Obesidad/Obesity

Cambios en la actividad física pre y postoperatorios en pacientes de cirugía bariátrica: autoreporte vs mediciones objetivas  Pre- to Postoperative Physical Activity Changes in Bariatric Surgery Patients: Self-Report vs. Objective Measures Dale S. Bond, John M. Jakicic, Jessica L. Unick, Sivamainthan Vithiananthan, Dieter Pohl, G. Dean Roye, Beth A. Ryder, Harry C. Sax and Rena R. Wing Obesity (2010) 18, 2395-2397. doi:10.1038/oby.2010.88 Bariatric surgery patients report significant pre- to postoperative increases in physical activity (PA). However, it is unclear whether objective measures would corroborate these changes. The present study compared self-reported and accelerometer-based estimates of changes in moderate-to-vigorous intensity PA (MVPA) from pre- (pre-op) to 6 months postsurgery (post-op). Twenty bariatric surgery (65% laparoscopic-adjustable gastric banding, 35% gastric bypass) patients (46.2 ± 9.8 years, 88% female, pre-op BMI = 50.8 ± 9.7 kg/m2) wore RT3 accelerometers as an objective measure of MVPA and completed the Paffenbarger Physical Activity Questionnaire (PPAQ) as a subjective measure before and 6 months after bariatric surgery. Time (min/week) spent in MVPA was calculated for the PPAQ and RT3 (≥1-min and ≥10-min bouts) at pre-op and post-op. Self-reported MVPA increased fivefold from pre-op to post-op (44.6 ± 80.8 to 212.3 ± 212.4 min/week; P < 0.005). By contrast, the RT3 showed nonsignificant decreases in MVPA for both ≥1-min (186.0 ± 169.0 to 151.2 ± 118.3 min/week) and ≥10-min (41.3 ± 109.3 to 39.8 ± 71.3 min/week) bouts. At pre-op, the percentage of participants who accumulated ≥150-in/week of MVPA in bouts ≥10-min according to the PPAQ and RT3 was identical (10%). However, at post-op, 55% of participants reported compliance with the recommendation compared to 5% based on RT3 measurement (P = 0.002). Objectively-measured changes in MVPA from pre-op to 6 months post-op appear to be much smaller than self-reported changes. Further research involving larger samples is needed to confirm these findings and to determine whether self-report and objective PA measures are differentially associated with surgical weight loss outcomes. http://onlinelibrary.wiley.com/doi/10.1038/oby.2010.88/pdf     Disfunción vascular en apnea obstructive del sueño y diabetes mellitus tipo 2  Vascular Dysfunction in Obstructive Sleep Apnea and Type 2 Diabetes Mellitus Susie Yim-Yeh, Shilpa Rahangdale, Anh Tu Duy Nguyen, Karen E. Stevenson, Victor Novack, Aristidis Veves  and Atul Malhotra Obesity (2011) 19, 17-22. doi:10.1038/oby.2010.116 Despite the high prevalence of obstructive sleep apnea (OSA) in type 2 diabetes mellitus (DM), the attributable vascular risk from each condition is unknown. We hypothesize that OSA may have a similar effect on vascular function as type 2 diabetes does. Healthy normal-weight subjects, healthy obese subjects, subjects with type 2 diabetes, and obese subjects with OSA were enrolled. Vascular function was assessed with brachial artery ultrasound for flowmediated dilatation (FMD) and in skin microcirculation by laser Doppler flowmetry. One hundred fifty-three subjects were studied: healthy normal-weight controls (NCs) (n = 14), healthy obese controls (OCs) (n = 33), subjects with DM (n = 68), and obese subjects with OSA (n = 38). The DM group did not undergo sleep study and thus may have had subclinical OSA. The OSA and type 2 diabetes groups had impaired FMD as compared to both the normal-weight and OC groups (5.8 ± 3.8%, 5.4 ± 1.6% vs. 9.1 ± 2.5%, 8.3 ± 5.1%, respectively, P < 0.001, post hoc Fischer test). When referenced to the NC group, a multiple linear regression model adjusting for covariates found that baseline brachial artery diameter (β = −3.75, P < 0.001), OSA (β = −2.45, P = 0.02) and type 2 diabetes status (β = −2.31, P = 0.02), negatively predicted % FMD. OSA status did not seem to affect nitroglycerin-induced vasodilation (endotheliumindependent) of the brachial artery or vascular function in the skin microcirculation. OSA impairs endothelial function in the brachial artery to a similar degree as type 2 diabetes does. OSA, however, does not appear to affect brachial endothelium-independent vasodilation or skin microcirculatory function. Treatment of OSA in patients with concomitant type 2 diabetes, therefore, may be a potential therapeutic option to improve macro-, but not microvascular outcomes. http://onlinelibrary.wiley.com/doi/10.1038/oby.2010.116/pdf  El efecto de la actividad física de 18 meses sobre el cambio de peso en adultos con sobrepeso meses   The Effect of Physical Activity on 18-Month Weight Change in Overweight Adults John M. Jakicic, Amy D. Otto, Wei Lang, Linda Semler, Carena Winters, Kristen Polzien and Kara I. Mohr Obesity (2011) 19, 100-109. doi:10.1038/oby.2010.122 Few studies have been conducted that have examined the long-term effect of different doses of physical activity (PA) on weight change in overweight adults without a prescribed reduction in energy intake. This study examined the effect of different prescribed doses of PA on weight change, body composition, fitness, and PA in overweight adults. Two hundred seventy-eight overweight adults (BMI: 25.0-29.9 kg/m2; age: 18-55 years) with no contraindications to PA were randomized to one of three intervention groups for a period of 18 months. MOD-PA was prescribed 150 min/week and HIGH-PA 300 min/week of PA. Self-help group (SELF) was provided a self-help intervention to increase PA. There was no recommendation to reduce energy intake. MOD-PA and HIGH-PA were delivered in a combination of in-person and telephone contacts across 18 months. 18-month percent weight change was −0.7 ± 4.6% in SELF, −0.9 ± 4.7% in MOD-PA, and −1.2 ± 5.6% in HIGH-PA. Subjects were retrospectively grouped as remaining within ±3% of baseline weight (WT-STABLE), losing >3% of baseline weight (WT-LOSS), or gaining >3% of baseline weight (WT-GAIN) for secondary analyses. 18-month weight change was 0.0 ± 1.3% for WT-STABLE, +5.4 ± 2.6% for WT-GAIN, and −7.4 ± 3.6% for WT-LOSS. 18-month change in PA was 78.2 ± 162.6 min/week for WT-STABLE, 74.7 ± 274.3 for WT-GAIN, and 161.9 ± 252.6 min/week for WT-LOSS. The weight change observed in WT-LOSS was a result of higher PA combined with improved scores on the Eating Behavior Inventory (EBI), reflecting the adoption of eating behaviors to facilitate weight loss. Strategies to facilitate the maintenance of these behaviors are needed to optimize weight control. http://onlinelibrary.wiley.com/doi/10.1038/oby.2010.122/pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Casos interesantes/Interesting cases

http://www.smo.edu.mx/jornada2013/






Ceguera postcarniectomía en posición supina: ¿Improbable o ignorada?


