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Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
martes, 6 de enero de 2015
Tópícos sobre transplantes / Topics in transplantation
domingo, 4 de enero de 2015
Aditivos espinales en cesárea / Spinal Additives for Cesarean Section
Comparación de dexmedetomidina espinal versus fentanilo espinal con bupivacaína epidural en analgesia obstétrica combinada
A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia .
Dilesh P K, Eapen S, Kiran S, Chopra V.
J Obstet Anaesth Crit Care [serial online] 2014 [cited 2014 Nov 1];4:69-74.
Abstract
Context: Combined spinal epidural (CSE) analgesia technique is effective for labor analgesia and various concentrations of bupivacaine and lipophilic opioids like fentanyl have been studied. Dexmedetomidine is a highly selective alpha 2 adrenoreceptor agonist with analgesic properties and has been used intrathecally with bupivacaine for prolonged postoperative analgesia. Recent reviews have shown that it is highly lipophilic and does not cross placenta significantly. Aim: The aim of this study is to compare the duration and quality of analgesia, maternal and neonatal outcomes after CSE labor analgesia with intrathecal dexmedetomidine and intrathecal fentanyl followed by epidural bupivacaine. Settings and Design: A randomized observational study with 112 parturients in a tertiary care hospital. Materials and Methods: 112 parturients were randomly divided to two groups. Group D (n = 58) received dexmedetomidine 10 μg and group F (n = 54) received fentanyl 20 μg intrathecally for labor analgesia. The time of onset, time to maximum analgesia, duration and quality of analgesia were noted. Maternal parameters of heart rate, noninvasive blood pressure, motor block and side-effects of pruritus, nausea and vomiting were recorded. Neonatal outcome in terms of mode of delivery, neonatal APGAR score, time to first cry, need for resuscitation, umbilical cord blood pH, initiation of breast feeding, Neurologic and Adaptive Capacity Score at 24 h and exclusivity of breast feeding at 6 weeks were recorded. Results: Duration of analgesia was 160.54 ± 52.4 min with dexmedetomidine and 124.1 ± 46.93 min with fentanyl (P < 0.001). Visual analog score (VAS) recorded at maximal analgesia was significantly lesser in the fentanyl group compared to dexmedetomidine group, denoting a significantly deeper level of analgesia with fentanyl. However, all the mothers in the dexmedetomidine group achieved a VAS <3 and were satisfied with the quality of analgesia. About 74% patients in the fentanyl group experienced pruritus after intrathecal injection whereas none of the mothers in dexmedetomidine group experienced pruritus (P < 0.001). There were no significant differences in neonatal outcome between the two groups. Conclusion: 10 μg dexmedetomidine intrathecally provides a longer duration of analgesia with lesser incidence of pruritus compared to 20 μg fentanyl intrathecally for CSE labor analgesia with comparable neonatal side-effects.
Keywords: Combined spinal epidural labor analgesia, dexmedetomidine, fentanyl
http://www.joacc.com/text.asp?2014/4/2/69/143875
http://www.joacc.com/downloadpdf.asp?issn=2249-4472;year=2014;volume=4;issue=2;spage=69;epage=74;aulast=Dilesh;type=2
Efecto ahorrador de bupivacaína con el midazolam intratecal en anestesia subaracnoidea para cesárea.
Bupivacaine sparing effect of intrathecal midazolam in sub-arachnoid block for cesarean section
Sanwal MK, Baduni N, Jain A..
J Obstet Anaesth Crit Care [serial online] 2013 [cited 2014 Nov 1];3:27-31.
Abstract
Background: Hypotension during subarachnoid block for caesarean section (CS) is the most common and potentially dangerous complication. Bupivacaine has been implicated for this effect in a dose dependent manner. Hypotension can be prevented by using lower doses of bupivacaine with intrathecal midazolam as an adjuvant drug, though the optimum dose-ratio of bupivacaine with midazolam remains unaddressed. Materials and Methods: A prospective, randomized, double-blind study was conducted enrolling 120 consecutive ASA grade I obstetric patients undergoing elective CS in a tertiary care hospital. A baseline supine position noninvasive blood pressure (BP) was recorded. All patients were preloaded with 500 ml of lactated Ringers' solution. Varying doses of 0.5% hyperbaric bupivacaine were used (7.5mg in group II, 6mg in group III and 5mg in group IV), in combination with 2mg midazolam in each group. Appropriately matched controls were given 11mg bupivacaine alone (Group I). Intra-operatively, BP was measured at every 2 minutes till 30 minutes and every 10 minutes thereafter. Hypotensive episodes [Systolic BP (SBP) < 100 mmHg] were recorded in each group. Quality of surgical anesthesia was graded as "excellent", "good" and "poor" as per the validated scoring system. The outcomes in different groups were compared by one-way ANOVA . intra group comparisons were done with t test. Results: All the four groups had 30 patients each. The incidence of hypotension was significantly lower in the groups using low-dose bupivacaine and midazolam, with a lesser fall in SBP than group I. Onset of sensory and motor blocks, and quality of surgical anesthesia were unaffected in group II while significant deterioration was noticed in groups III and IV. Conclusion: We found that 7.5 mg bupivacaine with 2 mg midazolam is the optimum dose ratio combination to be used in subarachnoid block for caesarean section.
