Clonidina intratecal para analgesia postoperatoria en histerectomía abdominal

Clonidina intratecal para analgesia postoperatoria en histerectomía abdominal.


Intrathecal clonidine for perioperative pain relief in abdominal hysterectomy.
Dutta D, Naskar C, Wahal R, Bhatia V K, Singh V.
Indian J Pain [serial online] 2013 [cited 2013 Jul 10];27:26-32.
Abstract
Background: Two different doses of intrathecal clonidine with hyperbaric bupivacaine fentanyl combination is compared in women undergoing abdominal hysterectomy to get best beneficial effects with minimal incidence of side effects/complications. Methods: 90 patients undergoing abdominal hysterectomy under spinal anesthesia, were randomized to 3 groups, BFC0: received 3 ml hyperbaric bupivacaine 0.5% + 25μg fentanyl, BFC30: received 3 ml hyperbaric bupivacaine 0.5% + 25μg fentanyl + 30μgm clonidine and BFC60: received 3 ml hyperbaric bupivacaine 0.5% + 25μg fentanyl + 60μgm clonidine. Time to reach peak sensory levels, sensory and motor regression times, intraoperative pain score and time for first analgesic requirement, hemodynamic changes, fluid and vasopressor requirement were recorded. Results: Addition of clonidine has not increased the rapidity of spread of sensory block to T4. Duration of motor block and time to regression to L1 is significantly less in BFC0, (167.78±25.09min and 213.59±22.99min respectively) compared to BFC30 (248.33±26.07 min and 297.33±25.96 min respectively) and BFC60 (260.18 ± 47.64min and 306.43±44.76min respectively). In patients of BFC0 intraoperative vas score (1.3±1.2) was significantly higher and demanded analgesics earlier (241.3 ± 27.76 min) compared to others. Fall in BP was observed in a dose dependent manner. Conclusions: Adding small doses of clonidine to bupivacaine-fentanyl combination improves the quality of perioperative analgesia in a dose dependent manner. However, 60μg clonidine shows significant hemodynamic changes. Hence, 30μg of intrathecal clonidine added to bupivacaine (15mg) fentanyl (25μg) combination is the preferred choice.
Keywords: α2-adrenoreceptor agonist, clonidine, intrathecal adjuvants, spinal anesthesia
http://www.indianjpain.org/text.asp?2013/27/1/26/114863



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Desvelado el mecanismo usado por una bacteria para degradar petróleo a baja temperatura

http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=57544&origen=notiweb&dia_suplemento=miercoles

Desvelado el mecanismo usado por una bacteria para degradar petróleo a baja temperatura


Un estudio internacional en el que ha participado el Consejo Superior de Investigaciones Científicas (CSIC) ha descifrado el genoma de la bacteria Oleispira antartica RB-8, originalmente aislada en el océano Antártico.
FUENTE | CSIC 24/07/2013

Esta bacteria, que se encuentra de forma natural en los océanos y mares, es capaz de degradar hidrocarburos a muy baja temperatura (entre 4 y 6 grados centígrados) a niveles superiores a los mostrados por otras bacterias. Los resultados de este trabajo, publicado en la revista Nature Communications, podrían aplicarse en programas de descontaminación de fondos marinos y zonas polares.

La investigación señala varios factores que explican el comportamiento de esta bacteria. "Su metabolismo, que es incapaz de obtener carbono de otra fuente que no sea un hidrocarburo y posee una alta afinidad hacia los iones metálicos, que son esenciales para el crecimiento y para mantener la actividad de las proteínas", explica el investigador del CSIC Manuel Ferrer, del Instituto de Catálisis y Petroleoquímica.

Otro de los factores es la capacidad de RB-8 para producir altas concentraciones de anticongelante natural y modificar su membrana celular para resistir condiciones de alta salinidad y baja temperatura. "Además, produce una proteína cuya estructura a baja temperatura favorece el correcto funcionamiento de otras proteínas necesarias para la degradación de hidrocarburos. En último lugar, la estructura de sus proteínas está muy cargada en la superficie, lo que favorece una adecuada actividad catalítica a baja temperatura", añade el investigador del CSIC Juan Pablo Albar, del Centro Nacional de Biotecnología.

