Vía aérea/Airway

Estudio observacional del grado de éxito de intubación e intubación fallida de la vía aérea con técnicas de rescate en 7256 intentos de intubación en pacientes de trauma por médicos prehospitalarios Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians. Lockey D, Crewdson K, Weaver A, Davies G. Br J Anaesth. 2014 Aug;113(2):220-5. doi: 10.1093/bja/aeu227. Abstract BACKGROUND: Effective airway management is a priority in early trauma management. Data on physician pre-hospital tracheal intubation are limited; this study was performed to establish the success rate for tracheal intubation in a physician-led system and examine the management of failed intubation and emergency surgical cricothyroidotomy in pre-hospital trauma patients. Failed intubation rates for anaesthetists and non-anaesthetists were compared. METHODS: A retrospective database review was conducted to identify trauma patients undergoing pre-hospital advanced airway management between September 1991 and December 2012. The success rate of tracheal intubation and the use and success of rescue techniques were established. Success rates of tracheal intubation by individuals and by speciality were recorded. RESULTS: The doctor-paramedic team attended 28 939 patients; 7256 (25.1%) required advanced airway management. A surgical airway was performed immediately, without attempted laryngoscopy, in 46 patients (0.6%). Tracheal intubation was successful in 7158 patients (99.3%). Rescue surgical airways were performed in 42 patients, seven had successful insertion of supraglottic devices, and two patients had supraglottic device insertion and a surgical airway. One patient breathed spontaneously with bag-valve-mask support during transfer. All rescue techniques were successful. Non-anaesthetists performed 4394 intubations and failed to intubate in 41 cases (0.9%); anaesthetists performed 2587 intubations and failed in 11 (0.4%) (P=0.02). CONCLUSIONS: This is the largest series of physician pre-hospital tracheal intubation; the success rate of 99.3% is consistent with other reported data. All rescue airways were successful. Non-anaesthetists were twice as likely to have to perform a rescue airway intervention than anaesthetists. Surgical airway rates reported here (0.7%) are lower than most other physician-led series (median 3.1%, range 0.1-7.7%).  PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Sistemas de respuesta rápido/Rapid response system

Sistemas de respuesta rápida: Revisión sistemática y meta-análisis Rapid response systems: a systematic review and meta-analysis Ritesh Maharaj, Ivan Raffaele and Julia Wendon. Critical Care (2015) 19:254 Introduction Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain. We conducted a meta-analysis to examine the impact of rapid response teams on hospital mortality and cardiopulmonary arrest. Method. We conducted a systematic review of studies published from January 1, 1990, through 31 December 2013, using PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library. We included studies that reported data on the primary outcomes of ICU and in-hospital mortality or cardiopulmonary arrests. Results: Twenty-nine eligible studies were identified. The studies were analysed in groups based on adult and paediatric trials that were further sub-grouped on methodological design. There were 5 studies that were considered either cluster randomized control trial, controlled before after or interrupted time series. The remaining studies were before and after studies without a contemporaneous control. The implementation of RRS has been associated with an overall reduction in hospital mortality in both the adult (RR 0.87, 95 % CI 0.81-0.95, p<0.001) and paediatric (RR=0.82 95 % CI 0.76-0.89) in-patient population. There was substantial heterogeneity in both populations. The rapid response system team was also associated with a reduction in cardiopulmonary arrests in adults (RR 0.65, 95 % CI 0.61-0.70, p<0.001) and paediatric (RR=0.64 95 % CI 0.55-0.74) patients. Conclusion. Rapid response systems were associated with a reduction in hospital mortality and cardiopulmonary arrest. Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Libro sobre Hipercolesterolemia/Free book on Hypercholesterolemia

Septiembre 17, 2015. No. 2088

Libro sobre Hipercolesterolemia Hypercholesterolemia Edited by Sekar Ashok Kumar, ISBN 978-953-51-2169-5, 232 pages, Publisher: InTech, Chapters published September 17, 2015 under CC BY 3.0 license   This book is aimed to accentuate the importance of hypercholesterolemia, since targeting and treating the hypercholesterolemia is increasingly well known as an essential strategy in the prevention of atherosclerosis-induced cardiovascular disease. It is important to look at hypercholesterolemia as it is proved to be crucial as well as the early stage of atherogenesis and can also be managed with appropriate treatment. This book describes the basics of hypercholesterolemia and its causes and various experimental animal models to understand and study the pathophysiology of hypercholesterolemia as well as to present practice-based clinical approaches to treat hypercholesterolemia. Further, the book describes various treatment strategies of hypercholesterolemia in detail, especially the appropriate use of statin. It is well known that the use of statin is an ideal as well as a potent therapy to lower cholesterol level and also has various beneficial pharmacological effects to prevent cardiovascular diseases. However, there exists less awareness about the use of statin. Hence, it is important to understand the appropriate use of statin in terms of doses for different stages of hypercholesterolemia, side effects, resistance of its use, and also interaction of statin with other drugs, which are well described in this book. In short, the major aim of this compendium is to present to the readers comprehensive, updated, and current research perspectives on hypercholesterolemia. Libro/Book

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Farmacodinamia en anestesia pediátrica/Pharmacodynamic in pediatric anesthesia