Post-craniotomy blindness in the supine position: Unlikely or ignored?.
Vahedi P, Meshkini A, Mohajernezhadfard Z, Tubbs R S.
Asian J Neurosurg [serial online] 2013 [cited 2013 Apr 8];8:36-41.



Immediate visual loss following craniotomy in the supine position is a disastrous complication in neurosurgical patients. The incidence is unknown and little is known on the definite pathogenesis. Also, preventive or restorative interventions are unclear. We describe the rare case of post-craniotomy optic neuropathy and sudden visual loss after craniotomy in the supine position for an olfactory groove meningioma, discuss the possible pathophysiology and review the literature on the pathogenesis, risk factors, and outcome. Although rare, neurosurgeons, as well as neuroanesthesiologists should be aware of the possibility of this devastating complication in the high-risk group of patients.
Keywords: Craniotomy, ischemic optic neuropathy, papilledema, pathophysiology, visual loss
http://www.asianjns.org/text.asp?2013/8/1/36/110278

Bloqueo del nervio popliteo guiado con ultrasonido en un paciente con degeneración maligna de neurofibromatosis 1
Ultrasound-guided popliteal nerve block in a patient with malignant degeneration of neurofibromatosis 1.
Desai A, Carvalho B, Hansen J, Hill J.
Department of Anesthesia, H3580, Stanford University School of Medicine, Stanford, CA 94305, USA.
Case Rep Anesthesiol. 2012;2012:753769. doi: 10.1155/2012/753769. Epub 2012 May 9.
Abstract
A 41-year-old female patient with neurofibromatosis 1 presented with new neurologic deficits secondary to malignant degeneration of a tibial lesion. Ultrasound mapping of the popliteal nerve revealed changes consistent with an intraneural neurofibroma. Successful popliteal nerve blockade was achieved under ultrasound guidance.
http://www.hindawi.com/crim/anesthesiology/2012/753769/



Lo más raro de lo raro
Rarer in a Rare.
Taksande B, Patil M M, Banode P, Deshpande R.
Ann Med Health Sci Res [serial online] 2013 [cited 2013 Mar 25];3:125-6.
Though moya moya disease is a disease of Asian origin, it is one of the very rare causes of stroke in India. It is a rare disease mainly characterized by progressive cerebrovascular episode due to the slowly progressive stenosis of supraclinoid segment of bilateral internal carotid arteries, the anterior and the middle cerebral arteries, and very rarely, posterior cerebral arteries. We hereby report a case of a young female who presented to us with the psychiatric complaints and refractory headache since her childhood. Therefore, we are reporting rarer (headache and neuropsychiatric) manifestations in the rare (moya moya) disease.
Keywords: Headache, Moya moya, Neuropsychiatry, Stroke
http://www.amhsr.org/text.asp?2013/3/1/125/109482


Afonía inducida por infartos bilaterales simultáneos de núcleo putamen: informe de caso y revisión de la literatura

Aphonia induced by simultaneous bilateral ischemic infarctions of the putamen nuclei: a case report and review of the literature
Vladimir V Senatorov1, Shirish Satpute1, Katherine Perry2, David M Kaylie3 and John W Cole
Journal of Medical Case Reports 2013, 7:83
Introduction
Isolated aphonia induced by acute stroke is a rare phenomenon with only a few cases reported in the literature. Case presentation. We report an unusual case of a 44-year-old African-American man with a history of hypertension, smoking and cocaine use who developed acute aphonia secondary to simultaneous ischemic infarctions of the bilateral putamen nuclei. Conclusion. We describe the clinical presentation of acute aphonia induced by bilateral putamen nuclei ischemic infarctions, correlating clinical symptoms with injury localization. We further highlight the anatomic and functional organization of the neural pathways involved.
http://www.jmedicalcasereports.com/content/pdf/1752-1947-7-83.pdf



Bloqueo del nervio frénico guiado con ultrasonido para el tratamiento del hipo: informe de caso

Phrenic nerve block with ultrasound-guidance for treatment of hiccups: a case report.
Kuusniemi K, Pyylampi V.
Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital, Luolavuorentie 2, Turku 20700, FI-20520, Finland. kristiina.kuusniemi@tyks.fi.
J Med Case Rep. 2011 Oct 3;5:493. doi: 10.1186/1752-1947-5-493.
Abstract
INTRODUCTION: Persistent hiccups can be more than a simple and short-lived nuisance and therefore sometimes call for serious consideration. Hiccupping episodes that last only a few minutes may be annoying, but persistent hiccups may initiate many major complications.
CASE PRESENTATION: A 72-year-old Caucasian man with spinal stenosis presented for L4-5 laminectomy under spinal anesthesia. The surgery and anesthesia, as well as the perioperative period, passed without any incident, except for persistent postoperative hiccups not responding to conservative and pharmacological treatment. Hiccups resulted in a prolonged hospital stay as they lasted until the seventh postoperative day. On that day, a right-sided ultrasound-guided phrenic nerve block with 5 ml of bupivacaine 5 mg/ml with epinephrine was performed successfully with a single-injection technique. Ten minutes after the procedure the hiccups vanished and a partial sensomotoric block of his right shoulder developed. No adverse effect occurred; our patient could be discharged on the same day and the hiccups did not return. CONCLUSION: Ultrasound provides us with non-invasive information regarding anatomy and allows anesthesiologists to visualize needle insertion, to identify the exact location of the injected solution and to avoid such structures as arteries or veins. As such, this method should be actively utilized. In cases where both pharmacological and non-pharmacological treatments prove to be ineffective when treating persistent hiccups, a single-shot ultrasound-guided technique should be considered before the patient becomes exhausted.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193825/pdf/1752-1947-5-493.pdf





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

Bibliotecas. Alerta

http://www.smo.edu.mx/jornada2013/



El alimento de las bibliotecas populares
Página 12
La Conabip aumentó a 10 millones de pesos el presupuesto para que unos 2800 bibliotecarios de todo el país adquieran libros a mitad de precio en los stands adheridos de la Feria del Libro. Y Quino recibirá el Premio Amigo de las Bibliotecas Populares.
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Página 12