EVOLUCIÓN DE AMBIENTES CÁLIDOS A FRÍOS

"Hemos visto que las proteínas de esta bacteria son activas a una temperatura de entre 20°C y 60°C, temperaturas a las que es incapaz de crecer en la actualidad RB-8. Esto plantea la posibilidad de que RB-8 sea una bacteria originaria de ambientes cálidos que se ha adaptado durante el proceso evolutivo a crecer y a ser activa en ambientes fríos. Esto lo ha conseguido flexibilizando y redistribuyendo las cargas iónicas en la superficie de sus proteínas para mantener una suficiente actividad catalítica a baja temperatura, lo que no ocurre con otras bacterias similares", concluye Ferrer.

Según los investigadores, estos resultados establecen las bases que podrían permitir en el futuro diseñar nuevos programas de descontaminación de zonas polares y fondos marinos afectados por vertidos.

Michael Kube, Tatyana N. Chernikova, Yamal Al-Ramahi, Ana Beloqui, Nieves Lopez-Cortez, María- Eugenia Guazzaroni, Hermann J. Heipieper, Sven Klages, Oleg R. Kotsyurbenko, Ines Langer, Taras Y. Nechitaylo, Heinrich Lünsdorf, Marisol Fernández, Silvia Juárez, Sergio Ciordia, Alexander Singer, Olga Kagan, Olga Egorova, Pierre Alain Petit, Peter Stogios, Youngchang Kim, Anatoli Tchigvintsev, Robert Flick, Renata Denaro, Maria Genovese, Juan P. Albar, Oleg N. Reva, Montserrat Martínez-Gomariz, Hai Tran, Manuel Ferrer, Alexei Savchenko, Alexander F. Yakunin, Michail M. Yakimov, Olga V. Golyshina, Richard Reinhardt & Peter N. Golyshin. Genome sequence and functional genomic analysis of the oil-degrading bacteriumOleispira antárctica. Nature Communications. DOI:10.1038/ncomms3156.

Profilaxis y tratamiento de tromboembolismo venoso en pacientes graves

Profilaxis y tratamiento de tromboembolismo venoso en pacientes graves


Prophylaxis and treatment of venous thromboembolism in the critically ill.
Adriance SM, Murphy CV.
Int J Crit Illn Inj Sci [serial online] 2013 [cited 2013 Jul 1];3:143-51.
Abstract
Venous thromboembolism (VTE) is a frequent complication in critically ill patients and is associated with increased rates of morbidity and mortality. The use of thromboprophylaxis to reduce the risk of VTE in this patient population is the standard of care. This review will summarize the recommendations set forth in consensus guidelines for the prevention and treatment of VTE across subgroups within the critically ill patient population. In addition, the drug properties of the recommended pharmacologic agents for thromboprophylaxis will be highlighted including their pharmacokinetics, dosing and complications. The critical care practitioner may also encounter novel oral anticoagulants with increasing frequency. These agents will be briefly reviewed in terms of their approved and investigational indications and the clinical concerns related to their use will also be discussed.
Keywords: Anticoagulant, critical care, embolism, prophylaxis, thrombosis, venous thromboembolism
http://www.ijciis.org/text.asp?2013/3/2/143/114274




Atentamente
Dr. J. Carlos Flores-Carillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Dexmedetomidina/Dexmedetomidine