Keywords: Cesarean section, intrathecal, midazolam, sub-arachnoid block
http://www.joacc.com/downloadpdf.asp?issn=2249-4472;year=2013;volume=3;issue=1;spage=27;epage=31;aulast=Sanwal;type=2
http://www.joacc.com/text.asp?2013/3/1/27/114288
Aditivos espinales en raquianestesia para operación cesárea
Spinal Additives in Subarachnoid Anaesthesia for Cesarean Section
Hala M. Goma, Juan C. Flores-Carrillo and Víctor Whizar-Lugo
Topics in Spinal Anaesthesia
Cesarean section is among the most commonly performed surgeries in women and neuroaxial anaesthesia is the technique of choice for this procedure. Although numerous side effects related to obstetric anaesthesia had been described, [1, 2, 3, 4] subarachnoid anaesthesia has a clear tendency to be used more often than epidural and combined spinal-epidural technique. It is safe, easy to perform, effective, low failure rate, no systemic local anaesthetic toxicity, inexpensive, prevents aspiration pneumonia, and has a high rate of maternal satisfaction. [5,6, 7] Produces a deep anaesthesia, inhibits the stress response to surgery, blunts the autonomic and somatic responses to pain, and facilitate breathing, coughing, sighing and early ambulation [8, 9] Finally, efferent sympathetic blockade results in increased blood flow to the blocked area resulting in better wound healing. It also reduces the risk of deep vein thrombosis and thromboembolism.
http://cdn.intechopen.com/pdfs-wm/47285.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia .
Dilesh P K, Eapen S, Kiran S, Chopra V.
J Obstet Anaesth Crit Care [serial online] 2014 [cited 2014 Nov 1];4:69-74.
Abstract
Context: Combined spinal epidural (CSE) analgesia technique is effective for labor analgesia and various concentrations of bupivacaine and lipophilic opioids like fentanyl have been studied. Dexmedetomidine is a highly selective alpha 2 adrenoreceptor agonist with analgesic properties and has been used intrathecally with bupivacaine for prolonged postoperative analgesia. Recent reviews have shown that it is highly lipophilic and does not cross placenta significantly. Aim: The aim of this study is to compare the duration and quality of analgesia, maternal and neonatal outcomes after CSE labor analgesia with intrathecal dexmedetomidine and intrathecal fentanyl followed by epidural bupivacaine. Settings and Design: A randomized observational study with 112 parturients in a tertiary care hospital. Materials and Methods: 112 parturients were randomly divided to two groups. Group D (n = 58) received dexmedetomidine 10 μg and group F (n = 54) received fentanyl 20 μg intrathecally for labor analgesia. The time of onset, time to maximum analgesia, duration and quality of analgesia were noted. Maternal parameters of heart rate, noninvasive blood pressure, motor block and side-effects of pruritus, nausea and vomiting were recorded. Neonatal outcome in terms of mode of delivery, neonatal APGAR score, time to first cry, need for resuscitation, umbilical cord blood pH, initiation of breast feeding, Neurologic and Adaptive Capacity Score at 24 h and exclusivity of breast feeding at 6 weeks were recorded. Results: Duration of analgesia was 160.54 ± 52.4 min with dexmedetomidine and 124.1 ± 46.93 min with fentanyl (P < 0.001). Visual analog score (VAS) recorded at maximal analgesia was significantly lesser in the fentanyl group compared to dexmedetomidine group, denoting a significantly deeper level of analgesia with fentanyl. However, all the mothers in the dexmedetomidine group achieved a VAS <3 and were satisfied with the quality of analgesia. About 74% patients in the fentanyl group experienced pruritus after intrathecal injection whereas none of the mothers in dexmedetomidine group experienced pruritus (P < 0.001). There were no significant differences in neonatal outcome between the two groups. Conclusion: 10 μg dexmedetomidine intrathecally provides a longer duration of analgesia with lesser incidence of pruritus compared to 20 μg fentanyl intrathecally for CSE labor analgesia with comparable neonatal side-effects.
