Casos raros/Rare cases

Inyección accidental de anestésico local en el espacio subdural durante bloqueo caudal


Accidental deposition of local anaesthetic in the subdural space following caudal block
Prachee Sachan, Veena Asthana, Sanjay Agrawal
South Afr J Anaesth Analg 2013;19(4):220-222
Abstract
The incidence of accidental injection of local anaesthetic into the subdural space during neuraxial blockade is rare. The presentation of unexplainable clinical signs that do not match the clinical picture of subarachnoid or intravascular injection of the local anaesthetic agent should invoke high suspicion of unintentional subdural block. We report on a case of a six-month-old infant who developed motor block and unconsciousness with haemodynamic stability, following a caudal block for postoperative analgesia. The report will help to illustrate the mechanism behind the complication of subdural deposition of the drug, its detection, treatment and possible avoidance.
http://www.sajaa.co.za/index.php/sajaa/article/view/1098/1301




Uso profiláctico de emulsión de lípidos en la resección de melanoma maligno invasivo realizada con anestesia local en un obeso mórbido

The Prophylactic Use of Lipid Emulsion Therapy in the Excision of Invasive Malignant Melanoma under Local Anaesthetic in a Morbidly Obese Patient.
Sharma KS, Lim P, Brotherston TM, Smith P.
Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield S10 2FJ, UK ; Department of Plastic and Reconstructive Surgery, Sheffield Teaching Hospitals, 4 Claremont Place, Glossop Road, Sheffield S102 FJ, UK.
Case Rep Surg. 2013;2013:765279. doi: 10.1155/2013/765279. Epub 2013 Jan 16.
Abstract
We present the first reported case of the prophylactic use of lipid emulsion therapy in the removal of an extensive, circumferential malignant melanoma in a morbidly obese patient, under local anaesthetic. The advantages of this technique allowed the patient to avoid intraoperative invasive monitoring and postoperative critical care admission and assisted during the operation by rotating her leg when needed. This is a useful technique that can be employed in urgent cases where there is a need to excise extensive skin malignancies in patients who are unsuitable for general or regional anaesthesia.
http://www.hindawi.com/crim/surgery/2013/765279/




Anestesia en un caso de hernia diafragmática congénita: retraso en el diagnóstico
Anesthetic management of a case of congenital diaphragmatic hernia; delayed diagnosis.
Joshi S, George A.
Med J DY Patil Univ [serial online] 2013 [cited 2013 Jul 10];6:281-3.
Abstract
Congenital diaphragmatic hernia results from the anomalous closure of pericardioperitoneal canal. There are various challenges faced by anesthesiologists during management of such cases which include intraoperative complications including hypoxia and hypercarbia, which leads to pulmonary hypertension and right to left shunt. Mortality remains high because of associated pulmonary hypoplasia and pulmonary hypertension. Here, we describe anesthetic management of a 2-month-old female child with difficulty in breathing since birth following feeding, due to congenital diaphragmatic hernia.
Keywords: Congenital diaphragmatic hernia, hypoxia, pulmonary hypertension, pulmonary hypoplasia


http://www.mjdrdypu.org/text.asp?2013/6/3/281/114644



Manejo anestésico del procedimiento EXIT. Informe de un caso
Anesthetic management of the ex utero intrapartum treatment (EXIT) procedure -A case report-.
Lee H, Ryu JW, Kim DY, Lee GY.
Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Korean J Anesthesiol. 2010 Dec;59 Suppl:S154-7. doi: 10.4097/kjae.2010.59.S.S154. Epub 2010 Dec 31.
Abstract
The ex utero intrapartum treatment (EXIT) procedure is a very rare technique performed in cases of fetal congenital malformations. The EXIT procedure increases the rate of survival at delivery by maintaining the uteroplacental circulation until the airway of the fetus is secured. To maintain the uteroplacental circulation, a higher dose of inhalational anesthetics and/or intravenous nitroglycerin can be used as compared to conventional Cesarean section. The aim of this report is to share our anesthetic experience during the EXIT procedure with members of the Korean society of anesthesiology for the first time, and to highlight the maternal implications of the use of inhalational anesthetics and nitroglycerin during Cesarean section for the EXIT procedure.
KEYWORDS: Cesarean delivery, Ex utero intrapartum treatment (EXIT), Fetal malformation, General anesthesia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030024/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030024/pdf/kjae-59-S154.pdf