Dosis óptima de dexmedetomidina para sedación durante anestesia raquídea


Optimal dose of dexmedetomidine for sedation during spinal anesthesia.
Ok HG, Baek SH, Baik SW, Kim HK, Shin SW, Kim KH.
Department of Anesthesia and Pain Medicine, Pusan National University College of Medicine, Yangsan, Korea.
Korean J Anesthesiol. 2013 May;64(5):426-31. doi: 10.4097/kjae.2013.64.5.426. Epub 2013 May 24.
Abstract
BACKGROUND: Sedation in spinal anesthesia can reduce patient's anxiety and discomfort. Dexmedetomidine has a sedative, hypnotic, analgesic, and minimal respiratory depression effect. However, use of the dexmedetomidine is associated with prolonged recovery. This study was designed to investigate the optimal dose of intravenous dexmedetomidine for proper sedation with minimal recovery time in spinal anesthesia. METHODS: One hundred twenty eight patients, aged 20-70 years (58.8 ± 0.7), were recruited. After performing the spinal anesthesia with hyperbaric bupivacaine (13 mg), a loading dose of dexmedetomidine (1 µg/kg) was administered for 10 min, followed by the maintenance infusion of the following: Group A (n = 33; normal saline), Group B (n = 35; dexmedetomidine 0.2 µg/kg/hr), and Group C (n = 39; dexmedetomidine 0.4 µg/kg/hr). Heart rate, blood pressure, and the bispectral index score (BIS) were recorded during the operation. In the recovery room, modified aldrete score (MAS) was measured. RESULTS: There were no significant differences in mean blood pressure and heart rate among the three groups. BIS was not significantly different among the three groups from baseline to 60 min after the infusion of dexmedetomidine. BIS were significantly increased in Group A after 70 and 80 min, and Group A and B after 90, 100, 110 min of dexmedetomidine infusion (P < 0.05). MAS was higher in Group A as compared to Group B and C, within 30 min after admission in the recovery room (P < 0.05). CONCLUSIONS: The loading dose (1 µg/kg/10 min) of dexmedetomidine was sufficient for surgery of less than 60 min. Dexmedetomidine infusion followed by maintenance dose (0.2 µg/kg/hr) was sufficient for surgery within 90 min.
KEYWORDS: Dexmedetomidine, Sedation, Spinal anesthesia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668104/pdf/kjae-64-426.pdf


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668104/



Infusión de dexmedetomidina para analgesia y prevención de agitación durante la emergencia en niños con síndrome de apnea obstructiva del sueño sometidos a amigdalectomía y adenoidectomía

Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy.
Patel A, Davidson M, Tran MC, Quraishi H, Schoenberg C, Sant M, Lin A, Sun X.
Associate Department of Anesthesiology and Perioperative Medicine, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Medical Science, Newark, NJ 07101, USA. patelan@umdnj.edu
Anesth Analg. 2010 Oct;111(4):1004-10. doi: 10.1213/ANE.0b013e3181ee82fa. Epub 2010 Aug 12.
Abstract
BACKGROUND: Dexmedetomidine, a specific α(2) agonist, has an analgesic-sparing effect and reduces emergence agitation. We compared an intraoperative dexmedetomidine infusion with bolus fentanyl to reduce perioperative opioid use and decrease emergence agitation in children with obstructive sleep apnea syndrome undergoing adenotonsillectomy (T&A). METHODS: One hundred twenty-two patients with obstructive sleep apnea syndrome undergoing T&A, ages 2 to 10 years, completed this prospective, randomized, U.S. Food and Drug Administration-approved study. After mask induction with sevoflurane, group D received IV dexmedetomidine 2 μg * kg(-1) over 10 minutes, followed by 0.7 μg * kg(-1) * h(-1), and group F received IV fentanyl bolus 1 μg * kg(-1). Anesthesia was maintained with sevoflurane, oxygen, and nitrous oxide. Fentanyl 0.5 to 1 μg * kg(-1) was given to subjects in both groups for an increase in heart rate or systolic blood pressure 30% above preincision values that continued for 5 minutes. Observers in the postanesthesia care unit (PACU) were blinded to treatment groups. Pain was evaluated using the objective pain score in the PACU on arrival, at 5 minutes, at 15 minutes, then every 15 minutes for 120 minutes. Emergence agitation was evaluated at the same intervals by 2 scales: the Pediatric Anesthesia Emergence Delirium scale and a 5-point scale described by Cole. Morphine (0.05 to 0.1 mg * kg(-1)) was given for pain (score >4) or severe agitation (score 4 or 5) lasting more than 5 minutes. RESULTS: In group D, 9.8% patients needed intraoperative rescue fentanyl in comparison with 36% in group F (P = 0.001). Mean systolic blood pressure and heart rate were significantly lower in group D (P < 0.05). Minimum alveolar concentration values were significantly different between the 2 groups (P = 0.015). The median objective pain score was 3 for group D and 5 for group F (P = 0.001). In group D, 10 (16.3%) patients required rescue morphine, in comparison with 29 (47.5%) in group F (P = 0.002). The frequency of severe emergence agitation on arrival in the PACU was 18% in group D and 45.9% in group F (P = 0.004); at 5 minutes and at 15 minutes, it was lower in group D (P = 0.028). The duration of agitation on the Cole scale was statistically lower in group D (P = 0.004). In group D, 18% of patients and 40.9% in group F had an episode of Spo(2) below 95% (P = 0.01). CONCLUSIONS: An intraoperative infusion of dexmedetomidine combined with inhalation anesthetics provided satisfactory intraoperative conditions for T&A without adverse hemodynamic effects. Postoperative opioid requirements were significantly reduced, and the incidence and duration of severe emergence agitation was lower with fewer patients having desaturation episodes.
http://www.anesthesia-analgesia.org/content/111/4/1004.full.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