Keywords: Combined spinal epidural labor analgesia, dexmedetomidine, fentanyl
http://www.joacc.com/text.asp?2014/4/2/69/143875
http://www.joacc.com/downloadpdf.asp?issn=2249-4472;year=2014;volume=4;issue=2;spage=69;epage=74;aulast=Dilesh;type=2
Efecto ahorrador de bupivacaína con el midazolam intratecal en anestesia subaracnoidea para cesárea.
Bupivacaine sparing effect of intrathecal midazolam in sub-arachnoid block for cesarean section
Sanwal MK, Baduni N, Jain A..
J Obstet Anaesth Crit Care [serial online] 2013 [cited 2014 Nov 1];3:27-31.
Abstract
Background: Hypotension during subarachnoid block for caesarean section (CS) is the most common and potentially dangerous complication. Bupivacaine has been implicated for this effect in a dose dependent manner. Hypotension can be prevented by using lower doses of bupivacaine with intrathecal midazolam as an adjuvant drug, though the optimum dose-ratio of bupivacaine with midazolam remains unaddressed. Materials and Methods: A prospective, randomized, double-blind study was conducted enrolling 120 consecutive ASA grade I obstetric patients undergoing elective CS in a tertiary care hospital. A baseline supine position noninvasive blood pressure (BP) was recorded. All patients were preloaded with 500 ml of lactated Ringers' solution. Varying doses of 0.5% hyperbaric bupivacaine were used (7.5mg in group II, 6mg in group III and 5mg in group IV), in combination with 2mg midazolam in each group. Appropriately matched controls were given 11mg bupivacaine alone (Group I). Intra-operatively, BP was measured at every 2 minutes till 30 minutes and every 10 minutes thereafter. Hypotensive episodes [Systolic BP (SBP) < 100 mmHg] were recorded in each group. Quality of surgical anesthesia was graded as "excellent", "good" and "poor" as per the validated scoring system. The outcomes in different groups were compared by one-way ANOVA . intra group comparisons were done with t test. Results: All the four groups had 30 patients each. The incidence of hypotension was significantly lower in the groups using low-dose bupivacaine and midazolam, with a lesser fall in SBP than group I. Onset of sensory and motor blocks, and quality of surgical anesthesia were unaffected in group II while significant deterioration was noticed in groups III and IV. Conclusion: We found that 7.5 mg bupivacaine with 2 mg midazolam is the optimum dose ratio combination to be used in subarachnoid block for caesarean section.
Keywords: Cesarean section, intrathecal, midazolam, sub-arachnoid block
http://www.joacc.com/downloadpdf.asp?issn=2249-4472;year=2013;volume=3;issue=1;spage=27;epage=31;aulast=Sanwal;type=2
http://www.joacc.com/text.asp?2013/3/1/27/114288
Aditivos espinales en raquianestesia para operación cesárea
Spinal Additives in Subarachnoid Anaesthesia for Cesarean Section
Hala M. Goma, Juan C. Flores-Carrillo and Víctor Whizar-Lugo
Topics in Spinal Anaesthesia
Cesarean section is among the most commonly performed surgeries in women and neuroaxial anaesthesia is the technique of choice for this procedure. Although numerous side effects related to obstetric anaesthesia had been described, [1, 2, 3, 4] subarachnoid anaesthesia has a clear tendency to be used more often than epidural and combined spinal-epidural technique. It is safe, easy to perform, effective, low failure rate, no systemic local anaesthetic toxicity, inexpensive, prevents aspiration pneumonia, and has a high rate of maternal satisfaction. [5,6, 7] Produces a deep anaesthesia, inhibits the stress response to surgery, blunts the autonomic and somatic responses to pain, and facilitate breathing, coughing, sighing and early ambulation [8, 9] Finally, efferent sympathetic blockade results in increased blood flow to the blocked area resulting in better wound healing. It also reduces the risk of deep vein thrombosis and thromboembolism.
http://cdn.intechopen.com/pdfs-wm/47285.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
El resurgir de las BIBLIOTECAS PÚBLICAS: suman socios y atraen público joven
http://richardebury.blogspot.mx/2014/11/el-resurgir-de-las-bibliotecas-publicas.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed:+IdentidadBibliotecaria+(Identidad+Bibliotecaria)
El resurgir de las BIBLIOTECAS PÚBLICAS: suman socios y atraen público joven
Por primera vez se sumaron a La Noche de los Libros.En la era de Internet habían perdido espacio. Pero las modernizaron y consiguieron acercar los ejemplares a la gente. Hoy ya se consultan 20 mil libros por mes.