Las bibliotecas de Badalona organizan tertulias 'on line'
La Vanguardia
Badalona. (Redacción). – Este martes empiezan las tertulias en línea de la web de las bibliotecas de Badalona. Se harán tres tertulias dedicadas a jóvenes, niños y adultos y a libros en inglés. El objetivo es trabajar en cada caso, durante dos meses ...
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Dos bibliotecas abrirán todos los fines de semana hasta julio
Gente Digital
El Ayuntamiento viene, desde hace años, abriendo las bibliotecas durante el día y la noche de los fines de semana, a lo largo del curso académico. Serán alrededor de 3.500 estudiantes los que harán uso de estos equipamientos municipales que ...
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El libro de la memoria visita bibliotecas populares
Crónica Digital
En esta oportunidad la red de bibliotecas populares solicitó ser parte de la iniciativa. El jueves pasado el Libro estuvo en la biblioteca “De Puerto Madryn” que preside Carlos Pascuariello (h), quien destacó la posibilidad de plasmar de esta manera ...
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Crónica Digital

Entregan paquetes de 551 Libros a bibliotecas públicas del Oriente
Cambio (Michoacán)
Gregorio García comentó que el material deberá de ser clasificado. En aquellas bibliotecas en donde el espacio sea insuficiente, se recomienda realizar acciones de descarte de libros en desuso y de aquel que ya está muy deteriorado, para dejar espacio ...
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Molina dice que el PSOE vuelve a dar otra lección de cinismo con el ...
Noticias de la Villa
El concejal de Bibliotecas, Manuel Molina, ha contestado este mediodía a la denuncia que ha hecho el PSOE de Los Barrios donde califica de “total dejadez” en el mantenimiento de la nueva BibliotecaMunicipal. Molina dice que el PSOE vuelve a dar otra ...
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La Diputación de Cáceres fomenta la lectura en 14 localidades de ...
Lainformacion.com
Un total de 14 municipios de la provincia se verán beneficiados con la campaña de animación 'Tesoros de Papel 2013' que la Diputación de Cáceres y la Asociación de Gestores Culturales de Extremadura han diseñado con el objetivo de promocionar el ...
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El carné de bibliotecas permitirá obtener descuentos en las ...
Madridpress.com
Los usuarios de la tarjeta de la red de bibliotecas del Ayuntamiento de Madrid podrán acceder a descuentos en entradas de teatro y otros espectáculos municipales, como ha anunciado este lunes la alcaldesa de la capital, Ana Botella. Fuentes del área de ...
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Bibliotecas para manipular la historia - DesEquiLIBROS
Hay bibliotecas cuyo principal objetivo es manipular la historia. Este es el caso de la George W. Bush Library.
desequilibros.blogspot.com/.../bibliotecas-para-manipular-la-hi...

Bibliomanazteca

http://bibliomanazteca.jimdo.com/
https://twitter.com/bibliomanazteca
http://paveca3.blogspot.mx/
https://www.youtube.com/user/biblioman1000/videos?view=0&flow=grid
https://www.facebook.com/victor.ravens
bibliomanazteca@yahoo.com.mx
http://www.livestream.com/bibliomanazteca_platicas_medicas
http://pinterest.com/bibliomanazteca/
https://plus.google.com/u/0/b/109860701305106468568/1098607013051
http://klout.com/#/bibliomanazteca/
http://paper.li/bibliomanazteca
http://bibliomanazteca.wordpress.com/
http://bibliomanazteca.tumblr.com/

Medicina alternativa y anestesia/Alternative medicine and anesthesia

http://www.flickr.com//photos/bibliomanazteca/sets/72157633309036463/show/

Medicina alternativa y anestesia: Implicaciones y consideraciones en la práctica diaria  Alternative medicine and anesthesia: Implications and considerations in daily practice. Bajwa SS, Panda A. AYU [serial online] 2012 [cited 2013 Apr 12];33:475-80. Nowadays, herbal medicines are widely used by most of the people, including the pre-surgical population. These medicines may pose numerous challenges during perioperative care. The objective of the current literature review is to dwell upon the impact of the use of herbal medicines during the perioperative period, and to review the strategies for managing their perioperative use. The data was generated from various articles of different journals, text books, web source, including, Entrez Pubmed, Medscape, WebMD, and so on. Selected only those herbal medicines for which information on, safety, usage, and precautions during the perioperative period was available. Thereafter, the information about safety, pharmacokinetics, and pharmacodynamics from selected literature was gathered and analyzed. The whole review focused on the fact that these commonly used alternative medicines could sometimes pose as a concern during the perioperative period, in various ways. These complications could be due to their direct action, pharmacodynamic effect, or pharmacokinetic effect. In view of the serious impacts of herbal medicine usage in perioperative care, the anesthesiologist should take a detailed history, especially stressing on the use of herbal medicine during the preoperative anesthetic assessment. The anesthesiologist should also be aware of the potential perioperative effects of those drugs. Accordingly, steps should to be taken to prevent, recognize, and treat the complications that may arise due to their use or discontinuation. Keywords: Anesthesia, Ayurveda, Echinacea, ephedra, garlic, ginger, herbal medicines http://www.ayujournal.org/text.asp?2012/33/4/475/110515

Atentamente Dr. Benito Cortes-Blanco Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Prensa digital en 2011-2012

http://www.smo.edu.mx/jornada2013/

http://www.thinkepi.net/prensa-digital-2011-2012?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+thinkepi+%28ThinkEPI%29&utm_content=Yahoo%21+Mail


Prensa digital en 2011-2012
30 abril, 2013 Por Javier Guallar
en Notas ThinkEPI 2013

Introducción

Desde el inicio (2008-2009) de la crisis económica actual, el panorama de la prensa digital se caracteriza por dos cuestiones clave que permanecen bastante estables año tras año. Por un lado, las empresas periodísticas aparecen estranguladas por la crisis de su modelo de negocio, las reducciones de sus ingresos y la necesidad de hacerles frente (reducciones de personal y de inversiones, debate sobre el pago por contenidos). En segundo lugar, se ven lanzadas a un proceso de tránsito de sus productos hacia la plena inserción en la denominada era postPC, caracterizada por la diversificación del consumo de información en múltiples plataformas, desde las ya clásicas, papel y web (ordenador personal) a las emergentes, tablets y smartphones.

En esta nota trataremos de manera sucinta, además de esos dos temas señalados -tendencias de largo recorrido-, otros que nos han llamado la atención en los años 2011-2012, como la aparición de nuevas cabeceras, algunas tendencias emergentes como el periodismo de datos, el fact checking, los micromedios y el crowdfunding....