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Este mes en la historia de la anestesiología

         http://www.convention-center.net/artroscopia2013/


Este mes en la historia de la anestesiología


This month in anesthesia history: July
http://ahahq.org/Calendar/July.php


Perspectivas históricas de la parálisis facial: Antes y después de Sir Charles Bell

Historical perspectives of facial palsy: Before and after Sir Charles Bell to facial emotional expression.
Shelley BP.
Arch Med Health Sci [serial online] 2013 [cited 2013 Jun 21];1:85-8.

Sir Charles Bell (1774-1842), Scottish surgeon anatomist, and First Professor of Anatomy and Surgery at the Royal College of Surgeons, London has long been considered to be the first to describe idiopathic facial paralysis in the early 19 th century. Bell's most important works are in the fields of research on the brain and the nerves. His book, "An Idea of a New Anatomy of the Brain" (1811), has been called the "Magna Carta of Neurology." Sir Charles Bell was one of the chief practicing surgeons at the Middlesex Hospital in London. In 1814, he accepted a position as a surgeon at the Middlesex Hospital and was instrumental in the founding of the Middlesex Hospital and Medical School in London in 1828. Charles Bell joined the British army as a surgeon and had a unique opportunity to study facial gunshot injuries during the Napoleonic wars, most notably in the Battle of Waterloo. It was the battlefield experiences along with animal experiments done in his laboratory that led to his conclusion that the seventh cranial nerve controlled facial expression. In 1821, Sir Charles Bell described the anatomy of the facial nerve and its association with the unilateral facial palsy that bears his name.
http://www.amhsjournal.org/text.asp?2013/1/1/85/113590



Sir Geoffrey Marshall (1887-1982): Neumólogo, catalizador para el desarrollo de la anestesia, doctor del Primer Ministro y del Rey, y Comandante Barge en la I Guerra Mundial


Sir Geoffrey Marshall (1887-1982): respiratory physician, catalyst for anaesthesia development, doctor to both Prime Minster and King, and World War I Barge Commander
Neil H Metcalfe

J Med Biogr 2011 19: 10

Summary:
Sir Geoffrey Marshall was a remarkable, hard-working man who helped in the development of anaesthesia and respiratory medicine. Both were in someway helped by his military experiences in World War I, first when working on an ambulance barge and then in the Casualty Clearing Stations researching the increasing problem of surgical shock. Among a
multitude of high-ranking medical posts he also acted as Physician to King George VI and Sir Winston Churchill when they developed respiratory conditions.
http://jmb.sagepub.com/content/19/1/10.full.pdf+html



Personajes notables del Hospital Johns Hopkins Hospital representados en el material filatélico

Johns Hopkins Hospital notables portrayed on philatelic material
Federica Guaraldi, Davide Gori, Ralph Hruban, Patrizio Caturegli
Correspondence: Federica Guaraldi, Department of Pathology, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, USA (email: federica.guaraldi@yahoo.it)
J Med Biogr 2011 19: 161