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

Biliotecas. Alertas

La Biblioteca Municipal de Madrona (Segovia) abre sus puertas ... Europa Press
La Biblioteca Municipal del barrio incorporado de Madrona (Segovia) abre sus puertas este lunes en las salas del antiguo ayuntamiento con cerca de 2.000 ...Ver todos los artículos sobre este tema »
La biblioteca de Onda amplia servicios y aumenta el número de ... el periodic
La biblioteca de Onda sigue aumentando el número de préstamos de libros y de usuarios gracias, entre otras medidas, a la ampliación del horario de apertura ...Ver todos los artículos sobre este tema »
Biblioteca de México lleva el rock a la pantalla grande en su Ciclo ... El Semanario Sin Limites
Ciudad de México.- La Biblioteca de México retoma su carácter de Cine Club que impulsó su director Jaime García Terrés en 1994, con la apertura del Patio del ...Ver todos los artículos sobre este tema »
La Biblioteca virtual de Canarias fusiona todas las bibliotecas en un ... eldia.es
Santa Cruz de Tenerife, EFE El Gobierno de Canarias ha concluido el proyecto de la biblioteca virtual de Canarias (BICA), con la fusión de las bibliotecas ...Ver todos los artículos sobre este tema »
Destaca la Biblioteca histórica de Xalapa con casi 18 mil recursos ... Observatorio Veracruzano
Xalapa, Ver., (28/Julio/2013).- Con casi 18 mil recursos documentales entre libros, revistas y folletos, la Biblioteca Histórica del Colegio Preparatorio de Xalapa ...Ver todos los artículos sobre este tema »
La Biblioteca de Isla celebra el Día del Mayor HuelvaYA
En esta ocasión fue Juan Venegas, director de la biblioteca isleña, el encargado de ir desgranando, ante la atenta mirada de los usuarios del centro, los ...Ver todos los artículos sobre este tema »
La Biblioteca Municipal amplía su fondo bibliográfico con libros en ... InfoVillanueva.com
La Biblioteca Municipal F. Lázaro Carreter pone a disposición de los usuarios un total de 132 títulos nuevos en inglés y en francés para el público adulto e ...Ver todos los artículos sobre este tema »
Estrenan biblioteca virtual El Diario de Otún
La Institución Educativa Bosques de la Acuarela construyó y adecuó un aula virtual con el fin de ofrecerles a los estudiantes un espacio moderno donde ...Ver todos los artículos sobre este tema »
Revuelo por la “mudanza” de una biblioteca pública Diario Uno
“Cerrado por refacciones hasta nuevo aviso”, se lee en la puerta de la biblioteca municipal General San Martín, de Tupungato. Adentro, sus empleados están ...Ver todos los artículos sobre este tema »
Fiesta de cumpleaños en la biblioteca avilared.com
La Biblioteca José Jiménez Lozano ha celebrado una década de vida con los usuarios más pequeños, los que todavía no leen y acuden a la bebeteca, la única ...Ver todos los artículos sobre este tema »

