Taokinesis. Medicina y Traumatología del Deporte, Artroscopia, Rehabilitación: Lumbalgia en Deportistas

Taokinesis. Medicina y Traumatología del Deporte, Artroscopia, Rehabilitación: Lumbalgia en Deportistas: Hasta el 70% de las personas experimentan un dolor de espalda baja en su vida, en el deporte las lumbalgias pueden llegar a ser hasta el...

Vecuronio y rocuronio / Vecuronium and rocuronium

Abril 4, 2016. No. 2286

Hemodinámica intraoperatoria con vecuronio y rocuronio en el mantenimiento de la anestesia general Intraoperative hemodynamics with vecuronium bromide and rocuronium for maintenance under general anesthesia. Mathew A, Sharma AN, Ganapathi P, Shankaranarayana P, Nazim M, Aiyappa DS. Anesth Essays Res. 2016 Jan-Apr;10(1):59-64. doi: 10.4103/0259-1162.164740. Abstract AIMS:The present study is undertaken to compare the hemodynamic effects using vecuronium versus rocuronium for maintenance in patients undergoing general surgical procedures.SETTINGS AND DESIGN: It is a prospective, randomized, and cohort study. SUBJECTS AND METHODS: 100 patients were randomly divided into two groups. All patients were induced with 5 mg/kg of thiopentone sodium, and intubation conditions were achieved with 1.5 mg/kg of suxamethonium, using a well-lubricated cuffed endotracheal tube of appropriate size. When the patient started to breathe spontaneously, they were administered either 0.6 mg/kg of rocuronium (Group A) or 0.1 mg/kg of vecuronium (Group B). Hemodynamic parameters (heart rate and mean arterial pressure [MAP]) were monitored before administering the drug; at 1, 5, 10, 15, and 20 min after the drug and at the end of the surgery. STATISTICAL ANALYSIS USED: Data were compiled, analyzed and presented as frequency, proportions, mean, standard deviation, percentages, and t-test using SPSS (version 16). A P < 0.05 was considered as significant. RESULTS: The heart rate increased significantly at 1-min and 5-min after administration of rocuronium (83.76 ± 10.37 and 86.8 ± 9.98), unlike vecuronium.  However, it gradually declined towards normal, and change in heart rate with either drug was not significant beyond 10 min. The MAP decreased significantly at 1-min after administration of rocuronium (96.68 ± 7.57) which later showed a gradual increasing trend when compared to vecuronium which had no statistically significant change at any time. CONCLUSIONS: For short surgical procedures rocuronium is a good alternative to vecuronium, as the drug is reasonably cardio stable, produces excellent intubation conditions, has a shorter duration of action, and shows minimal cumulative effect. KEYWORDS: Hemodynamic changes; rocuronium; vecuronium PDF

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Vía aérea pediátrica / Pediatric airway