The philatelic medium is an extensive repository of the portraits of doctors of many nations. Using an electronic matching system to identify links between the lists of alumni and faculties register of Johns Hopkins Hospital in Baltimore and that of three stamp catalogues, 14 notable persons have been identified in the philatelic record. The Johns Hopkins Hospital was established in Baltimore in 1889 and instituted the revolutionary concept of combining patient care with research and teaching. Its founder Johns Hopkins (1795-1873) and 13 among alumni and faculties have been portrayed on postage stamps and first day covers of USA, Canada, Antigua, Barbuda, Palau, Maldives, Canada and Sweden. Five of them - du Vigneaud (1901-78), Smith (b. 1931), Nathans (1928-99), Hubel (b. 1926) and Wiesel (b. 1924) - were awarded the Nobel Prize for Medicine or Physiology. By means of the philatelic medium, portraits of Hopkins scientists and doctors, including Sir William Osler (1849-1919) and Dr Virgina Apgar (1909-74), are distributed in their many tens of thousands on envelopes sent not only to recipients in the USA but to the wider world.
http://jmb.sagepub.com/content/19/4/161.full.pdf+html





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Controversias en Ablactación y Desarrollo de Alergia a Alimentos

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 31 de Julio 2013 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia:“Controversias en Ablactación y Desarrollo de Alergia a Alimentos” por la “Dra. Rosa Elena Huerta Hernández“ Alergóloga Pediatra, de la Cd. Pachuca Hidalgo La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador

http://connectpro60196372.adobeconnect.com/ablactacion_alergia/

2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia 6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.



Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La clinica 2520-310
Colonia Sertoma ,Mty N.L. México
CP 64710
Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx

PAPEL DE LA ARTROSCOPIA EN EL DIAGNÓSTICO Y TRATAMIENTO DE LA PATOLOGÍA DE CODO/ DR RUIZ/ dvd29 3

PAPEL DE LA ARTROSCOPIA EN EL DIAGNÓSTICO Y TRATAMIENTO DE LA PATOLOGÍA DE CODO/ DR RUIZ/ dvd29 3


ARTROSCOPIA
XXVII JORNADA NACIONAL DE ORTOPEDIA
58° REUNÍON ANUAL 2013
1° AL 5 DE MAYO 2013
ACAPULCO GRO. MÉXICO

http://youtu.be/CjusYr10wOg

TRATAMIENTO CON PRP/ DR JORGE ROMO

TRATAMIENTO CON PRP/ DR JORGE ROMO/ dvd19 5
MEDICINA DEL DEPORTE
XXVII JORNADA NACIONAL DE ORTOPEDIA
58° REUNION ANUAL 2013
DEL 1° AL 5 DE MAYO
ACAPULCO GRO., MÉXICO

http://youtu.be/p9_ROtoUbjM

Anesthetic implications of robotic gynecologic surgery

Implicaciones anestésicas de la cirugía ginecológica robótica


Anesthetic implications of robotic gynecologic surgery.
McLarney J T, Rose GL.
J Gynec Endosc Surg [serial online] 2011 [cited 2013 Jun 29];2:75-8.

Abstract

Surgery using robotic techniques is becoming more and more common. One of the specialties at the fore-front of robotic surgery has been gynecology, much like it was at the fore-front a generation ago in bringing laparoscopy into the operating room. New considerations have been noted and new techniques have been learned on both sides of the drape in order to ensure a successful outcome for the patient undergoing robotic gynecologic surgery. The purpose of this article is to bring, to light the concerns facing the anesthesiologist in regards to robotic procedures. We discuss the problems facing anesthesiologists, when a patient is experiencing both intraabdominal insufflation and steep Trendelenburg position, and also the intraoperative management of such a patient.
Keywords: Anesthesia, physiology of laparoscopy, perioperative management, robotic surgery
http://www.gynecendoscopy.org/text.asp?2011/2/2/75/114077

Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Más dexmedetomidina/More dexmedetomidine

Cuidados anestésicos monitorizados con dexmedetomidina: estudio prospectivo, randomizado, doble ciego y multicéntrico


