Bibliotecas. Alerta

La Biblioteca árabo-suramericana, la última firma de Niemeyer en ... Lainformacion.com
Argel, 12 nov (EFE).- La Biblioteca árabo-suramericana de Argel, que aspira a convertirse en uno de los hitos arquitectónicos de la Argel contemporánea y en ...
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Te Interesa

Biblioteca Nacional realiza conversatorio sobre la obra de Andrés ... EntornoInteligente
Como parte de una selecta agenda cultural diseñada para el disfrute del pueblo capitalino, la Biblioteca Nacional Venezuela, realizará un conversatorio sobre ...
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EntornoInteligente

Una biblioteca más se suma a Misiones, esta vez en paraje El Saltito Misiones OnLine
La Fundación “Un sueño para Misiones” inauguró una nueva biblioteca, la numero 16, en Paraje El Saltito, ubicado a 35 kilómetros de la ciudad de 25 de Mayo ...
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Misiones OnLine

Biblioteca de puro rock and roll El Universal - Colombia
Biblioteca de puro rock and roll. SERGIO VILLAMIZAR D. 12 de Noviembre de 2013 08:21 am. Manolo Bellon, escribió ABC del Rock and Roll, cuya primera ...
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El Universal - Colombia

Obtiene Biblioteca Campeche mención honorífica en Premio México ... Rotativo de Querétaro
(Notimex).- La Biblioteca Campeche obtuvo mención honorífica en el “Premio México Lee 2013″, por desarrollar el proyecto “Aprovechamiento de los medios ...
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Biblioteca Nacional realiza conferencia sobre la lectura en la era ... Pachamama radio 850 AM
lectura Para fomentar la lectura en los tiempos actuales, la Biblioteca Nacional del Perú (BNP) realizará el 14 y 15 de noviembre la conferencia “La cultura de la ...
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La Biblioteca Municipal de Arucas, presente en el II Congreso del ... InfonorteDigital
La Concejalía de Cultura del Ayuntamiento de Arucas, que coordina Lidia E. Morales, informa de que la Biblioteca Municipal ha participado en el II Congreso ...
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InfonorteDigital

Celebra Biblioteca Pública Central "Carlos Montemayor" el Día ... El Digital
A partir del lunes 11 y hasta el 15 de noviembre, en las diferentes áreas de la biblioteca los usuarios podrán disfrutar de exposiciones permanentes, maratones ...
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El Digital

Mejorarán la biblioteca y el polideportivo con fondos de la Diputación Tribuna de Toledo
La alcaldesa de La Puebla de Almoradiel, Julia Villarejo, ha trasladado al presidente de la Diputación, Arturo García-Tizón, su intención de ampliar la biblioteca ...
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La biblioteca de Salinas atrae a jóvenes lectores a ritmo de rap La Nueva España
Los responsables de la biblioteca de Salinas han abierto las puertas del centro a grupos de escolares del colegio "Manuel Álvarez iglesias" de la localidad que ...
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La Nueva España

Donan libros a biblioteca municipal · El Nuevo Diario
La Biblioteca Municipal “Octavio Gallardo”, de Juigalpa, recibió un lote de más de cien libros, resultado de una gestión realizada por Edelmira Acevedo, ante la ...
El Nuevo Diario - Nacionales

Consolidando la gestión y el posicionamiento de la biblioteca ... eliana8811
Consolidando la gestión y el posicionamiento de la biblioteca pública municipal “María de los Ángeles Murcia” en la comunidad académica y general (1 Parte) ...
Blogs de la Biblioteca Nacional de Colombia

Un lugar físico para la Biblioteca Popular Atahualpa Yupanqui ... Ernesto Della Riva
Le pedimos que interfiera a favor de nuestra Institución Sin Fines de Lucro, que desde hace 15 años venimos peticionando. Existe una Ley Provincial que ...
RINCON DEL BIBLIOTECARIO

Animación a la lectura en la biblioteca de Velilla | zafarache Ribera Baja del Ebro
Los niños de Velilla asistieron ayer, 11 de noviembre, a una actividad de animación a la lectura incluida en el programa de otoño de la Diputación Provincial de ...
zafarache

Beca Editorial Aranzadi - Biblioteca UC3M
Escrito por Universia. Objeto: Realización de actividades en el Aula Aranzadi de la Biblioteca UC3M Convocante:Editorial Aranzadi Plazo:20 de octubre de ...
Universidad y Noticias