Una alcaldesa 'popular' quiere cerrar las bibliotecas municipales ... sergiocolado
“Las bibliotecas no dan nada de dinero, y hay 14 personas trabajando en ellas”, ... Castellano advirtió de que la biblioteca municipal está en el disparadero, ...el plural
Nuevo número de la revista Mi Biblioteca - DIM-EDU
Estimados amigos: Durante los próximos días los suscriptores a la revista MI BIBLIOTECA comenzarán a recibir el nuevo número (Verano 2013) de nuestra ...Última actividad en DIM-EDU
Continúan los Encuentros Distritales de Escrituras Creativas en la ...
Continúan los Encuentros Distritales de Escrituras Creativas en la Biblioteca ... Auditorio Germán Arciniegas- Biblioteca Nacional de Colombia (Calle 24, No.Ministerio De Cultura
Clausuran en Valladolid 'Mis Vacaciones en la Biblioteca' editorweb
Con una exposición de los trabajos elaborados durante los talleres, el presidente municipal Roger Alcocer García, clausuró hoy las actividades del programa ...La Verdad Yucatán
El Ayuntamiento de Pozuelo dona 2.500 libros a la biblioteca de la ... salemsahara
Pozuelo de Alarcón (Madrid), 29/07/13(SPS)-. El Ayuntamiento de Pozuelo ha donado para la biblioteca de Bir Lahlu en los campamentos de refugiados ...Voz del Sahara Occidental en Argentina
Biblioteca Nicanor Parra, ejemplo de uso de luz natural | Iluminet Iluminet
Leer en un espacio lleno de luz natural, de silencio y vegetación se puede hacer, sin necesidad de estar al aire libre, en la Biblioteca Nicanor Parra, de la.Iluminet

Anestesia para cirugía plástica/anesthesia for plastic surgery

Utilidad de anestesia intravenosa usando un sistema infusión controlada al órgano blanco con anestesia local en aumento mamario submuscular


Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery.
Chung KJ, Cha KH, Lee JH, Kim YH, Kim TG, Kim IG.
Department of Plastic and Reconstructive Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.
Arch Plast Surg. 2012 Sep;39(5):540-5. doi: 10.5999/aps.2012.39.5.540. Epub 2012 Sep 12.
Abstract
BACKGROUND: Patients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI) system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anesthesia using the TCI system with propofol and remifentanil would be an effective method of anesthesia in breast augmentation. METHODS: This study recruited 100 patients who underwent breast augmentation surgery from February to August 2011. Intravenous anesthesia was performed with 10 mg/mL propofol and 50 µg/mL remifentanil simultaneously administered using two separate modules of a continuous computer-assisted TCI system. The average target concentration was set at 2 µg/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinical effect and vital signs. Oxygen saturation, electrocardiography, and respiratory status were continuously measured during surgery. Blood pressure was measured at 5-minute intervals. Information collected includes total duration of surgery, dose of drugs administered during surgery, memory about surgery, and side effects. RESULTS: Intraoperatively, there was transient hypotension in two cases and hypoxia in three cases. However, there were no serious complications due to anesthesia such as respiratory difficulty, deep vein thrombosis, or malignant hypertension, for which an endotracheal intubation or reversal agent would have been needed. All the patients were discharged on the day of surgery and able to ambulate normally. CONCLUSIONS: Our results indicate that anesthetic methods, where the TCI of propofol and remifentanil is used, might replace general anesthesia with endotracheal intubation in breast augmentation surgery.
http://e-aps.org/Synapse/Data/PDFData/2023APS/aps-39-540.pdf



http://e-aps.org/DOIx.php?id=10.5999/aps.2012.39.5.540









Efecto de lidocaína intraoperatoria sobre el consumo anestésico, la función intestinal, el dolor, consumo de analgésicos y estancia hospitalaria después de cirugía mamaria



Effect of intraoperative lidocaine on anesthetic consumption, and bowel function, pain intensity, analgesic consumption and hospital stay after breast surgery.
Choi SJ, Kim MH, Jeong HY, Lee JJ.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2012 May;62(5):429-34. doi: 10.4097/kjae.2012.62.5.429. Epub 2012 May 24.
Abstract
BACKGROUND: Perioperative lidocaine infusion improves postoperative outcomes, mostly after abdominal and urologic surgeries. Knowledge of the effect of lidocaine on peripheral surgeries is limited. Presently, we investigated whether intraoperative lidocaine infusion reduced anesthetic consumption, duration of ileus, pain intensity, analgesic consumption and hospital stay after breast plastic surgeries. METHODS: Sixty female patients, aged 20-60 years, enrolled in this prospective study were randomly and equally divided to two groups. One group (n = 30) received a 1.5 mg/kg bolus of lidocaine approximately 30 min before incision followed by continuous infusion of lidocaine (1.5 mg/kg/h) until skin closure (lidocaine group). The other group (n = 30) was untreated (control group). Balanced inhalation (sevoflurane) anesthesia and multimodal postoperative analgesia were standardized. End tidal sevoflurane concentration during surgery, time to the first flatus and defecation, visual analog pain scale (0-10), analgesic consumption and associated side effects at 24, 48, and 72 h after surgery, hospital stay, and patient's general satisfaction were assessed. RESULTS: Compared to the control group, intraoperative lidocaine infusion reduced by 5% the amount of sevoflurane required at similar bispectral index (P = 0.014). However, there were no significant effects of lidocaine regarding the return of bowel function, postoperative pain intensity, analgesic sparing and side effects at all time points, hospital stay, and level of patient's satisfaction for pain control. CONCLUSIONS: Low dose intraoperative lidocaine infusion offered no beneficial effects on return of bowel function, opioid sparing, pain intensity and hospital stay after various breast plastic surgeries.
KEYWORDS: Analgesic consumption, Anesthetic consumption, Bowel function, Hospital stay, Intravenous lidocaine, Pain score