Monitored anesthesia care with dexmedetomidine: a prospective, randomized, double-blind, multicenter trial.
Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W, Bekker AY; MAC Study Group. Collaborators (26)
Allard MW, Bekker AY, Bergese SD, Candiotti KA, Diamond EL, Doblar DD, Ebert TJ, Feldman M, Fisher RB, Gan TJ, Gayer S, Gottlieb IJ, Hartrick CT, Haynes GR, Lenkovsky F, Monk T, Moore PA, Pajewski TN, Philip BK, Ramsay MA, Ricardo R, Riedel BJ, Roberson CR, Shapiro FE, Silverstein JH, Stierer TL.
Division of Perioperative Medicine, University of Miami, Miami, Florida 33101, USA. kcandiot@med.miami.edu
Anesth Analg. 2010 Jan 1;110(1):47-56. doi: 10.1213/ane.0b013e3181ae0856. Epub 2009 Aug 27.
Abstract
BACKGROUND: Dexmedetomidine (DEX) is increasingly being used as a sedative for monitored anesthesia care (MAC) because of its analgesic properties, "cooperative sedation," and lack of respiratory depression. In this randomized, multicenter, double-blind, Phase III Food and Drug Administration study, we evaluated the safety and efficacy of two doses of DEX for sedation of patients undergoing a broad range of surgical or diagnostic procedures requiring MAC. METHODS: Three hundred twenty-six patients were randomized 2:2:1 to DEX 0.5 microg/kg, DEX 1 microg/kg, or saline placebo initial loading dose, followed by a maintenance infusion of 0.2-1.0 microg x kg(-1) x h(-1) of DEX (or equivalent volume of saline) titrated to a targeted level of sedation (< or = 4 on the Observer's Assessment of Alertness/Sedation Scale [OAA/S]). Study drug was started at least 15 min before placement of regional or local anesthetic block. Midazolam was given for OAA/S > 4 and fentanyl for pain. The primary end-point was the percentage of patients not requiring rescue midazolam. RESULTS: Significantly fewer patients in the 0.5- and 1-microg/kg DEX groups required supplemental midazolam compared with placebo (59.7% [80/134], 45.7% [59/129] vs 96.8% [61/63], respectively; P < 0.001) and at lower doses to achieve an OAA/S < or = 4 before and during surgery compared with the saline group (1.4 and 0.9 mg vs 4.1 mg, respectively; P < 0.001, each group compared with placebo). Both DEX groups required significantly less fentanyl (84.8 and 83.6 microg vs 144.4 microg, respectively; P < 0.001, for both DEX groups versus placebo) for all surgical subtypes. Anesthesiologists indicated significantly increased ease of achieving and maintaining targeted sedation in both DEX groups compared with placebo with midazolam (P < 0.001). Patient satisfaction was significantly higher with DEX (P < or = 0.009, both groups versus placebo). Common adverse events with DEX were protocol-defined bradycardia and hypotension that were predominately mild to moderate in severity. The incidence of clinically significant respiratory depression (defined as a respiratory rate of < 8 or an oxygen saturation of < 90%) was lower in DEX-treated patients (P = 0.018, for both groups versus placebo). CONCLUSIONS: DEX is an effective baseline sedative for patients undergoing MAC for a broad range of surgical procedures providing better patient satisfaction, less opioid requirements, and less respiratory depression than placebo rescued with midazolam and fentanyl.
http://www.anesthesia-analgesia.org/content/110/1/47.full.pdf




Dexmedetomidina para cuidados anestésicos monitorizados en pacientes sometidos al ¨Procedimiento Liberación¨ para la esclerosis múltiple: estudio observacional