En tiempos de e-books e Internet, las bibliotecas siguen siendo un bastión del libro. En sus salas confluyen jóvenes que van a estudiar con jubilados que se dan el gusto de leer a sus anchas. En las 29 que integran la red de Bibliotecas Públicas porteñas se consultan 20.000 libros por mes. Y ayer, por primera vez, participaron en La Noche de los Libros, organizada por los ministerios de Cultura y Desarrollo Económico de la Ciudad.
La red tiene 81.589 socios y cuenta con 360.468 ejemplares de 84.676 obras. En 15 de sus 29 bibliotecas hay dispositivos para leer e-books. Y existe un catálogo centralizado (catalogo.bibliotecas.gov.ar), que en lo que va del año recibió 224.488 consultas.
En una sala de planta baja de la Biblioteca Ricardo Güiraldes, en Retiro, los libros están al alcance de quien los desee. Igual que en una librería, la gente puede hojearlos y elegir el que quiera para leerlo allí o llevarlo a su casa. Prestan hasta tres a la vez, por 15 días. El bibliotecario siempre está cerca, para ayudar, sugerir y responder dudas.
Elsa Sábato, una historiadora del arte de 68 años, toma “El buen dolor”, de Guillermo Saccomanno. “Me gusta mucho esta generación de escritores argentinos”, cuenta. Hace seis años que se asoció a la red. “Desde que me jubilé, leo tres libros por semana –afirma–. Poder venir a este lugar y acceder a todos estos volúmenes es un sueño hecho realidad. Es mucho más de lo que yo podría adquirir”.
“La biblioteca es igualadora. A la Güiraldes vienen chicos de la Villa 31 y de los colegios privados de la zona para participar en los grupos de apoyo escolar”, apunta Alejandra Ramírez, la directora general del Libro, Bibliotecas y Promoción de la Lectura de la Ciudad, que tiene su oficina en el primer piso. La funcionaria admite que, en la era de Internet, las bibliotecas se alejaron de las personas y las personas de las bibliotecas, “Hoy eso se está revirtiendo. Para lograrlo, las modernizamos, armando estanterías abiertas para que la gente tenga contacto directo con los libros”. Según Ramírez, las bibliotecas públicas reciben muchos estudiantes, extranjeros y jubilados. Y lo que más se lee es la narrativa.
“Estudio Psicología y empecé a venir para buscar libros de estudio –cuenta Federico (22), en la Biblioteca Miguel–. Después comencé a llevarme literatura. En los prólogos de los libros, suelen recomendar otros, o le pido al bibliotecario que me aconseje. Leo unos cinco por mes”, asegura. Y muestra los tres que pidió prestados: las obras completas de Dostoyevski, “El extranjero”, de Albert Camus, y “Modernidad líquida”, del sociólogo Zygmunt Bauman.
“Llega toda clase de lectores, desde el que busca best sellers hasta el que quiere pensar y se lleva filosofía”, dice Osvaldo Ponce, el director de la biblioteca.
La Miguel Cané fue fundada en 1927 y, desde 1935, funciona en Carlos Calvo y Muñiz, Boedo. Sus muebles y estanterías son los mismos que estaban cuando, entre 1938 y 1946, Jorge Luis Borges fue auxiliar de la biblioteca. El padre de Bioy Casares se lo recomendó al entonces director, el poeta Francisco Bernardez. En el primer piso, hay un cuartito donde Borges solía leer y escribir, que ahora está dedicado al escritor. Hay primeras ediciones y ejemplares originales que leyó en ese lugar. Como Historia de la decadencia y caída del Imperio romano, de Edward Gibbon.
“Siempre se le dio un tratamiento a las bibliotecas como si fueran lugares solemnes, con libros intocables, cuando son lugares de familiarización con los libros y su función es acercárselos a la gente”, dice el ministro de Cultura porteño, Hernán Lombardi. Y explica que las sumaron a la Noche de las Librerías para darles visibilidad.
Participaron 50 bibliotecas, incluyendo a las 29 públicas, donde hubo desde encuentros corales hasta liberaciones de libros. La gente llevó un ejemplar para soltar y pudo apropiarse de otro, “olvidado” con la contraseña: “Llevame, estoy liberado”. Esta actividad también se hizo en la Miguel Cané, donde Borges se inspiró para escribir “La Biblioteca de Babel”. Un cuento que empieza así: “El universo (que otros llaman la Biblioteca) ...”
Fuente: http://www.clarin.com/ciudades/biblioetcas-resurgir-libros_0_1258074214.html Transplante hepático / Liver transplant
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sábado, 3 de enero de 2015
Feliz 2015/Happy 2015
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Más de transplante renal/More on kidney transplant
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