A la Poesía Rafael Pombo - Biblioteca Pública Héctor González ... Red de Bibliotecas Públicas Comfenalco Antioquia
Posted by: Red de Bibliotecas Públicas Comfenalco Antioquia. Eco Aldeas | 48minutos. Lugar: Hall de la Biblioteca Héctor González Mejía. Lunes a viernes a ...
Biblioteca Pública Héctor González Mejía

Una biblioteca en tu mano. Campaña de bookcrossing digital | Ocio ... Ocio Urbano Zaragoza
La campaña de desarrollo del 24 de octubre al 24 de noviembre en colaboración con los transportes Urbanos de Zaragoza, Tranvía de Zaragoza y las ...
Diario Digital Ocio Urbano Zaragoza

La biblioteca de la Escuela Primaria Hancock es renovada por ... noreply@blogger.com (San Diego Unified School District News)
Target Corp. y The Heart of America Foundation han finalizado la renovación de la biblioteca de la Primaria Hancock de Murphy Canyon, con 2,000 libros ...
Informativo del Distrito Escolar Unificado de San Diego

Tercera lectura del ciclo 2013-2014 del Círculo Literario de la ... bibliotecaiie
Participa leyendo el libro recomendado y asistiendo al coloquio que habitualmente se celebra el último jueves de cada mes. Sesión dirigida por Jacqueline ...
Biblioteca del Instituto Internacional

La Biblioteca Municipal de Arucas, presente en el II Congreso del ... Canarias
La Biblioteca Municipal de Arucas, presente en el II Congreso del proyecto 'LIBRARY. I LOVE IT!' El encuentro tuvo lugar en la ciudad de Aydin (Turquía) a ...
canariasactual.com



Web 1 resultado nuevo para Biblioteca

Biblioteca de la Universidad de Oviedo - Biblioteca de Ciencias ...
Biblioteca de Ciencias Jurídico-Sociales Dirección: Campus de El Cristo Alto-33006 Oviedo Email: buocjs@uniovi.es Teléfono: 985103778 Fax: 985104761 ...
buo.uniovi.es/.../biblioteca-de-ciencias-juridico-sociales;...

Complicaciones de raquia/Spinal anesthesia complications

Cefalea postpunción espinal, un problema viejo y conceptos nuevos: revisión de artículos y factores predisponentes


Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors.
Jabbari A, Alijanpour E, Mir M, Bani Hashem N, Rabiea SM, Rupani MA.
Department of Anesthesiology and Intensive Care, Golestan University of Medical Sciences, Gorgan, Iran.
Caspian J Intern Med. 2013 Winter;4(1):595-602.
Abstract
Post spinal puncture headache (PSPH) is a well known complication of spinal anesthesia. It occurs after spinal anesthesia induction due to dural and arachnoid puncture and has a significant effect on the patient's postoperative well being. This manuscript is based on an observational study that runs on Babol University of Medical Sciences and review of literatures about current concepts about the incidence, risk factors and predisposing factors of post spinal puncture headache. The overall incidence of post-dural puncture headache after intentional dural puncture varies form 0.1-36%, while it is about 3.1% by atraumatic spinal needle 25G Whitacre. 25G Quincke needle with a medium bevel cutting is popular with widespread use and the incidence of PSPH is about 25%, but its incidence obtained 17.3% by spinal needle 25G Quincke in our observation. The association of predisposing factors like female, young age, pregnancy, low body mass index, multiple dural puncture, inexpert operators and past medical history of chronic headache, expose the patient to PSPH. The identification of factors that predict the likelihood of PSPH is important so that measures can be taken to minimize this painful complication resulting from spinal anesthesia.
KEYWORDS: Headache, Post spinal puncture headache (PSPH), Risk factors, Spinal anesthesia, Treatment

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762227/pdf/cjim-4-595.pdf





Hematoma espinal subaracnoideo después de anestesia raquídea

Spinal subarachnoid hematoma after spinal anesthesia.
Jeon SB, Ham TI, Kang MS, Shim HY, Park SL.
Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea.
Korean J Anesthesiol. 2013 Apr;64(4):388-9. doi: 10.4097/kjae.2013.64.4.388.

Moen et al. reported that spinal hematoma occurred in 8 out of 1,260,000 cases of spinal anesthesia in Sweden, and subarachnoid hematoma is known to be very rare. We report a case of subarachnoid hematoma after spinal anesthesia in a patient without coagulopathy....