Bibliotecas. Alerta

http://www.smo.edu.mx/jornada2013/



Modernizarán bibliotecas en 12 municipios de Sonora
Milenio.com
En el caso de este municipio, además del mejoramiento de las bibliotecas de la zona urbana, agregó que también se hará la labor en la del poblado pesquero Golfo de Santa Clara. "Para fomentar el hábito de la lectura y despertar el interés en los textos ...
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Milenio.com

Los usuarios del carné de las bibliotecas municipales podrán ...
elEconomista.es
El anuncio lo ha hecho la alcaldesa durante la inauguración de la biblioteca Eugenio Trías, en la antigua Casa de Fieras del Retiro. Se une así a una red que en los últimos siete meses cuenta con nuevas dependencias, como las de Conde Duque y la Ana ...
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Las bibliotecas no pueden ser sólo libros: Carolina Jaramillo
Excélsior
Cuando asumió la dirección de la Biblioteca Vasconcelos, en marzo pasado, el editor Daniel Goldin manifestó su propósito de firmar convenios con instituciones “hermanas” como la biblioteca pública de Santiago en Chile y con las colombianas de ...
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Las bibliotecas de las pedanías superan la media española de ...
Información
m. josé sanmartín Las bibliotecas de las pedanías ilicitanas, como son Pedro Salinas en El Altet, José Fuentes en Torrellano y la de La Marina, registraron durante 2012 los mayores índices de visitas por número de habitantes de todo Elche. De hecho ...
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Información


Marín anima a familias, profesores y bibliotecas a que fomenten la ...
Te Interesa
El consejero de Educación, Cultura y Deportes, Marcial Marín, ha animado a las familias, a los profesores y a las bibliotecas a que fomenten la lectura para que así mejoren los hábitos de lectura de los escolares castellano-manchegos. Durante la ...
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Te Interesa

Subsidios para bibliotecas populares - Momarandu
Momarandu.com
Simultáneamente se hizo entrega a dichas bibliotecas de un libro del Centenario del Teatro Vera de nuestra ciudad, que se presentará el 1 de mayo en la Feria Internacional del libro en Buenos Aires. El acto se realizó hoy (lunes 29 de abril) en el ...
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Red Solidaria y "Un abrazo solidario con libros"
TN.com.ar
AYUDA. Colaborá con Red Solidaria para reconstruir bibliotecas. Colectivo Imaginario y Red Solidaria lanzaron la campaña "Un abrazo solidario con libros" con la que te invitan a colaborar con lasbibliotecas destuidas en la últmas inundaciones. Desde ...
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Target planea renovar 25 bibliotecas escolares en 2013 | Target ...
Junto con The Heart of America Foundation, la cadena de tiendas espera fomentar el amor de los estudiantes por la lectura con nuevas bibliotecas, donaciones ...
pressroom.target.com/.../target-planea-renovar-25-bibliotecas-...

Coagulopatía posttraumática/Posttraumatic coagulopathy

http://www.smo.edu.mx/jornada2013/


La coagulopatía leve y retrasada se relaciona con la evolución de los pacientes con lesión cerebral traumática aislada


Acute and delayed mild coagulopathy are related to outcome in patients with isolated traumatic brain injury.
Greuters S, van den Berg A, Franschman G, Viersen VA, Beishuizen A, Peerdeman SM, Boer C; ALARM-BLEEDING investigators.
Source
Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. s.greuters@vumc.nl
Crit Care. 2011;15(1):R2. doi: 10.1186/cc9399. Epub 2011 Jan 5.
Abstract
INTRODUCTION: The relationship between isolated traumatic brain injury (TBI) associated coagulopathy and patient prognosis frequently lacks information regarding the time course of coagulation disorders throughout the post-traumatic period. This study was conducted to assess the prevalence and time course of post-traumatic coagulopathy in patients with isolated TBI and the relationship of these hemostatic disorders with outcome. METHODS: The local Human Subjects Committee approved the study. We retrospectively studied the medical records of computed tomography (CT)-confirmed isolated TBI patients with an extracranial abbreviated injury scale (AIS) <3 who were primarily referred to a Level 1 trauma centre in Amsterdam (n = 107). Hemostatic parameters including activated partial thromboplastin time (aPTT), prothrombin time (PT), platelet count, hemoglobin, hematocrit, glucose, pH and lactate levels were recorded throughout a 72-hour period as part of a routine standardized follow-up of TBI. Coagulopathy was defined as a aPPT >40 seconds and/or a PTT in International Normalized Ratio (INR) >1.2 and/or a platelet count <120*109/l. RESULTS: Patients were mostly male, aged 48 ± 20 years with a median injury severity score of 25 (range 20 to 25). Early coagulopathy as diagnosed in the emergency department (ED) occurred in 24% of all patients. The occurrence of TBI-related coagulopathy increased to 54% in the first 24 hours post-trauma. In addition to an increased age and disturbed pupillary reflex, both coagulopathy upon ED arrival and during the first 24 hours post-trauma provided an independent prognostic factor for unfavorable outcome (odds ratio (OR) 3.75 (95% CI 1.07 to 12.51; P = 0.04) and OR 11.61 (2.79 to 48.34); P = 0.003). CONCLUSIONS: Our study confirms a high prevalence of early and delayed coagulopathy in patients with isolated TBI, which is strongly associated with an unfavorable outcome. These data support close monitoring of hemostasis after TBI and indicate that correction of coagulation disturbances might need to be considered.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222029/pdf/cc9399.pdf


La tromboelastografía y tromboelastometría para evaluar la coagulopatía por trauma
Thrombelastography and tromboelastometry in assessing coagulopathy in trauma.
Johansson PI, Stissing T, Bochsen L, Ostrowski SR.
Regional Blood Bank, Rigshospitalet, University of Copenhagen, Denmark. per.johansson@rh.regionh.dk
Scand J Trauma Resusc Emerg Med. 2009 Sep 23;17:45. doi: 10.1186/1757-7241-17-45.
Abstract
Death due to trauma is the leading cause of lost life years worldwide, with haemorrhage being responsible for 30-40% of trauma mortality and accounting for almost 50% of the deaths the initial 24 h. On admission, 25-35% of trauma patients present with coagulopathy, which is associated with a several-fold increase in morbidity and mortality. The recent introduction of haemostatic control resuscitation along with emerging understanding of acute post-traumatic coagulability, are important means to improve therapy and outcome in exsanguinating trauma patients. This change in therapy has emphasized the urgent need for adequate haemostatic assays to monitor traumatic coagulopathy and guide therapy. Based on the cell-based model of haemostasis, there is emerging consensus that plasma-based routine coagulation tests (RCoT), like prothrombin time (PT) and activated partial thromboplastin time (APTT), are inappropriate for monitoring coagulopathy and guide therapy in trauma. The necessity to analyze whole blood to accurately identify relevant coagulopathies, has led to a revival of the interest in viscoelastic haemostatic assays (VHA) such as Thromboelastography (TEG) and Rotation Thromboelastometry (ROTEM). Clinical studies including about 5000 surgical and/or trauma patients have reported on the benefit of using the VHA as compared to plasma-based assays, to identify coagulopathy and guide therapy. This article reviews the basic principles of VHA, the correlation between the VHA whole blood clot formation in accordance with the cell-based model of haemostasis, the current use of VHA-guided therapy in trauma and massive transfusion (haemostatic control resuscitation), limitations of VHA and future perspectives of this assay in trauma.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758824/pdf/1757-7241-17-45.pdf