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366309/pdf/kjae-62-429.pdf



Infiltración para liposucción: La formula Quito. Un nuevo abordaje basado en un concepto antiguo
Liposuction infiltration: The Quito formula - a new approach based on an old concept.
Cueva Galárraga IM.
Plastic Surgery Service, Clínica Club de Leones Quito Central, Quito, Pichincha, Ecuador.
Can J Plast Surg. 2011 Spring;19(1):17-21.
Abstract
INTRODUCTION: Liposuction is a highly sought after surgical procedure. Despite its popularity, not all of the factors associated with its execution are well understood. No well-established guidelines exist for plastic surgeons regarding the subcutaneous infiltration of fluid and, thus, the procedure is often performed subjectively. OBJECTIVE: To establish the usefulness of the Quito formula (infiltrate volume = weight [kg] × percentage of body surface to be liposuctioned × 2.4 [mL]) for calculating the volume of fluid to be infiltrated subcutaneously during small-volume liposuction performed under epidural anesthesia. METHODS: A prospective study was conducted on a group of 50 patients who were candidates for liposuction on multiple body parts between November 2004 and February 2010. RESULTS: The maximum volume of infiltrate was 5000 mL and the maximum volume of aspirate was 4500 mL, with a 30% total aspirated area. No patient required blood transfusion, and there were no major complications. However, one patient presented with a small local infection, another with a sacral seroma and two patients had postdural puncture headaches. No patient showed clinical signs consistent with overhydration, dehydration, pulmonary embolism, fat embolism or lidocaine intoxication. CONCLUSIONS: When performing small-volume liposuction, subcutaneous infiltration using the Quito formula to calculate the volume of infiltrate proved to be useful, safe and objective.
KEYWORDS: Infiltration, Liposuction, Quito formula, Small volume


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086502/pdf/cjps19017.pdf





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

Antibióticos en UCI/ICU antibiotics

Farmacocinética plasmática de antimicrobianos en pacientes críticamente enfermos


Plasma Pharmacokinetics of Antimicrobial Agents in Critically Ill Patients
Federico Pea*
Current Clinical Pharmacology, 2013, 8, 5-12 5
Abstract:
Prompt optimal antimicrobial treatment in critically ill patients is mandatory and must be achieved not only in terms of spectrum of activity, but also in terms of exposure at the infection site. Plasma profile of antimicrobial agents may represent a valid surrogate marker of drug exposure and allow to identify the correct dosage for a given drug. However, in the critically ill patients the pharmacokinetic behavior of antimicrobials may be altered by some very peculiar pathophysiological conditions, so that dosages significantly different from those used in clinically stable patients or from those originally studied in healthy volunteers for regulatory purposes may often be needed in order to ensure optimal plasma drug exposure in such population. This is especially true for hydrophilic antimicrobials (aminoglycosides, betalactams, glycopeptides, lipopeptides, echinocandins, fluconazole, acyclovir, ganciclovir) whose volume of distribution and clearance may be significantly altered by these conditions. These aspects are particularly relevant in patients with severe sepsis or with septic shock for whom the time for being considered as a special population to be studied apart from the general population has probably come. From the healthcare system perspective, this means that individualization of antimicrobial therapy by means of a real time therapeutic drug monitoring coupled with clinical pharmacological advice should be considered an invaluable tool for optimizing antimicrobial therapy and for the containment of microbial resistance in this setting.
Keywords:
Augmented renal clearance, loading dose, maintenance dose, sepsis, Hydrophilic Antimicrobials, Lipophilic Antimicrobials, diet in renal disease, therapeutic drug, tigecycline, azithromycin
http://www.eurekaselect.com/106036/article