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640179/pdf/kjae-64-388.pdf





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

Cirugía y uso de procedimientos poco inavasivos en lesiones benignas...

DR GERMAN FARFALLI/ CIRUGÍA Y USO DE PROCEDIMIENTOS POCO INVASIVAS EN LESIONES BENIGNAS/ dvd47 5
TUMORES ÓSEOS
XXVII JORNADA NACIONAL DE ORTOPEDIA
58°REUNIÓN ANUAL 2013
1° AL 5 DE MAYO ACAPULCO GRO, MÉXICO
http://youtu.be/UOx1TjFcgwg

DR GERMAN FARFALLI/ CIRUGÍA Y USO DE PROCEDIMIENTOS POCO INVASIVAS EN LESIONES BENIGNAS/ dvd47 5

www.youtube.com

TUMORES ÓSEOS XXVII JORNADA NACIONAL DE ORTOPEDIA 58°REUNIÓN ANUAL

Cirugía de vía rápida

Cirugía de vía rápida: un nuevo concepto de manejo perioperatorio de los pacientes quirúrgicos


Fast-track surgery: A new concept of perioperative management of surgical patients.
Rodrigues G, Ravi C, Prabhu R.
J Health Spec [serial online] 2013 [cited 2013 Oct 30];1:114-21.
Abstract
In the past few decades, surgery has advanced greatly because of an improved understanding of perioperative pathophysiology, development of minimally invasive operative techniques and advanced anaesthetic techniques. Fewer operations are requiring extended periods of hospital stay and a growing number of procedures are performed on an ambulatory basis. The pressure on medical systems is continuously growing as a result of economic constraints, increasing numbers of patients undergoing surgical procedures and greater patient autonomy. Patient awareness is steadily increasing along with their participation in their own care, leading to expectations of a higher standard of care. This has led to the development of a new concept of fast-track surgery.
Keywords: Anaesthesia, hospital stay, perioperative, recovery, surgery
http://www.thejhs.org/text.asp?2013/1/3/114/120843





Resecciones laparoscópicas de colon con alta en menos de 24 horas

Laparoscopic colon resections with discharge less than 24 hours.

Dobradin A, Ganji M, Alam SE, Kar PM.

Winter Park Memorial Hospital, Winter Park, FL, USA. adobradin@aol.com

JSLS. 2013 Apr-Jun;17(2):198-203. doi: 10.4293/108680813X13654754535791.

Abstract

BACKGROUND AND OBJECTIVES:A short hospital stay is one of the main advantages of laparoscopic surgery. Previous studies have shown that after a multimodal fast-track process, the hospital length of stay can be shortened to between 2 and 5 days. The objective of this review is to show that the hospital length of stay can, in some cases, be reduced to <24 hours.METHODS: This study retrospectively reviews a surgeon's experience with laparoscopic surgery over a 12-month period. Seven patients were discharged home within 24 hours after minimally invasive laparoscopic surgical treatment, following a modified fast-track protocol that was adopted for perioperative care. RESULTS: Of the 7 patients, 4 received laparoscopic right hemicolectomy for malignant disease and 3 underwent sigmoid colectomies for recurrent diverticulitis. The mean hospital stay was 21 hours, 47 minutes; the mean volume of intraoperative fluid (lactated Ringer) was 1850 mL; the meansurgical blood loss was only 74.3 mL; the mean duration of surgery was 118 minutes; and the patients were ambulated and fed a liquid diet after recovery from anesthesia. The reviewed patients had functional gastrointestinal tracts and were agreeable to the timing of discharge. On the follow-up visit, they showed no adverse consequences such as bleeding, infection, or anastomotic leak. CONCLUSION: Laparoscopic colon surgery that incorporated multimodal perioperative care allowed patients to be discharged within the first 24 hours. Careful postoperative outpatient follow-up is important in monitoring complications such as anastomotic leak, which may not present until postoperative day 5.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771785/pdf/jls198.pdf