Septiembre 21, 2015. No. 2092

Modelos de interacciones farmacocinéticas en anestesia pediátrica Pharmacodynamic interaction models in pediatric anesthesia. Hannam JA, Anderson BJ. Paediatr Anaesth. 2015 Oct;25(10):970-80. doi: 10.1111/pan.12735. Epub 2015 Aug 4. Abstract Pharmacokinetic (PK) and pharmacodynamic (PD) models are important tools for summarizing drug dose, concentration, and effect relationships. Co-administration of drugs may alter PK and PD relationships. Traditional methods of evaluating PD interactions include using isoboles, shifts in dose-response curves, or interaction indices based on parameters of potency derived from separate monotherapy and combination therapy analyses. These methods provide an estimation of the magnitude of effect for dose or concentration combinations, but they do not inform us on the time course of that effect, or its associated variability. A better way to investigate PD interactions is to use modeling, and to take advantage of the benefits of population analyses. A population analysis is a statistical method in which a model describing the typical (or population) response, and the variability between individuals within that population, is developed. Models for monotherapy, derived using a population approach, can be combined and extended to incorporate PD interactions between two or more drugs. The purpose of this article was to provide a general road map for understanding and interpreting PD interaction models, including the 'response surface' models. Several types of response surface models exist, and here we review these with examples taken from the literature. We also consider current and future applications for this type of analysis for clinical anesthesia and pediatrics. Keywords: drug interactions, pharmacodynamics, pharmacokinetics, pharmacometrics, population modeling PDF

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Anemia en el Niño, hipocrómica microcítica, ¿como abordarla?

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 23 Septiembre 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Anemia en el Niño, hipocrómica microcítica, ¿como abordarla?” por el “Dr. Euler Chargoy Vivaldo”, Hematólogo Pediatra de la Cd. De Oaxaca Oax. 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/anemia_pediatria/
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.

Henrys


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

Más sobre BIS/More on BIS

Septiembre 19, 2015. No. 2090

Efecto del monitoreo BIS sobre los requerimientos de anestesia en TCI para microdiscectomía lumbar The effect of bispectral index monitoring on anaesthetic requirements in target-controlled infusion for lumbar microdiscectomy. Karwacki Z, Niewiadomski S, Rzaska M, Witkowska M. Anaesthesiol Intensive Ther. 2014 Sep-Oct;46(4):284-8. doi: 10.5603/AIT.2014.0046. CONCLUSION: BIS monitoring reduces the doses of opioids and hypnotics used during total intravenous anaesthesia by TCI. PDF Monitoreo BIS durante sedación con propofol y remifentanil para disección endoscópica submucosa. Bispectral index monitoring during anesthesiologist-directed propofol and remifentanil sedation for endoscopic submucosal dissection: a prospective randomized controlled trial. Park WY, Shin YS, Lee SK, Kim SY, Lee TK, Choi YS. Yonsei Med J. 2014 Sep;55(5):1421-9. doi: 10.3349/ymj.2014.55.5.1421. Abstract PURPOSE: Endoscopic submucosal dissection (ESD) is a technically difficult and lengthy procedure requiring optimal depth of sedation. The bispectral index (BIS) monitor is a non-invasive tool that objectively evaluates the depth of sedation. The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol, and thus reduce the incidence of sedation- and/or procedure-related complications. MATERIALS AND METHODS: A total of 180 patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups. The control group (n=90) was monitored by the Modified Observer's Assessment of Alertness and Sedation scale and the BIS group (n=90) was monitored using BIS. The total doses of propofol and remifentanil, the need for rescue propofol, and the rates of complications were recorded. RESULTS: The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group (47.8% vs. 30.0%, p=0.014). There were no significant differences in the incidence of sedation- and/or procedure-related complications. CONCLUSION: BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures. However, this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation. KEYWORDS: Bispectral index; endoscopic submucosal dissection; propofol; remifentanil PDF    BIS en la detección de dolor en pacientes adultos con ventilación mecánica en UCI The use of the bispectral index in the detection of pain in mechanically ventilated adults in the intensive care unit: a review of the literature. Coleman RM, Tousignant-Laflamme Y, Ouellet P, Parenteau-Goudreault É, Cogan J, Bourgault P. Pain Res Manag. 2015 Jan-Feb;20(1):e33-7. Epub 2014 Jul 22. Abstract BACKGROUND: Pain assessment is an immense challenge for clinicians, especially in the context of the intensive care unit, where the patient is often unable to communicate verbally. Several methods of pain assessment have been proposed to assess pain in this environment. These include both behavioural observation scales and evaluation of physiological measurements such as heart rate and blood pressure. Although numerous validation studies pertaining to behavioural observation scales have been published, several limitations associated with using these measures for pain assessment remain. Over the past few years, researchers have been interested in the use of the bispectral index monitoring system as a proxy for the evaluation of encephalography readings to assess the level of anesthesia and, potentially, analgesia. OBJECTIVES: To synthesize the main studies exploring the use of the bispectral index monitoring system for pain assessment, to guide future research in adults under sedation in the intensive care unit. METHOD: The EMBASE, Medline, CINAHL and PsycINFO databases were searched for studies published between 1996 and 2013 that evaluated the use of the bispectral index in assessing pain. RESULTS: Most studies conclude that nociceptive stimulation causes a significant increase in the bispectral index and revealed the importance of controlling certain confounding variables such as the level of sedation. DISCUSSION: Further studies are needed to clearly demonstrate the relationship between nociceptive stimuli and the bispectral index, as well as the specificity of the bispectral index in detecting pain. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015