-MEDIC): protocolo de estudio para un ensayo controlado aleatorizado.

Prophylactic Melatonin for Delirium in Intensive Care (Pro-MEDIC): study protocol for a randomised controlled trial.

Martinez FE1, Anstey M2,3,4, Ford A5, Roberts B6, Hardie M7, Palmer R6, Choo L7, Hillman D8,9, Hensley M10, Kelty E11, Murray K12, Singh B13,14,15, Wibrow B2,16.

Trials. 2017 Jan 6;18(1):4. doi: 10.1186/s13063-016-1751-0.

Abstract

BACKGROUND: Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium. METHODS: This trial will be a multi-centre, randomised, placebo-controlled study conducted in closed ICUs in Australia. Our aim is to enrol 850 adult patients with an expected ICU length of stay (LOS) of 72 h or more. Eligible patients for whom there is consent will be randomised to receive melatonin 4 mg enterally or placebo in a 1:1 ratio according to a computer-generated randomisation list, stratified by site. The study drug will be indistinguishable from placebo. Patients, doctors, nurses, investigators and statisticians will be blinded. Melatonin or placebo will be administered once per day at 21:00 until ICU discharge or 14 days after enrolment, whichever occurs first. Trained staff will assess patients twice daily to determine the presence or absence of delirium using the Confusion Assessment Method for the ICU score. Data will also be collected on demographics, the overall prevalence of delirium, duration and severity of delirium, sleep quality, participation in physiotherapy sessions, ICU and hospital LOS, morbidity and mortality, and healthcare costs. A subgroup of 100 patients will undergo polysomnographic testing to further evaluate the quality of sleep. DISCUSSION: Delirium is a significant issue in ICU because of its frequency and associated poorer outcomes. This trial will be the largest evaluation of melatonin as a prophylactic agent to prevent delirium in the critically ill population. This study will also provide one of the largest series of polysomnographic testing done in ICU.

Agonistas del receptor de la melatonina para la prevención del delirio

Melatonin Receptor Agonists for Delirium Prevention.

Walker CK1,2, Gales MA1,3,4.

Ann Pharmacother. 2017 Jan;51(1):72-78. doi: 10.1177/1060028016665863. Epub 2016 Aug 20.

Abstract

OBJECTIVE: To review the prospective controlled trials available for the use of melatonin receptor agonists for delirium prevention. DATA SOURCES: A MEDLINE literature search (1946 to July 2016) was conducted using the search terms delirium, melatonin, ramelteon, tryptophan, and melatonin-receptor agonist. Prospective controlled clinical trials with delirium prevention as an outcome were included. The references of identified articles were reviewed to identify other relevant articles. STUDY SELECTION AND DATA EXTRACTION: Controlled clinical trials in humans, limited to the English language, were reviewed. Five randomized and 1 nonrandomized prospective controlled clinical trial exploring the use of melatonin receptor agonists for delirium preventionwere evaluated. DATA SYNTHESIS: Melatonin agonist therapy for delirium prevention has produced conflicting results in clinical trials. Delirium incidence ranged from no change to significant reductions of approximately 12% to 30%. Four trials were conducted with melatonin as the investigated agent, 1 with l-tryptophan, and 1 with ramelteon. The study setting also varied, with 4 trials being conducted in surgical patients and 2 trials in medical patients. Melatonin provided conflicting results, with 3 trials showing decreased delirium incidence and the largest randomized controlled trial showing no benefit. No benefit was found using l-tryptophan in delirium prevention. The single, small ramelteon trial showed decreased delirium incidence. Safety evaluations during trials were limited. Three trials found adverse effects similar to placebo, whereas the remaining 3 trials did not evaluate adverse effects. CONCLUSIONS: The routine use of melatonin receptor agonists for delirium prevention cannot be recommended at this time.

KEYWORDS: delirium; melatonin; melatonin-receptor agonist; ramelteon; tryptophan

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Congreso Nacional de Residentes de Anestesiología

7 al 9 de junio, 2018. Lima, Perú

X Foro Internacional de Medicina del Dolor y Paliativa

Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Ciudad de México, 7 al 9 de junio de 2018.

Información/ Information

V Congreso Internacional de Vía Aérea, EVALa, México

Junio 7-9, 2018. Guadalajara. México

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

lunes, 21 de mayo de 2018

Sueño postoperatorio / Postoperative sleep

Mayo 19, 2018. No. 3085

Mejora el sueño postoperatorio: ¿qué podemos hacer?