Dexmedetomidine for monitored anesthesia care in patients undergoing liberation procedure for multiple sclerosis: An observational study.
Anand S, Bhatia A, Rajkumar, Sapra H, Gupta V, Mehta Y.
Institute of Critical Care and Anaesthesia Medanta, The Medicity, Gurgaon, Haryana, India.
Saudi J Anaesth. 2012 Oct-Dec;6(4):358-62. doi: 10.4103/1658-354X.105865.
Abstract
BACKGROUND: It has been postulated that Multiple sclerosis (MS) stems from a narrowing in the veins that drain blood from the brain, known medically as chronic cerebrospinal venous insufficiency, or CCSVI. It has been proposed that balloon angioplasty should alleviate the symptoms of MS. This procedure is also known as The "Liberation Procedure". Accordingly, a clinical study was undertaken to determine the effects of dexmedetomidine in patients undergoing the liberation procedure. AIMS: To assess the effectiveness of dexmedetomidine in providing adequate sedation and pain relief for patients undergoing the liberation procedure. SETTINGS AND DESIGN: A prospective, nonrandomized observational study of 60 consecutive adult patients undergoing the liberation procedure under monitored anesthesia care (MAC) who will receive dexmedetomidine as an anesthetic agent. METHODS: A total of 60 adult patients were enrolled in the study. Dexmedetomidine was administered to all patients in a loading dose of 1 mcg/kg, which was followed by a maintenance dose of 0.2-0.5 mcg/kg/h. The evaluation of quality of sedation was based on Ramsay Sedation and the quality of analgesia was assessed using the visual analog scale. The following parameters were measured continuously: heart rate, mean arterial pressure and hemoglobin oxygen saturation. Patients were asked to answer the question, "How would you rate your experience with the sedation you have received during surgery?" using a seven-point Likert-like verbal rating scale.STATISTICAL ANALYSIS: Repeated measurements were analyzed by repeated measures ANOVA for HR and BP. RESULTS: Most of our patients were satisfied with their sedation. In most of the patients, MAP and HR dropped after the bolus dose of dexmedetomidine, and the drop was statistically significant. CONCLUSIONS: Dexmedetomidine can be used as a sole sedative agent in patients undergoing the liberation procedure.
KEYWORDS: Dexmedetomidine, monitored anesthesia care, multiple sclerosis liberation procedure
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591554/



Efecto de la suplementación de dosis bajas de dexmedetomidina sobre las características de la anestesia raquídea con bupivacaína hiperbárica

Effect of supplementation of low dose intravenous dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine
Harsoor S S, Rani D D, Yalamuru B, Sudheesh K, Nethra S S.
Indian J Anaesth [serial online] 2013 [cited 2013 Jul 25];57:265-9.
Abstract
Aims: Intravenous (IV) dexmedetomidine with excellent sedative properties has been shown to reduce analgesic requirements during general anaesthesia. A study was conducted to assess the effects of IV dexmedetomidine on sensory, motor, haemodynamic parameters and sedation during subarachnoid block (SAB). Methods: A total of 50 patients undergoing infraumbilical and lower limb surgeries under SAB were selected. Group D received IV dexmedetomidine 0.5 mcg/kg bolus over 10 min prior to SAB, followed by an infusion of 0.5 mcg/kg/h for the duration of the surgery. Group C received similar volume of normal saline infusion. Time for the onset of sensory and motor blockade, cephalad level of analgesia and duration of analgesia were noted. Sedation scores using Ramsay Sedation Score (RSS) and haemodynamic parameters were assessed. Results: Demographic parameters, duration and type of surgery were comparable. Onset of sensory block was 66±44.14 s in Group D compared with 129.6±102.4 s in Group C. The time for two segment regression was 111.52±30.9 min in Group D and 53.6±18.22 min in Group C and duration of analgesia was 222.8±123.4 min in Group D and 138.36±21.62 min in Group C. The duration of motor blockade was prolonged in Group D compared with Group C. There was clinically and statistically significant decrease in heart rate and blood pressures in Group D. The mean intraoperative RSS was higher in Group D. Conclusion: Administration of IV dexmedetomidine during SAB hastens the onset of sensory block and prolongs the duration of sensory and motor block with satisfactory arousable sedation.
http://www.ijaweb.org/text.asp?2013/57/3/265/115616


http://www.ijaweb.org/temp/IndianJAnaesth573265-4928714_134127.pdf



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Fracturas Supracondíleas Humerales en Pacientes Pediátricos

Fracturas Supracondíleas Humerales en Pacientes Pediátricos

Fracturas Supracondíleas Humerales en Pacientes Pediátricos Dr. Jorge Gómez Chavarría. Ortopedia mixta. IMSS
http://t.co/BvSjryBWQl

Dexmedetomidina espinal/Spinal dexmedetomidine

Eficacia de dexmedetomidina intratecal versus dexmedetomidina con fentanilo intratecales en pacientes con cirugía abdominal mayor por cáncer