Marzo 31, 2016. No. 2282

Videolaringoscopios en anesthesia pediátrica. ¿Que hay Nuevo? Videolaryngoscopes in pediatric anesthesia: what's new? Fiadjoe JE, Kovatsis P. Minerva Anestesiol. 2014 Jan;80(1):76-82. Epub 2013 Sep 3. Abstract Anesthesiologists are increasingly turning to videolaryngoscopes (VLs) for normal and difficult endotracheal intubations. As children grow the airwayis in constant transition. This means that a device that works well in an older child may fail in an infant. Are VLs ideal in all children? What are the pitfalls and strengths of these devices? When are they indicated? How should their efficacy be assessed? Can they play a role in teaching standard laryngoscopy? This article explores these questions and reviews the literature relating to VLs use in children. PDF   Comparación del TruView EVO2 PCD™ y el laringoscopio C-MAC con el laringoscopio de Macintosh para intubación de rutina en infantes con vía aérea normal Comparison of the TruView infant EVO2 PCD™ and C-MAC video laryngoscopes with direct Macintosh laryngoscopy for routine tracheal intubation in infants with normal airways. Mutlak H, Rolle U, Rosskopf W, Schalk R, Zacharowski K, Meininger D, Byhahn C. Clinics (Sao Paulo). 2014 Jan;69(1):23-7. doi: 10.6061/clinics/2014(01)04. Abstract OBJECTIVE: Videolaryngoscopy has mainly been developed to facilitate difficult airway intubation. However, there is a lack of studies demonstrating this method's efficacy in pediatric patients. The aim of the present study was to compare the TruView infant EVO2 and the C-MAC videolaryngoscope with conventional direct Macintosh laryngoscopy in children with a bodyweight ≤10 kg in terms of intubation conditions and the time to intubation. METHODS: In total, 65 children with a bodyweight ≤10 kg (0-22 months) who had undergone elective surgery requiring endotracheal intubation were retrospectively analyzed. Our database was screened for intubations with the TruView infant EVO2, the C-MAC videolaryngoscope, and conventional direct Macintosh laryngoscopy. The intubation conditions, the time to intubation, and the oxygen saturation before and after intubation were monitored, and demographic data were recorded. Only children with a bodyweight ≤10 kg were included in the analysis. RESULTS: A total of 23 children were intubated using the C-MAC videolaryngoscope, and 22 children were intubated using the TruView EVO2. Additionally, 20 children were intubated using a standard Macintosh blade. The time required for tracheal intubation was significantly longer using the TruView EVO2 (52 sec vs. 28 sec for C-MAC vs. 26 sec for direct LG). However, no significant difference in oxygen saturation was found after intubation. CONCLUSION: All devices allowed excellent visualization of the vocal cords, but the time to intubation was prolonged when the TruView EVO2 was used. The absence of a decline in oxygen saturation may be due to apneic oxygenation via the TruView scope and may provide a margin of safety. In sum, the use of the TruView by a well-trained anesthetist may be an alternative for difficult airway management in pediatric patients. PDF Cueros extraños en la vía aérea. Revisión crítica de una emergencia pediátrica común Airway foreign bodies: A critical review for a common pediatric emergency. Salih AM, Alfaki M, Alam-Elhuda DM. World J Emerg Med. 2016;7(1):5-12. doi: 10.5847/wjem.j.1920-8642.2016.01.001. Abstract BACKGROUND: Airway foreign bodies (AFBs) is an interdisciplinary area between emergency medicine, pediatrics and otolaryngology. It is a life-threatening condition that is not infrequently seen; however, it is poorly covered in medical literature. Accidental aspiration of an element into airways is a widespread clinical scenario among children under 3 years, predominantly males. Moreover, it is the leading cause of infantile deaths and the fourth one among preschool children. DATA RESOURCES: A systemic search was conducted in July 2015 using PubMed/PubMed Central Database of The National Center for Biotechnology Information (NCBI) (http://www.ncbi.nlm.nih.gov/). A total of 1 767 articles were identified and most of them were meta-analyses, systematic reviews, and case series. Those thoroughly discussing assessment and management of AFBs were retrieved. RESULTS: AFBs episodes may be either witnessed or missed. Presence of a witness for the inhalation is diagnostic. The later usually present with persistent active cough. A classical triad of paroxysmal cough, wheezing, and dyspnoea/decreased air entry was reported, though many presentations have inconsistent findings. Hence, diagnosis requires high index of clinical suspicion. Flexible fibro-optic bronchoscopy is the gold standard of diagnosis, whereas inhaled objects are best retrieved by rigid bronchoscopes. CONCLUSIONS: Close supervision of pediatrics is the hallmark of prevention. Caregivers should ensure a safe surrounding milieu, including the toys their offspring play with. Immediate complications result from direct obstruction or injury by the inhaled object. Alternatively, prolonged lodging traps air and induces inflammatory response causing atelectesis and pneumonia, respectively. KEYWORDS: Airway foreign bodies; Airway obstruction; Aspiration/inhalation; Breathing difficulties; Café coronary syndrome PDF

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