Definición funcional y caracterización de la coagulopatía aguda traumática

Functional definition and characterization of acute traumatic coagulopathy.
Davenport R, Manson J, De'Ath H, Platton S, Coates A, Allard S, Hart D, Pearse R, Pasi KJ, MacCallum P, Stanworth S, Brohi K.
Trauma Sciences, Blizard Institute of Cell and Molecular Science, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, UK.
Crit Care Med. 2011 Dec;39(12):2652-8. doi: 10.1097/CCM.0b013e3182281af5.
Abstract
OBJECTIVE: To identify an appropriate diagnostic tool for the early diagnosis of acute traumatic coagulopathy and validate this modality through prediction of transfusion requirements in trauma hemorrhage. DESIGN: Prospective observational cohort study. SETTING: Level 1 trauma center. PATIENTS: Adult trauma patients who met the local criteria for full trauma team activation. Exclusion criteria included emergency department arrival >2 hrs after injury, >2000 mL of intravenous fluid before emergency department arrival, or transfer from another hospital.
INTERVENTIONS: None.MEASUREMENTS: Blood was collected on arrival in the emergency department and analyzed with laboratory prothrombin time, point-of-care prothrombin time, and rotational thromboelastometry. Prothrombin time ratio was calculated and acute traumatic coagulopathy defined as laboratory prothrombin time ratio >1.2. Transfusion requirements were recorded for the first 12 hrs following admission. MAIN RESULTS: Three hundred patients were included in the study. Laboratory prothrombin time results were available at a median of 78 (62-103) mins. Point-of-care prothrombin time ratio had reduced agreement with laboratory prothrombin time ratio in patients with acute traumatic coagulopathy, with 29% false-negative results. In acute traumatic coagulopathy, the rotational thromboelastometry clot amplitude at 5 mins was diminished by 42%, and this persisted throughout clot maturation. Rotational thromboelastometry clotting time was not significantly prolonged. Clot amplitude at a 5-min threshold of ≤35 mm had a detection rate of 77% for acute traumatic coagulopathy with a false-positive rate of 13%. Patients with clot amplitude at 5 mins ≤35 mm were more likely to receive red cell (46% vs. 17%, p < .001) and plasma (37% vs. 11%, p < .001) transfusions. The clot amplitude at 5 mins could identify patients who would require massive transfusion (detection rate of 71%, vs. 43% for prothrombin time ratio >1.2, p < .001). CONCLUSIONS: In trauma hemorrhage, prothrombin time ratio is not rapidly available from the laboratory and point-of-care devices can be inaccurate. Acute traumatic coagulopathy is functionally characterized by a reduction in clot strength. With a threshold of clot amplitude at 5 mins of ≤35 mm, rotational thromboelastometry can identify acute traumatic coagulopathy at 5 mins and predict the need for massive transfusion.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223409/pdf/ukmss-36410.pdf




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

Control de infecciones y anestesia/Infection control and anesthesia

http://www.smo.edu.mx/jornada2013/

Prevención de infecciones durante la ventilación en anestesia utilizando filtros respiratorios.


Infection prevention during anaesthesia ventilation by the use of breathing system filters (BSF): Joint recommendation by German Society of Hospital Hygiene (DGKH) and German Society for Anaesthesiology and Intensive Care (DGAI).
Kramer A, Kranabetter R, Rathgeber J, Züchner K, Assadian O, Daeschlein G, Hübner NO, Dietlein E, Exner M, Gründling M, Lehmann C, Wendt M, Graf BM, Holst D, Jatzwauk L, Puhlmann B, Welte T, Wilkes AR.
Institute for Hygiene and Environmental Medicine, University Greifswald, Germany.
GMS Krankenhhyg Interdiszip. 2010 Sep 21;5(2). pii: Doc13. doi: 10.3205/dgkh000156.
Abstract
An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anaesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anaesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anaesthetic system. The anaesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use.THE BREATHING SYSTEM AND THE MANUAL VENTILATION BAG ARE CHANGED IMMEDIATELY AFTER THE RESPECTIVE ANAESTHESIA IF THE FOLLOWING SITUATION HAS OCCURRED OR IT IS SUSPECTED TO HAVE OCCURRED: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.g. tuberculosis, acute viral hepatitis, measles, influenza virus, infection and/or colonisation with a multi-resistant pathogen or upper or lower respiratory tract infections. In case of visible contamination e.g. by blood or in case of defect, it is required that the BSF and also the anaesthesia breathing system is changed and the breathing gas conducting parts of the anaesthesia ventilator are hygienically reprocessed.Observing of the appropriate hand disinfection is very important. All surfaces of the anaesthesia equipment exposed to hand contact must be disinfected after each case.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951096/pdf/KHI-05-13.pdf




Control de infecciones en anestesia

Infection control in anaesthesia.
Association of Anaesthetists of Great Britain and Ireland.
Anaesthesia. 2008 Sep;63(9):1027-36. doi: 10.1111/j.1365-2044.2008.05657.x.
1.0. Summary
(1) A named consultant in each department of anaesthesia should liaise with Trust Infection Control Teams and Occupational Health Departments to ensure that relevant specialist standards are established and monitored in all areas of anaesthetic practice. (2) Precautions against the transmission of infection between patient and anaesthetist or between patients should be a routine part of anaesthetic practice. In particular, anaesthetists must ensure that hand hygiene becomes an indispensable part of their clinical culture. (3) Anaesthetists must comply with local theatre infection control policies including the safe use and disposal of sharps. (4) Anaesthetic equipment is a potential vector for transmission of disease. Policies should be documented to ensure that nationally recommended decontamination practices are followed and audited for all reusable anaesthetic equipment. (5) Single use equipment should be utilised where appropriate but a sterile supplies department (SSD) should process reusable items. (6) An effective, new bacterial viral breathing circuit filter should be used for every patient and a local policy developed for the re-use of breathing circuits in line with manufacturer's instructions. The AAGBI recommends that anaesthetic departments should consider changing anaesthetic circuits (7) Appropriate infection control precautions should be established for each anaesthetic procedure, to include maximal barrier precautions for the insertion of central venous catheters, spinal and epidural procedures and any invasive procedures in high risk patients.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773534/pdf/ana0063-1027.pdf




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

Artritis reumatoide juvenil

http://www.smo.edu.mx/jornada2013/



Eficacia, farmacocinética y seguridad del adalimumab en pacientes pediátricos con artritis idiopática en Japón