Resistencia a antibióticos en pacientes con sepsis: Evaluación y recomendaciones del uso de antibióticos

Antibiotic resistance in sepsis patients: Evaluation and recommendation of antibiotic use.
Pradipta IS, Sodik DC, Lestari K, Parwati I, Halimah E, Diantini A, Abdulah R.
North Am J Med Sci [serial online] 2013 [cited 2013 Jun 28];5:344-52.
Abstract
Background: The appropriate selection of empirical antibiotics based on the pattern of local antibiotic resistance can reduce the mortality rate and increase the rational use of antibiotics. Aims: We analyze the pattern of antibiotic use and the sensitivity patterns of antibiotics to support the rational use of antibiotics in patients with sepsis. Materials and Methods: A retrospective observational study was conducted in adult sepsis patient at one of Indonesian hospital during January-December 2011. Data were collected from the hospital medical record department. Descriptive analysis was used in the processing and interpretation of data. Results: A total of 76 patients were included as research subjects. Lung infection was the highest source of infection. In the 66.3% of clinical specimens that were culture positive for microbes, Klebsiella pneumoniae, Escherichia coli, Staphylococcus hominis were detected with the highest frequency. The six most frequently used antibiotics, levofloxacin, ceftazidime, ciprofloxacin, cefotaxime, ceftriaxone, and erythromycin, showed an average resistance above 50%. Conclusions: The high use of antibiotic with a high level resistance requires a policy to support its rational use. Local microbial pattern based on site infection and pattern of antibiotics sensitivity test can be used as supporting data to optimize appropriateness of empirical antibiotics therapy in sepsis patients.
Keywords: Antibiotic resistance, Bacteremia, Sepsis, Systemic infection
http://www.najms.org/text.asp?2013/5/6/344/114165



Más sobre antibióticos en UCI
Current Clinical Pharmacology VOLUME: 8 ISSUE: 1; 2013
http://www.eurekaselect.com/106032/issue/1




Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Clonidina intratecal para analgesia postoperatoria en histerectomía abdominal

Clonidina intratecal para analgesia postoperatoria en histerectomía abdominal.