Resumen

OBJETIVO DE LA REVISIÓN: Revisamos las evidencias con respecto a la ocurrencia, los factores de riesgo, los efectos nocivos, la prevención y el manejo de las alteraciones del sueño en los pacientes después de la cirugía. HALLAZGOS RECIENTES: El sueño normal es importante para mantener la salud física y mental. Los disturbios del sueño ocurren con frecuencia en pacientes después de la cirugía. Los factores asociados con el desarrollo de trastornos del sueño postoperatorios incluyen la vejez, la comorbilidad preoperatoria, el tipo de anestesia, la gravedad del trauma quirúrgico, el dolor postoperatorio, el estrés ambiental, así como otros factores que conducen a la incomodidad de los pacientes. El desarrollo de trastornos del sueño produce efectos nocivos en pacientes postoperados, es decir, conduce a un mayor riesgo de delirio, mayor sensibilidad al dolor, más eventos cardiovasculares y peor recuperación. Se pueden usar medidas no farmacológicas y farmacológicas (como zolpidem, melatonina y dexmedetomidina) para mejorar el sueño postoperatorio. Evidencias recientes muestran que la promoción del sueño puede mejorar el resultado de los pacientes, pero requiere más evidencias.

RESUMEN: Los trastornos del sueño son comunes en los pacientes después de la cirugía y producen efectos nocivos en la recuperación postoperatoria. La terapia de promoción del sueño puede ser útil para mejorar la recuperación postoperatoria, pero los efectos a largo plazo merecen más estudio.

Improve postoperative sleep: what can we do?

Su X1, Wang DX.

Curr Opin Anaesthesiol. 2018 Feb;31(1):83-88. doi: 10.1097/ACO.0000000000000538.

Abstract

PURPOSE OF REVIEW: We reviewed evidences regarding occurrence, risk factors, harmful effects, prevention, and management of sleep disturbances in patients after surgery. RECENT FINDINGS: Normal sleep is important to maintain physical and mental health. Sleep disturbances frequently occur in patients after surgery. Factors associated with the development of postoperative sleep disturbances include old age, preoperative comorbidity, type of anesthesia, severity of surgical trauma, postoperative pain, environment stress, as well as other factors leading to discomfort of patients. Development of sleep disturbances produces harmful effects on postoperative patients, that is, leading to higher risk of delirium, increased sensitivity to pain, more cardiovascular events, and poorer recovery. Both nonpharmacological and pharmacological measures (such as zolpidem, melatonin, and dexmedetomidine) can be used to improve postoperative sleep. Recent evidences show that sleep promotion may improve patients' outcome, but requires further evidences.

SUMMARY: Sleep disturbances are common in patients after surgery and produce harmful effects on postoperative recovery. Sleep-promotion therapy may be helpful to improve postoperative recovery, but long-term effects deserve further study.

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Congreso Nacional de Residentes de Anestesiología

7 al 9 de junio, 2018. Lima, Perú

X Foro Internacional de Medicina del Dolor y Paliativa

Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Ciudad de México, 7 al 9 de junio de 2018.

Información / Information

V Congreso Internacional de Vía Aérea, EVALa, México

Junio 7-9, 2018. Guadalajara. México

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

Actualización en Reflujo Gastro-Esofágico en Niños

Conferencia: Actualidades en. RGE en pediatria por el Dr Jose Luis martinez Orozco de Fresno Ca

Proxima conferencia el dia 23 de mayo 2018, 9 pm

Estimado Ciberpediatra
lo invitamos a unirse al seminario web Zoom.
Cuándo: may 23, 2018 9:00 PM Ciudad de México
Tema: Actualización en Reflujo Gastro-Esofágico en Niños, por el Dr. José Luis Martínez Orozco
Gastroenterologo pediatra de Fresno Ca.
Haga clic en el enlace a continuación para unirse al seminario web:
https://zoom.us/j/313789104
O un toque en iPhone :
Estados Unidos: +16468769923,,313789104# or +16699006833,,313789104#
O teléfono：
Marcar：
Estados Unidos: +1 646 876 9923 or +1 669 900 6833
ID de seminario web: 313 789 104
Números internacionales disponibles: https://zoom.us/u/dsSfyBEnn

Recomendamos que bajes e instales el programa Zoom en tu computadora, para poder accesar la reunión,

También que dejes tu nombre completo y correo electrónico para tomar asistencia a la conferencia

Pasaremos las preguntas al final de la presentacion y se quedaran al final de la Grabacion, por si la revisan en forma Off Line.

Puedes accesar la conferencia a través de la siguientes ligas en las paginas de Conapeme y Ciberpeds.