Efficacy, pharmacokinetics, and safety of adalimumab in pediatric patients with juvenile idiopathic arthritis in Japan.
Imagawa T, Takei S, Umebayashi H, Yamaguchi K, Itoh Y, Kawai T, Iwata N, Murata T, Okafuji I, Miyoshi M, Onoe Y, Kawano Y, Kinjo N, Mori M, Mozaffarian N, Kupper H, Santra S, Patel G, Kawai S, Yokota S.
Yokohama City University, Japan. timagawa@ca2.so-net.ne.jp
Clin Rheumatol. 2012 Dec;31(12):1713-21. doi: 10.1007/s10067-012-2082-5.
Abstract
The objective of this study was to evaluate the efficacy, pharmacokinetics, and safety of adalimumab in patients with polyarticular juvenile idiopathic arthritis (JIA) in Japan. Patients aged 4 to 17 years were enrolled in a single-arm, open-label, multicentre study of adalimumab. Patients weighing <30 kg received 20 mg every other week (eow), and those ≥30 kg received 40 mg eow. Concomitant methotrexate (MTX) was allowed (≤10 mg/m(2) per week). The primary efficacy outcome was the percent of patients with American College of Rheumatology Pediatric 30 response (ACR Pedi 30) at week 16. JIA core variables, serum adalimumab concentrations, and anti-adalimumab antibodies (AAAs) were analysed. Patients were monitored for adverse events (AEs). Twenty-five patients (20 with concomitant MTX at baseline and 5 without) were enrolled: 24 patients completed 16 weeks of therapy and 22 patients completed 60 weeks. At week 16, 90 % of patients with MTX and 100 % without MTX achieved ACR Pedi 30; response rates were maintained through week 60 in 94 and 80 % of patients, respectively. Each JIA core variable improved over time. Six patients became AAA positive (two each at weeks 8, 16, and 60), some of which were transient. All six AAA-positive patients achieved ACR Pedi 30 at week 16, and four maintained that response at week 60. Six patients (all with MTX) experienced nine serious AEs (JIA, pyrexia, arthralgia, pneumonia, hepatitis B infection, pharyngitis, dehydration, pharyngeal pain, and pneumonia). In pediatric patients with polyarticular JIA in Japan, adalimumab was safe and effective for reducing disease activity for up to 60 weeks.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505492/pdf/10067_2012_

Article_2082.pdf




Artritis juvenil idiopática en dos centros de tercer nivel en Western Cape, África del Sur

Juvenile idiopathic arthritis in two tertiary centres in the Western Cape, South Africa.
Weakley K, Scott C, Esser M.
Pediatr Rheumatol Online J. 2012 Oct 10;10(1):35
Abstract
BACKGROUND: Juvenile idiopathic arthritis (JIA) is a disease that shows wide variations between differing populations. Since the recent international consensus on classification criteria, JIA has been widely described in many countries and population groups. There has been almost no data that describes JIA in an African, specifically Sub-Saharan African, setting. Therefore, the aim of this study is to describe disease characteristics, disease course, and functional disability in two tertiary centres in the Western Cape, South Africa and compare the findings to other JIA populations. METHODS: Eighty-six children were recruited during random clinic visits to rheumatology clinics at Tygerberg and Groote Schuur Hospital between April 2010 and April 2011. Children were diagnosed using International League of Associations for Rheumatology (ILAR) 2001 classification criteria. Consent was obtained and medical records examined. The Childhood Health Assessment Questionnaires (CHAQ) and visual analogue scales (VAS) for pain and general well-being were completed and all children were examined by a researcher in conjunction with a paediatric rheumatologist. HIV status as well as tuberculosis disease and treatment were investigated. RESULTS: A total of 86 children were enrolled. Eight children were excluded (2 HIV arthropathy, 1 TB arthritis, 1 SLE, 4 with insufficient data), leaving a total of 78 patients. There was an equal female to male ratio-39 males and 39 females. There were 6 systemic JIA patients (7.69%), 17 persistent oligoarthritis (21.79%), 4 extended oligoarthritis (5.12%), 11 polyarthritis rheumatoid factor (RF) positive (14.10%), 21 polyarthritis RF negative (26.9%), 1 psoriatic arthritis (1.28%), and 18 enthesitis-related arthritis (23%). The median CHAQ for the group was 0.5 (IQR 0.1-1.25), the median VAS for pain was 18 mm (IQR 4--42) and median VAS for general well-being was 25 mm (IQR 3--49). Enthesitis-related arthritis and polyarthritis disease subtypes in this South African population may be more common than seen in JIA populations described in northern Europe, India, United Kingdom, and Turkey. CONCLUSION: This Western Cape South African JIA population appears to have a different profile of JIA than what has been described elsewhere. Enthesitis-related arthritis and polyarthritis disease subtypes appear to be more prevalent. There are also significant challenges in this setting such as later presentation to pediatric rheumatologists, different disease characteristics, and variable disease courses.
http://www.ped-rheum.com/content/pdf/1546-0096-10-35.pdf




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

Día Clásico del Bacteriólogo y Laboratorista Clínico

La Escuela de Microbiología de la Universidad de Antioquia se une a la celebración del Día Clásico del Bacteriólogo y Laboratorista Clínico y con ocasión de esta festividad expresa su gratitud y reconocimiento a estos profesionales que con gran esmero y dedicación han hecho aportes fundamentales al desarrollo de la microbiología y el bioanálisis en Colombia y en el mundo.
La Escuela de Microbiología de la Universidad de Antioquia se une a la celebración del Día Clásico del Bacteriólogo y Laboratorista Clínico y con ocasión de esta festividad expresa su gratitud y reconocimiento a estos profesionales que con gran esmero y dedicación han hecho aportes fundamentales al desarrollo de la microbiología y el bioanálisis en Colombia y en el mundo.

Ketamina / Ketamine

                        http://www.smo.edu.mx/jornada2013/

Mecanismos de la inmunosupresión inducida por ketamina  Mechanisms of ketamine-induced immunosuppression Feng-Lin Liu, Ta-Liang Chen, Ruei-Ming Chen, Liu F-L, et al. Acta Anaesthesiologica Taiwanica (2012),http://dx.doi.org/10.1016/j.aat.2012.12.001 Abstract Ketamine, a noncompetitive N-methyl-D-aspartate receptor antagonist, is widely used as an intravenous anesthetic agent. It is known to produce increases in blood pressure and stroke volume, which implies its importance in clinical practice. Ketamine has also been shown to possess anti-inflammatory effects. Our previous studies showed that ketamine, at clinically relevant concentrations, can downregulate endotoxin-induced macrophage activation through toll-like receptor-dependent activation of mitogen activated protein kinases and the transcription factors nuclear factor-kappa B and activator protein-1.As to the responsible mechanisms, considerable attention was devoted to ketamine-involved regulation of proinflammatory gene expression. The assessment of how ketamine regulates proinflammatory gene expressions is significant in determining the signal cascades that are influenced by this anesthetic agent and its clinical application in the tactical use of ketamine in preventing sepsis. Herein, we review the literature on the pharmacodynamics, pharmacokinetics, and possible mechanisms involved in ketamine's immunology. http://download.journals.elsevierhealth.com/pdfs/journals/1875-4597/PIIS1875459712000951.pdf   Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Alergia a los anestésicos locales/Local anesthetics alergy