Efficacy of intrathecally administered dexmedetomidine versus dexmedetomidine with fentanyl in patients undergoing major abdominal cancer surgery.
Mohamed AA, Fares KM, Mohamed SA.
Pain Physician. 2012 Jul-Aug;15(4):339-48.
Abstract
BACKGROUND: Most of the clinical experience gained in the use of intrathecal alpha-2- adrenoceptor agonists has been described with clonidine. Human studies using a combination of intrathecal dexmedetomidine and local anesthetics are lacking. OBJECTIVES: A safety investigation and comparison of the analgesic efficacy of intrathecally administered dexmedetomidine or dexmedetomidine combined with fentanyl in patients undergoing major abdominal cancer surgery. STUDY DESIGN: A randomized, double-blind trial.SETTING:
Academic medical center. METHODS: Ninety patients were randomly assigned to receive intrathecally either 10 mg bupivacaine 0.5% (control group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine (dexmedetomidine group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine and 25 μg fentanyl (dexmedetomidine= group, n = 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 24 hours. RESULTS: The mean intraoperative heart rate was significantly reduced in the dexmedetomidine group (P < 0.05) and the dexmedetomidine= group (P < 0.05) compared with the control group. Also, there was a significant reduction in mean intraoperative systolic and diastolic blood pressure in the dexmedetomidine group (P < 0.05) and the dexmedetomidine= group (P < 0.05) compared with the control group, with no significant differences in postoperative hemodynamics or sedation scores among all the study groups. The mean visual analog scale scores showed a significant reduction immediately and at 12 hours postoperatively in both the dexmedetomidine and dexmedetomidine= groups compared to the control group. The mean time of the first analgesic request was significantly prolonged in the dexmedetomidine group (3.30 ± 0.87 hours, P < 0.01) and the dexmedetomidine= group (5.41 ± 1.23 hours, P < 0.01) compared with the control group (0.23 ± 0.11 hours). Moreover, postoperative tramadol consumption was significantly reduced in the dexmedetomidine (142.85 ± 13.04 mg, P < 0.01) and the dexmedetomidine= (131.25 ± 11.96 mg, P < 0.01) groups, compared with the control group (310.0 ± 12.08 mg). No significant serious adverse effects were recorded during the study. LIMITATIONS: This study is limited by its sample size. CONCLUSION: Dexmedetomidine 5 μg given intrathecally improves the quality and the duration of postoperative analgesia and also provides an analgesic sparing effect in patients undergoing major abdominal cancer surgery. Furthermore, the addition of intrathecal fentanyl 25 μg has no valuable clinical effect.
http://www.painphysicianjournal.com/2012/august/2012;15;339-348.pdf




Estudio comparativo de dexmedetomidina y fentanilo intratecales como adyuvantes de bupivacaína
A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine.
Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK.
Department of Anaesthesia, Chhatrapati Shahuji Maharaj Medical University, Uttar Pradesh, Lucknow, India.
J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):339-43. doi: 10.4103/0970-9185.83678.
Abstract
BACKGROUND: Various adjuvants have been used with local anesthetics in spinal anesthesia to avoid intraoperative visceral and somatic pain and to provide prolonged postoperative analgesia. Dexmedetomidine, the new highly selective α2-agonist drug, is now being used as a neuraxial adjuvant. The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of dexmedetomidine or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine. MATERIALS AND METHODS: Sixty patients classified in American Society of Anesthesiologists classes I and II scheduled for lower abdominal surgeries were studied. Patients were randomly allocated to receive either 12.5 mg hyperbaric bupivacaine plus 5 μg dexmedetomidine (group D, n = 30) or 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl (group F, n = 30) intrathecal. RESULTS: Patients in dexmedetomidine group (D) had a significantly longer sensory and motor block time than patients in fentanyl group (F). The mean time of sensory regression to S1 was 476±23 min in group D and 187±12 min in group F (P<0.001). The regression time of motor block to reach modified Bromage 0 was 421±21 min in group D and 149±18 min in group F (P<0.001). CONCLUSIONS: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability, and reduced demand for rescue analgesics in 24 h as compared to fentanyl.
KEYWORDS: Bupivacaine, dexmedetomidine, fentanyl, spinal anaesthesia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161458/



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

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