Ciberpeds: https://bit.ly/2wSTXHq

Conapeme: https://bit.ly/2tnUcnb

Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La Clinica 2520-310 col Sertoma
Monterrey N.L. CP 64718
Tel (81) 83482940, (81)81146053
Cel 0448183094806

Anatomía del flexor largo del pulgar

http://www.manoytrauma.com.mx/academia/anatomia-del-flexor-largo-del-pulgar/

Anatomy of the Flexor Pollicis Longus

Fuente

Este artículo y/o video es originalmente publicado en:

https://youtu.be/3CJ77o6BvKU

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

nabil ebraheim

Dr. Ebraheim’s educational animated video describes the anatomy of the flexor pollicis longus muscle.

Follow me on twitter:

https://twitter.com/#!/DrEbraheim_UTMC

Categoría

Formación

Licencia

Licencia de YouTube estándar

Sueño, melatonina, UCI / ICU, sleep, and melatonine

Mayo 21, 2018. No. 3087

Calidad del sueño y alteraciones del ritmo circadiano en UCI. Una revisión

Sleep quality and circadian rhythm disruption in the intensive care unit: a review.

Boyko Y1, Jennum P2, Toft P1.

Nat Sci Sleep. 2017 Nov 10;9:277-284. doi: 10.2147/NSS.S151525. eCollection 2017.

Abstract

Sleep and circadian rhythm are reported to be severely abnormal in critically ill patients. Disturbed sleep can lead to the development of delirium and, as a result, can be associated with prolonged stay in the intensive care unit (ICU) and increased mortality. The standard criterion method of sleep assessment, polysomnography (PSG), is complicated in critically ill patients due to the practical challenges and interpretation difficulties. Several PSG sleep studies in the ICU reported the absence of normal sleep characteristics in many critically ill patients, making the standard method of sleep scoring insufficient in this patient group. Watson et al proposed a modified classification for sleep scoring in critically ill patients. This classification has not yet been validated. Sleep disturbance in the ICU is a multifactorial problem. The ICU environment, mechanical ventilation, medication, as well as the critical illness itself have been reported as important sleep disturbing factors. Secretion of sleep hormone, melatonin, expressing circadian rhythmicity was found abolished or phase delayed in critically ill patients. Various interventions have been tested in several studies aiming to improve sleep quality and circadian rhythm in the ICU. The results of these studies were inconclusive due to using the sleep assessment methods other than PSG or the absence of a reliable sleep scoring tool for the analysis of the PSG findings in this patient population. Development of a valid sleep scoring classification is essential for further sleep research in critically ill patients.

KEYWORDS: critically ill patients; environmental factors; mechanical ventilation; melatonin; polysomnography; sedation; sleep patterns

Patrón de secreción de melatonina en paciente graves. Estudio piloto descriptivo

Melatonin Secretion Pattern in Critically Ill Patients: A Pilot Descriptive Study.

Boyko Y1, Holst R2, Jennum P3, Oerding H4,5, Nikolic M6, Toft P1.

Crit Care Res Pract. 2017;2017:7010854. doi: 10.1155/2017/7010854. Epub 2017 May 11.

Abstract

Critically ill patients have abnormal circadian and sleep homeostasis. This may be associated with higher morbidity and mortality. The aims of this pilot study were (1) to describe melatonin secretion in conscious critically ill mechanically ventilated patients and (2) to describe whether melatonin secretion and sleep patterns differed in these patients with and without remifentanil infusion. Eight patients were included. Blood-melatonin was taken every 4th hour, and polysomnography was carried out continually during a 48-hour period. American Academy of Sleep Medicine criteria were used for sleep scoring if sleep patterns were identified; otherwise, Watson's classification was applied. As remifentanil was periodically administered during the study, its effect on melatonin and sleep was assessed. Melatonin secretion in these patients followed a phase-delayed diurnal curve. We did not observe any effect of remifentanil on melatonin secretion. We found that the risk of atypical sleep compared to normal sleep was significantly lower (p < 0.001) under remifentanil infusion. Rapid Eye Movement (REM) sleep was only observed during the nonsedation period. We found preserved diurnal pattern of melatonin secretion in these patients. Remifentanil did not affect melatonin secretion but was associated with lower risk of atypical sleep pattern. REM sleep was only registered during the period of nonsedation.

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Congreso Nacional de Residentes de Anestesiología

7 al 9 de junio, 2018. Lima, Perú

X Foro Internacional de Medicina del Dolor y Paliativa

Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Ciudad de México, 7 al 9 de junio de 2018.

Información / Information

V Congreso Internacional de Vía Aérea, EVALa, México

Junio 7-9, 2018. Guadalajara. México

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people