Impacto de la calidad de sueño sobre la recuperación de histerectomía abdominal de vía rápida
The impact of quality of sleep on recovery from fast-track abdominal hysterectomy.
Kjølhede P, Langström P, Nilsson P, Wodlin NB, Nilsson L.
Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, County Council of Östergötland, Sweden.
J Clin Sleep Med. 2012 Aug 15;8(4):395-402. doi: 10.5664/jcsm.2032.
Abstract
STUDY OBJECTIVES:To examine the impact of mode of anesthesia on perceived quality of sleep and to analyze the perceived quality of sleep in affecting recovery from surgery. METHODS:A randomized, controlled, open multicenter trial was conducted in 5 hospitals in Southeast Sweden. One-hundred eighty women scheduled for fast-track abdominal hysterectomy for benign conditions were randomized to spinal anesthesia or general anesthesia; 162 women completed the trial; 82 allocated to spinal anesthesia and 80 to general anesthesia. Symptoms and perceived quality of sleep after surgery were registered daily in the Swedish Postoperative Symptoms Questionnaire.RESULTS:Women in the general anesthesia group experienced bad quality of sleep the night after surgery significantly more often than the women who had spinal anesthesia (odds ratio [OR] 2.45; p = 0.03). This was almost exclusively attributed to a significantly higher consumption of opioids postoperatively in the general anesthesia group. Risk factors for bad quality of sleep during the first night postoperatively were: opioids (OR 1.07; p = 0.03); rescue antiemetics (OR 2.45; p = 0.05); relative weight gain (OR 1.47; p = 0.04); summary score of postoperative symptoms (OR 1.13; p = 0.02); and stress coping capacity (OR 0.98; p = 0.01). A longer hospital stay was strongly associated with a poorer quality of sleep the first night postoperatively (p = 0.002). CONCLUSIONS:The quality of sleep the first night after abdominal hysterectomy is an important factor for recovery. In fast-track abdominal hysterectomy, it seems important to use anesthesia and multimodal analgesia reducing the need for opioids postoperatively and to use strategies that diminish other factors that may interfere negatively with sleep. Efforts to enhance quality of sleep postoperatively by means of preventive measures and treatment of sleep disturbances should be included in fast-track programs.
KEYWORDS:Abdominal hysterectomy, fast track, general anesthesia, postoperative recovery, quality of sleep, spinal anesthesia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407258/pdf/jcsm.8.4.395.pdf







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

Libros digitales. alerta

Plataformas de préstamos de libros digitales en las bibliotecas ... JulianMarquina
Alonso-Arévalo, Julio Plataformas de préstamos de libros digitales en las bibliotecas públicas., 2013 . In Conversaciones líquidas: buscando nuevas ...
RecBib - Recursos Bibliotecarios

Plataformas de documentos y libros digitales en bibliotecas ... julio
Serrano-Muñoz, J. [e-Book] Plataformas de documentos y libros digitales en bibliotecas universitarias. Peñaranda de Bracamonte, Lectyo, 2013. Texto.
Universo Abierto

Todos los libros digitales en Promoebooks | Comunicación Cultural Equipo Dosdoce
Promoebooks es una marca que ha creado Libranda y cuya función es ayudar a promocionar los libros digitales del catálogo de los editores adscritos a su ...
Comunicación Cultural

Plataformas de préstamos de libros digitales en las bibliotecas ... webmaster
Plataformas de préstamos de libros digitales en las bibliotecas públicas, artículo de Julio Alonso Arévalo que cita las Plataformas existentes en el mercado y las ...
xerblog

Bibliotecas. Alerta

Biblioteca ambulante busca edificio Los Andes (Argentina)
Con un carrito llevan ejemplares a las escuelas y promueven el interés por la lectura. La iniciativa es parte del programa de bibliotecaspopulares de Mendoza.
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Los Andes (Argentina)

Ofrecen bibliotecas del área diversos programas para residentes Bajo el Sol
Los derechos y las responsabilidades de votantes serán el tema de una programa que se ofrecerá en la Biblioteca Principal de Yuma el 18 de noviembre para ...
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Bibliotecas públicas del Quindío, al día en calidad La Cronica del Quindio
Bibliotecas públicas del Quindío se encuentran al día tanto en procesos ... Así lo manifestó Diana Lucía Martínez Naranjo, tutora regional de bibliotecas en su ...
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La Cronica del Quindio

Las bibliotecas universitarias se reúnen en Zaragoza Heraldo de Aragon
El Paraninfo acogerá este jueves y viernes a directores y vicerrectores responsables de las 75 bibliotecas universitarias españolas para planificar sus acciones ...
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Heraldo de Aragon