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



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

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

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

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


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

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

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

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

EVOLUCIÓN DE AMBIENTES CÁLIDOS A FRÍOS

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

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

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

Profilaxis y tratamiento de tromboembolismo venoso en pacientes graves

Profilaxis y tratamiento de tromboembolismo venoso en pacientes graves


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




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

Dexmedetomidina/Dexmedetomidine

Dosis óptima de dexmedetomidina para sedación durante anestesia raquídea


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

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


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



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

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




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

Bibliotecas. Alerta

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Tras finalizar el primer trimestre de actividad de la Biblioteca Municipal María Moliner, la concejal de Cultura, Antonia Moreno, detalló ayer los primeros datos ...Ver todos los artículos sobre este tema »
Biblioteca Nacional de España lanza recurso educativo BNEscolar Letralia
En colaboración con la empresa Gnoss, la Biblioteca Nacional de España (BNE) ha creado BNEscolar, un espacio web realizado con tecnología semántica y ...Ver todos los artículos sobre este tema »
Geronimo Stilton rueda en la biblioteca de Mieres La Nueva España
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La biblioteca de los libros asesinos Letralia
En 2011 publicamos el artículo “La biblioteca de los libros asesinos”, en el que el escritor argentino Gustavo Rubén Giorgi narra la historia de tres libros ...Ver todos los artículos sobre este tema »
Geronimo Stilton rueda en la biblioteca de Mieres La Nueva España
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La Biblioteca Virtual Cervantes incorpora lo mejor de la dramaturgia ... Información
La Biblioteca Virtual presenta hoy en el marco del Festival de Teatro Clásico en la Villa de Olmedo, Valladolid, un portal de referencia dedicado a la ...Ver todos los artículos sobre este tema »
Nueva Biblioteca APEDE La Estrella Online Panama
IMPORTANTE: El sistema de verificación de comentarios requiere el uso de una dirección de correo electrónico válida, ya que en esta cuenta recibirá un e-mail ...Ver todos los artículos sobre este tema »
Nicoya tendrá nueva Biblioteca Pública en seis meses Columbia
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Vivas cede Humanidades, la UNED, la Biblioteca y la casa de la ... El Pueblo de Ceuta
El presidente de la Ciudad, Juan Vivas, ofreció ayer al ministro de Educación, Cultura y Deportes, José Ignacio Wert, la cesión de los edificios que albergan la ...Ver todos los artículos sobre este tema »
Biblioteca Pública - Blas de Otero, las "Obras completas" de un ... RTVE
Blas de Otero es el poeta del compromiso, no solo social y político, sino también y sobre todo humano y literario. Su obra se nos revela como una de las ...Ver todos los artículos sobre este tema »

Biblioteca de Saint-Laurent - Noticias de Arquitectura - Buscador de ... danielm
En las afueras de Montreal, la Biblioteca de Saint-Laurent propone integrar las calles de este suburbio y funcionar como nexo de la ciudad.Arquitectura Noticias
Ciutadans (C's) de Cunit denuncia la Biblioteca Marta Mata por ...
Ciutadans (C's) de Cunit denuncia la Biblioteca Marta Mata por permitir publicidad propagandística.Ciudadanos-Cs | Sala de prensa
La Casa Orduña y su biblioteca | ALQUIBLA Eva
La biblioteca se ubicaba en una habitación situada en la primera planta con orientación norte. Poseia una puerta de doble hoja que la cerraba y una ventana ...ALQUIBLA
Efemérides de Julio - Biblioteca Central - Universidad Nacional del ... webiblio
Mes Anterior: Efemérides de Junio. Juan Carlos Onetti (Montevideo, 1 de julio de 1909 - Madrid, 30 de mayo de 1994) Novelista uruguayo, considerado no sólo ...Biblioteca Central
Antonio Revert nutre a la Biblioteca con 610 títulos | Pagina 66 Redacción
Entre libros, documentos antiguos e ilustraciones. [caption id=attachment_80760 align=aligncenter width=598] Antonio Revert junto a Josep Lluís.Pagina66 - Noticias e información de Alcoy
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capacitando a la cuarta generación de pasantes perdidos en el ... cholguin2
En la Biblioteca Nacional ubicada en el centro de Bogotá. abajito de los cerros. cerquita de la ladera. se encuentran. Esta entrada fue publicada en Tradiciones.Blogs de la Biblioteca Nacional de Colombia