http://www.smo.edu.mx/jornada2013/








Hipersensibilidad a los anestésicos locales. Seis hechos y 7 mitos


HYPERSENSITIVITY TO LOCAL ANAESTHETICS- 6 FACTS AND 7 MYTHS
Joanna Lukawska, MRCP, M Rosario Caballero, PhD,Sophia Tsabouri, MD, PhD, Pierre Dugué, FRCP, MD, APH
Drug Allergy Clinic, Guy's & St
Current Allergy & Clinical Immunology, August 2009 Vol 22, No. 3
ABSTRACT
Local anaesthetics (LAs) are commonly used drugs. In spite of their widespread use, true hypersensitivity appears to be very infrequent. In fact most of the adverse reactions are due to pharmacological, toxic or vasovagal effects of LAs. Our review of the literature has shown that true allergy to LA is in fact exceptional. Skin tests for LA allergy, including skin-prick tests (SPT) and intradermal (ID) tests, have poor sensitivity and specificity. True LA allergy, when appropriate, has to be confirmed by challenge. Provocation challenge is safe and well tolerated.
http://www.allergysa.org/journals/2009/august/hypersensitivity-to-local-anaesthetics.pdf


Pruebas intradérmicas en pacientes con reacciones alérgicas putativas a los anestésicos locales. Análisis de 611 casos

INTRADERMAL TESTING ON PATIENTS WITH PUTATIVE ALLERGIC REACTIONS TO LOCAL ANAESTHETICS - ANALYSIS OF 611 CASES
Petrus J Germishuys, BChD, MSc, MDent
School of Dentistry, Faculty of Health Sciences,
University of Pretoria, Pretoria
Current Allergy & Clinical Immunology, March 2004 Vol 17, No. 1
SUMMARY
Background. Although allergic reactions to local anaesthetics (LAs) of the amide type are relatively rare, many patients and practitioners label any adverse reaction after administration of an LA as 'allergic'. Objective. The aim of this study was to evaluate the reliability of intradermal testing (IDT) of patients with a history of adverse reactions to LA, and to rule out a possible allergy so an alternative LA, unlikely to cause any reaction, could be selected. Methods. IDT was done on 611 patients referred to the author for assessment of LA allergy. Results. Positive skin reactions were found in 15 patients (2.5%). All responded favourably when a different amide LA was prescribed. Conclusion. These results indicate that IDT is safe and can be used to identify an LA that patients with a prior history of adverse reactions can tolerate.
http://www.allergysa.org/journals/march2004/intradermal%20testing.pdf



Reactividad cruzada entre anestésicos locales de tipo amida en un caso de alergia a mepivacaína

Cross-Reactivity Among Amide-Type Local Anesthetics in a Case of Allergy to Mepivacaine
P González-Delgado,1 R Antón,2 V Soriano,1 P Zapater,3 E Niveiro1
J Investig Allergol Clin Immunol 2006; Vol. 16(5): 311-313
Abstract.
Among the various adverse reactions to local anesthetics, IgE-mediated reactions, particularly to the more commonly used amide group, are extremely rare. We report the case of a 39-year-old man who suffered itching and generalized urticaria with facial angioedema 15 minutes after administration of mepivacaine. Skin tests revealed a strong positive reaction to mepivacaine, lidocaine, and ropivacaine, but negative reactions to bupivacaine and levobupivacaine. Furthermore, double-blind placebo-controlled subcutaneous challenge with bupivacaine and levobupivacaine was well tolerated. We conclude that an extensive allergologic study must be carried out in rare cases of true allergic reaction to amide-type local anesthetics in order to rule out cross reactivity.
Key words: Local anesthetics. Amide group. Allergy. Mepivacaine. Lidocaine. Ropivacaine. Bupivacaine. Levobupivacaine.
http://www.jiaci.org/issues/vol16issue05/8.pdf


Anafilaxia secundaria a levobupivacaina

Anaphylaxis secondary to levobupivacaine
Gupta,1 M. Fennelly,2 V. Ramesh3 and K. Agyare
Anaesthesia, 2011, 66, pages 942-944 doi:10.1111/j.1365-2044.2011.06815.x
Summary
We describe the case of a 25-year-old woman presented for elective lumbar decompression and microdiscectomy who, towards the end of her surgery, developed clinical signs of anaphylaxis. Skin testing later confirmed sensitisation to levobupivacaine and possibly MediShield, an anti-adhesion gel used following microdiscectomy. This case is the first confirmed case report of anaphylaxis in response to levobupivacaine. It also highlights the possibility that multiple agents may simultaneously trigger a life-threatening reaction. Anaesthetists should remain alert to the use of potentially allergenic agents employed by surgeons.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2011.06815.x/pdf



Alergia a ropivacaína peridural

Whizar-Lugo VM, Ontiveros-Morales P, Garfias-Flores ME.
Anest Mex 2004;16:180-183.
Resumen
Las reacciones alérgicas a los anestésicos locales del grupo amino amida son muy raras, y no hay casos reportados de alergias secundarios a la ropivacaína peridural. Informamos un paciente mexicano, de 62 años de edad, diabético con dolor torácico intenso secundario a herpes Zoster agudo, al cual se le realizó un bloqueo peridural con 6 mL de ropivacaína simple al 0.25% y 20 minutos después desarrolló una dermatosis pruriginosa localizada en el cuello y el tórax. Esta reacción se repitió con la segunda inyección peridural de 6 mL de ropivacaína simple al 0.125%, por lo que las subsecuentes inyecciones peridurales se hicieron con bupivacaína racémica 0.125%, sin efectos secundarios. El paciente fue seguido durante un año y no tuvo secuelas neurológicas, ni desarrolló neuropatía postherpética. Se ha dicho que los nuevos anestésicos locales levoisoméricos no inducen reacciones alérgicas. Este paciente demuestra que debemos
de estar alertas ante esta remota posibilidad.
Palabras clave: Alergias, anestésicos locales, ropivacaína epidural.
http://www.anestesiaenmexico.org/RAM3/011.pdf





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

Analgesia postoperatoria/Postoperataive analgesia

http://www.smo.edu.mx/jornada2013/

Analgesia epidural controlada por el paciente con ropivacaína y fentanilo: experiencia con 2276 pacientes quirúrgicos


