Revisiones_bibliográficas TyO

J Thorac Dis. 2018 Mar;10(3):1998-2004. doi: 10.21037/jtd.2018.02.48.

Abstract

The use of enhanced recovery after surgery (ERAS), as in other surgical specialties, is an emerging concept in cardio-thoracic surgery but there is still a lack of effective protocols to reduce the burden of surgery on the patient, shorten the period of postoperative recovery, and reduce the likelihood of chronic pain developing. The use of local anaesthetic (LA) techniques, such as thoracic epidural analgesia (TEA) and paravertebral blocks (PVB), as an adjunct to anaesthesia are considered key components, though there is little data for direct comparison of the techniques. This review aims to evaluate the role of LA techniques in a thoracic ERAS program through evidence from literature and considering aspects of clinical practice. We discuss how ERAS is adapting and evolving with the increasing use of video-assisted thoracoscopic surgery (VATS) is thoracic surgery. It also examines the advantages of multimodal, opioid-sparing analgesia in the post-operative period to minimise the inflammatory response and improve functional recovery. LA techniques within ERAS protocols have the potential to hasten recovery when managed appropriately and to their full potential.

KEYWORDS: Enhanced recovery; epidural anaesthesia; local anaesthetics (LA); paravertebral block (PVB)

Aumento de las vías de recuperación en cirugía torácica del grupo italiano VATS: protocolos de analgesia perioperatoria.

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols.

Piccioni F1, Segat M2, Falini S2, Umari M2, Putina O3, Cavaliere L4, Ragazzi R5, Massullo D6, Taurchini M7, Del Naja C7, Droghetti A8.

J Thorac Dis. 2018 Mar;10(Suppl 4):S555-S563. doi: 10.21037/jtd.2017.12.86.

Abstract

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodalanalgesia principles for implementing an ERAS program after VATS lobectomy.

KEYWORDS: Regional analgesia; pain management; video-assisted thoracoscopic surgery (VATS)

Los beneficios de la recuperación mejorada después de los programas de cirugía y su aplicación en la cirugía cardiotorácica.

The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery.

Brown JK1, Singh K1, Dumitru R1, Chan E1, Kim MP1.

Methodist Debakey Cardiovasc J. 2018 Apr-Jun;14(2):77-88. doi: 10.14797/mdcj-14-2-77.

Abstract

The perioperative care of the surgical patient is undergoing a paradigm shift. Enhanced Recovery After Surgery (ERAS) programs are becoming the standard of care and best practice in many surgical specialties throughout the world. ERAS is a multimodal, multidisciplinary, evidence-based approach to care of the surgical patient that aims to optimize perioperative management and outcomes. Implementation, however, has been slow because it challenges traditional surgical doctrine. The key elements of ERAS Pathways strive to reduce the response to surgical stress, decrease insulin resistance, and maintain anabolic homeostasis to help the patient return to baseline function more quickly. Data suggest that these pathways have produced not only improvements in clinical outcome and quality of care but also significant cost savings. Large trials reveal an increase in 5-year survival and a decrease in immediate complication rates when strict compliance is maintained with all pathway components. Years of success using ERAS in colorectal surgery have helped to establish a body of evidence through a number of randomized controlled trials that encourage application of these pathways in other surgical specialties.

KEYWORDS: ERAS; cardiothoracic surgery; enhanced recovery after surgery; length of stay; lung resection; multimodal analgesia; transcatheter aortic valve replacement

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Inscripciones Abiertas

Curso de Alta Especialidad en Medicina del Dolor y Paliativa 2019

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

Ciudad de México

Convocatoria / Announcement

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

vwhizar@anestesia-dolor.org

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

Informes / Information

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

miércoles, 12 de septiembre de 2018

Libro sobre Cardiomiopatias / Book on Cardiomyopathies

Septiembre 11, 2018. No. 3183

Viaje Culinario en Chiapas

Cardiomiopatías. Tipos y manejos

Cardiomyopathies Types and Treatments

Edited by Kaan Kırali

Sakarya University, Turkey

Cardiomyopathies are the most featured cardiac pathologies in the twenty-first century, that threaten public health and burden healthcare budgets. This book is composed of the main topics on pathophysiology, general forms and specific types of cardiomyopathies and it also introduces new research in the field. Specific forms with or without genetic inheritance are discussed separately to attract the readers' attention on these topics. Well-known medical follow-up strategies occur ineffective at the end-stage heart failure, however, new surgical approaches can be an alternative for these patients to get a chance at the last crossroad and to improve their life quality and survival and also to gain or prolong time until possible heart transplantation.

Libro / Book / Livre

Cardiomiopatías y anestesia

Cardiomyopathies and anaesthesia.

Juneja R1, Nambiar PM1.

Indian J Anaesth. 2017 Sep;61(9):728-735. doi: 10.4103/ija.IJA_385_17.

Abstract

Cardiomyopathy is considered as a heart muscle disease of multiple aetiologies, unlike other cardiac diseases related to a definitive pathophysiology. With more and more research and with the advent of genetic analysis pin pointing the disease causing mutations, causative factors have been defined and classifications and definitions have changed over time. Patients with these conditions present to anaesthesiologists in elective and emergency situations, placement of automated internal cardioverter defibrillator (AICD) devices or biventricular pacing but may also be diagnosed at anaesthetic pre-assessment. We describe cardiomyopathies such as dilated cardiomyopathy, hypertrophic cardiomyopathy, post-partum cardiomyopathy and Takotsubo cardiomyopathy in brief and their anaesthetic management.

KEYWORDS: Anaesthesiologist; cardiomyopathy; hypertrophic cardiomyopathy

Anestesia en pacientes con cardiomiopatía dilatada para cirugía no cardiaca

Anesthetic management of patients with dilated cardiomyopathy for noncardiac surgery.

Chen CQ1, Wang X, Zhang J, Zhu SM.

Eur Rev Med Pharmacol Sci. 2017 Feb;21(3):627-634.Abstract

Anesthetic management of patients with dilated cardiomyopathy (DCM) is a challenge to the anesthesiologist, due to poor left systolic function, ventricular enlargement, risk of malignant arrhythmias and sudden cardiac death. Therefore, preoperative assessment and appropriate anesthetic management are important in patients with DCM. This review describes the preoperative evaluation and anesthesiaconsiderations of patients with DCM undergoing non-cardiac surgery. Patient pathophysiology and clinical status, such as ventricular function, degree of myocardial fibrosis, resting heart rate and high-sensitivity C-reactive protein can affect survival rates. Advanced monitoring devices, such as transesophageal echocardiography and cardiac resynchronization therapy can be used to assess ventricular function and myocardial fibrosis. Thoracic epidural blockade can improve ventricular function. In summary, the optimal anesthetic management of patients with dilated cardiomyopathy requires good preoperative assessment, close perioperative monitoring, suitable anesthetic, optimization fluid management, and stable hemodynamic status.

Inscripciones Abiertas

Curso de Alta Especialidad en Medicina del Dolor y Paliativa 2019

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

Ciudad de México

Convocatoria / Announcement

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World