Bibliotecas. Alerta

Al rescate de las bibliotecas públicas El Nuevo Herald
El alcalde de Miami Dade, Carlos Giménez, y la Comisión del Condado deben hacer todo lo posible por restaurar los fondos para el sistema de Bibliotecas ...Ver todos los artículos sobre este tema »
Inauguran moderna biblioteca en Yucatán La verdad Yucatán
Con una inversión superior a los 12 millones de pesos, el Gobernador Rolando Zapata Bello inauguró esta noche la primera etapa de la biblioteca “El gran ...Ver todos los artículos sobre este tema »
Biblioteca Pública - "Estambul. Paseos, miradas, resuellos", un viaje ... RTVE
Estambul, la vieja Constantinopla, es una de las ciudades más literaria del mundo, por bella, por mítica, por alumbrar el alucinante encuentro entre oriente y ...Ver todos los artículos sobre este tema »
Una muestra en la Biblioteca Foral recupera imágenes de las ... Deia
Ahora, apocas semanas de cumplirse tres décadas de las inundaciones que asolaron el territorio, la Diputación ha inaugurado en la Biblioteca Foral la muestra ...Ver todos los artículos sobre este tema »
Se inauguró la Biblioteca del Centro de Jubilados San Roque ... CN Saladillo
Ayer a la tarde en el CAPS San Roque la Biblioteca Mitre realizó una donación de libros al Centro de Jubilados. Marta Macchi indicó que luego realizarán ...Ver todos los artículos sobre este tema »
Continúan las Jornadas de Lectura en la Biblioteca Municipal de ... La Comarca de Puertollano
La programación veraniega Biblioteca Municipal cruza su ecuador con las jornadas de animación lectura como principal atractivo. Con ellas se pretende ...Ver todos los artículos sobre este tema »
18 computadores hurtados de biblioteca universitaria en Neiva RCN Radio
Los computadores portátiles de marca hp, fueron sacados de la biblioteca, sin que nadie se diera cuenta, tras permanecer guardados, según confirmaron los ...Ver todos los artículos sobre este tema »
Muestra conjunta en la Biblioteca Popular de Arroyo Seco Arroyo Diario
Este viernes las protagonistas serán las profesoras. Dicha muestra se realiza en el marco del 95º Aniversario de la Biblioteca y en el 12º Aniversario de la sala ...Ver todos los artículos sobre este tema »
Reabrió sus puertas la biblioteca "Rosalia de Castro" que funciona ... Diario La Ciudad de Avellaneda
La biblioteca, llamada "Rosalia de Castro" cuenta con volúmenes de gran valor histórico, tanto en idioma castellano, como en idioma gallego, de literatura en ...Ver todos los artículos sobre este tema »
CICLO DE FILMES DE JORGE ACHA EN LA BIBLIOTECA NACIONAL El Comercial.com.ar
El Museo del libro y de la Lengua y la Biblioteca Nacional comenzarán el ciclo con la proyección de "Hábeas Corpus" -premiada en el Festival de Operas ...Ver todos los artículos sobre este tema »

Inauguran moderna biblioteca en Yucatán editorweb
Con una inversión superior a los 12 millones de pesos, el Gobernador Rolando Zapata Bello inauguró esta noche la primera etapa de la biblioteca “El gran ...La Verdad Yucatán
Apoyaría Conaculta construcción de nueva biblioteca en el Centro ...
Por su parte, Tovar y de Teresa contempló la posibilidad de que Conaculta apoye al gobierno estatal con la construcción de la biblioteca que se planea erigir, ...Pulso Online | Pulso Diario de San Luis
Archivo y Biblioteca Municipal de Guardamar | ALQUIBLA Eva
El Archivo Municipal de Guardamar del Segura y la biblioteca pública son un buen ejemplo de cómo han evolucionado los organismos encargados de recoger ...ALQUIBLA
Descontexto: “El tigre está en la biblioteca”. Carta a Jorge Luis ... V i l l a v i c e n c i o
“El tigre está en la biblioteca”. Carta a Jorge Luis Borges, de Susan Sontag. Querido Borges: Dado que siempre colocaron a su literatura bajo el signo de la ...Descontexto
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Este proyecto queda enmarcado dentro de las actividades de la biblioteca durante el presente mes de julio. En esta actividad han participado chicos y chicas ...Biblioteca Solidaria

Este mes en la historia de la anestesiología

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


Este mes en la historia de la anestesiología


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


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

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

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



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


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

J Med Biogr 2011 19: 10

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



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

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

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





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

Controversias en Ablactación y Desarrollo de Alergia a Alimentos

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

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

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



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

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

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


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

http://youtu.be/CjusYr10wOg

TRATAMIENTO CON PRP/ DR JORGE ROMO

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

http://youtu.be/p9_ROtoUbjM

Anesthetic implications of robotic gynecologic surgery

Implicaciones anestésicas de la cirugía ginecológica robótica


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

Abstract

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

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

Más dexmedetomidina/More dexmedetomidine

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


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




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

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



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

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


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



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

Fracturas Supracondíleas Humerales en Pacientes Pediátricos

Fracturas Supracondíleas Humerales en Pacientes Pediátricos

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