Patient-controlled Epidural Analgesia with Ropivacaine and Fentanyl: Experience with 2,276 Surgical Patients.
Kim SH, Yoon KB, Yoon DM, Kim CM, Shin YS.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Korean J Pain. 2013 Jan;26(1):39-45. doi: 10.3344/kjp.2013.26.1.39. Epub 2013 Jan 4.
Abstract
BACKGROUND: Good postoperative pain control is an important part of adequate postoperative care. Patient-controlled epidural analgesia (PCEA) provided better postoperative analgesia compared to other conventional analgesic methods, but several risks have been observed as well. We therefore surveyed the efficacy and safety of PCEA in this retrospective observational study. METHODS: We analyzed collected data on 2,276 elective surgical patients who received PCEA with ropivacaine and fentanyl. Patients were assessed by a PCA service team in the post-anesthesia care unit (PACU), at 1-6 h, 6-24 h, and 24-48 h postoperatively for adequate pain control. The presence of PCEA-related adverse events was also assessed. RESULTS: Numerical pain score (median [interquartile range]) were 3 [1-4], 5 [4-7], 4 [3-5], and 3 [3-5] in the PACU, at 1-6 h, 6-24 h, and 24-48 h postoperatively. Median pain scores in patients underwent major abdominal or thoracic surgery were higher than other surgical procedure in the PACU, at 1-6 h after surgery. Nausea and vomiting (20%) and numbness and motor weakness (15%) were revealed as major PCEA-related adverse events during the postoperative 48 h period. There were 329 patients (14%) for whom PCEA was ceased within 48 h following surgery. CONCLUSIONS: Our data suggest that the use of PCEA provides proper analgesia in the postoperative 48 h period after a wide variety of surgical procedures and that is associated with few serious complications. However, more careful pain management and sustainable PCEA monitoring considering the type of surgical procedure undergone is needed in patients with PCEA.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546209/pdf/kjpain-26-39.pdf


Guías para el manejo de dolor postoperatorio después de artroplastia total de rodilla.

Guidelines for the management of postoperative pain after total knee arthroplasty.
Korean Knee Society.
Knee Surg Relat Res. 2012 Dec;24(4):201-7. doi: 10.5792/ksrr.2012.24.4.201. Epub 2012 Nov 29.
Abstract
This clinical practice guideline was approved by Korean Knee Society on February 28, 2012. It is based on a systematic review of published studies on the management of postoperative pain after total knee arthroplasty and was developed to include the overall pain management modalities. The purpose of the guideline is to help improve treatment based on current best evidence. Eleven recommendations have been developed based on a systematic review of research evidence and the consensus opinions of a multidisciplinary working group of experts. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526756/pdf/ksrr-24-201.pdf


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

Más sobre AINES/More on NSAIDs

                 http://www.smo.edu.mx/

Todas las causas de mortalidad en ancianos veteranos Australianos que usan AINES COX-2 selectivos o no selectivos: estudio longitudinal  All-cause mortality of elderly Australian veterans using COX-2 selective or non-selective NSAIDs: a longitudinal study. Kerr SJ, Rowett DS, Sayer GP, Whicker SD, Saltman DC, Mant A. National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, NSW 2052, Australia. Br J Clin Pharmacol. 2011 Jun;71(6):936-42. doi: 10.1111/j.1365-2125.2010.03702.x. Epub 2010 May 6. Abstract WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Previous studies have found varying impact of exposure to COX-2 selective and non-selective NSAIDs. WHAT THIS STUDY ADDS: * Individuals receiving a COX-2 selective NSAID had an increased risk of all-cause mortality after correction for age, sex and cardiovascular risk as measured by co-prescription. * Despite differences in the pharmacokinetic properties of the COX-2 selective inhibitor drugs, our study lends no support to clinicians preferring any one COX-2 selective inhibitor drug, or substituting one for another on the grounds of mortality risk alone. * The Australian Department of Veterans' Affairs data sets make it possible to conduct timely record linkage studies of all-cause mortality from use of medicines in a large and clinically relevant population. AIM: To determine hazard ratios for all-cause mortality in elderly Australian veterans taking COX-2 selective and non-selective NSAIDs. METHODS: Patient cohorts were constructed from claims databases (1997 to 2007) for veterans and dependants with full treatment entitlement irrespective of military service. Patients were grouped by initial exposure: celecoxib, rofecoxib, meloxicam, diclofenac, non-selective NSAID. A reference group was constructed of patients receiving glaucoma/hypothyroid medications and none of the study medications. Univariate and multivariate analyses were performed using Cox proportional hazards regression models. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated for each exposure group against each of the reference group. The final model was adjusted for age, gender and co-prescription as a surrogate for cardiovascular risk. Patients were censored if the gap in supply of study prescription exceeded 30 days or if another study medication was initiated. The outcome measure in all analyses was death. RESULTS: Hazard ratios and 95% CIs, adjusted for age, gender and cardiovascular risk, for each group relative to the reference group were: celecoxib 1.39 (1.25, 1.55), diclofenac 1.44 (1.28, 1.62), meloxicam 1.49 (1.25, 1.78), rofecoxib 1.58 (1.39, 1.79), non-selective NSAIDs 1.76 (1.59, 1.94). CONCLUSIONS: In this large cohort of Australian veterans exposed to COX-2 selective and non-selective NSAIDs, there was a significant increased mortality risk for those exposed to either COX-2-selective or non-selective NSAIDs relative to those exposed to unrelated (glaucoma/hypothyroid) medications. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099381/pdf/bcp0071-0936.pdf     Uso de AINES que elevan el riesgo cardiovascular: una revisión de las ventas y las listas de medicamentos esenciales en los países de ingreso bajo, mediano y alto.  Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries. McGettigan P, Henry D. William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom. PLoS Med. 2013 Feb;10(2):e1001388. doi: 10.1371/journal.pmed.1001388. Epub 2013 Feb 12.Abstract BACKGROUND: Certain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib [Vioxx]) increase the risk of heart attack and stroke and should be avoided in patients at high risk of cardiovascular events. Rates of cardiovascular disease are high and rising in many low- and middle-income countries. We studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries. METHODS AND FINDINGS: Data on the relative risk (RR) of cardiovascular events with individual NSAIDs were derived from meta-analyses of randomised trials and controlled observational studies. Listing of individual NSAIDs on Essential Medicines Lists (EMLs) was obtained from the World Health Organization. NSAID sales or prescription data for 15 low-, middle-, and high-income countries were obtained from Intercontinental Medical Statistics Health (IMS Health) or national prescription pricing audit (in the case of England and Canada). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with a low risk. Diclofenac was listed on 74 national EMLs, naproxen on just 27. Rofecoxib use was not documented in any country. Diclofenac and etoricoxib accounted for one-third of total NSAID usage across the 15 countries (median 33.2%, range 14.7-58.7%). This proportion did not vary between low- and high-income countries. Diclofenac was by far the most commonly used NSAID, with a market share close to that of the next three most popular drugs combined. Naproxen had an average market share of less than 10%. CONCLUSIONS: Listing of NSAIDs on national EMLs should take account of cardiovascular risk, with preference given to low risk drugs. Diclofenac has a risk very similar to rofecoxib, which was withdrawn from worldwide markets owing to cardiovascular toxicity. Diclofenac should be removed from EMLs http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570554/pdf/pmed. 1001388.pdf     Revisión sobre drogas analgésicas, antiinflamatorios no esteroideas  Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs) Final Update 4 Report November 2010 http://www.ncbi.nlm.nih.gov/books/NBK53955/pdf/TOC.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org