Bibliotecas, lugares para combatir la violencia www.nssoaxaca.com
Oaxaca, Oax. Al considerar como equívoco que se usen las bibliotecas como espacios de castigo u obligatorios, Eva Janovitz promotora de la lectura, dijo que ...
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Bibliotecas de la UV con 270 mil títulos impresos El Golfo Info
Xalapa, Ver.-Las bibliotecas de la Universidad Veracruzana (UV) cuentan con cerca de 270 mil títulos en 800 mil volúmenes de formato impreso, además de ...
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Inician bibliotecas programa "Computación para Todos" Hoy Laredo
La décima regidora, María Echartea Barajas, de la Comisión de Educación, acudió a la apertura del curso en la Biblioteca Rubén Miranda Villalba y dijo que ...
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Hoy Laredo

La biblioteca nacional expone la muestra 'caligrafía japonesa' Lainformacion.com
La Biblioteca Nacional de España (BNE) presentará el próximo 13 de noviembre la exposición 'Caligrafía japonesa', en un acto que tendrá lugar a las 11.00 de ...
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Finanzas.com

Poca gente consulta las bibliotecas municipales Milenio.com
Según datos del INEGI del censo de 2010, en Tampico existen 303.924 habitantes; el dato interesante llega al tratar el caso de las bibliotecas municipales, ...
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La biblioteca central, la que menos recursos recibe de Xunta y Estado Faro de Vigo
De las seis bibliotecas nodales de Galicia -Vigo, A Coruña, Ourense, Pontevedra, Santiago de Compostela y Lugo- la situada en Joaquín Yáñez es, según los ...
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Faro de Vigo

Venta digital a bibliotecas | Antinomias Libro antinomiasblog
La semana pasada estuve en las II Jornadas de Bibliotecas de Extremadura. Las jornadas estaban dirigidas a profesionales de bibliotecas públicas, escolares, ...
Antinomias Libro

Dónde comprar libros digitales para bibliotecas en España ... julio
Alonso-Arévalo, Julio. Dónde comprar libros digitales para bibliotecas en España. En: Conversaciones líquidas: buscando nuevas dimensiones sobre el libro.
Universo Abierto

Plataformas de documentos y libros digitales en bibliotecas ... julio
Serrano-Muñoz, J. [e-Book] Plataformas de documentos y libros digitales en bibliotecas universitarias. Peñaranda de Bracamonte, Lectyo, 2013. Texto.
Universo Abierto

Videos de las ponencias del V Encuentro de Bibliotecas y Municipio ... huelvatecas
Ya se pueden visionar los videos de las ponencias del V Encuentro de Bibliotecas y Municipio, centradas en la cooperación entre bibliotecas públicas y ...
Huelvatecas:

Verba Al-Qázeres: II JORNADAS DE BIBLIOTECAS DE ... - Blogger Coro
El pasado día 30 de octubre, nuestros alumnos de 1º ESO A participaron activamente en las II Jornadas de Bibliotecas de Extremadura asistiendo a un ...
Verba Al-Qázeres

BIBLIOTECAS PENITENCIARIAS | Buenalectura Editor
Lina Vargas, Revista Arcadia, 17 octubre 2013 (La biblioteca de la cárcel para mujeres El Buen Pastor de Bogotá cuenta con 15.000 títulos. En un país donde el ...
Buenalectura

La Solidaridad revoluciona el espacio de 23 Bibliotecas Públicas de ... PROBIT
Del 21 al 26 de octubre de 2013 los profesionales de las bibliotecas públicas municipales de Tenerife volvieron a demostrar que están dispuestos a trabajar ...
PROBIT

¡¡¡Atención!!! Los datos digitales de investigación necesitan admin
¿Les suena el mediático caso de Reinhardt y Rogoff? Pues bien, gracias a los datos de investigación un estudiante de doctorado fue capaz de demostrar los ...
El profesional de la información

Inteligencias Múltiples y aprendizaje por Competencias: un nuevo ... @bibliotescolar
See on Scoop.it - Recursos TIC para educación Boletín SCOPEO No. 93. 04 de Noviembre de 2013See on scopeo.usal.es.
Bibliotecas escolares y recursos educativos

Competencia informacional, sí. Pero ¿cómo?: Saber buscar ... @bibliotescolar
See on Scoop.it - Recursos TIC para educaciónSee on competenciainformacionalrecursos.blogspot.com.es.
Bibliotecas escolares y recursos educativos

Apariencias

Apariencias from San Antonio de Padua

Cirugía cardiaca de vía rápida/Fast track cardiac surgery

Programa de estancia corta en cirugía cardiaca: Análisis de morbimortalidad en 533 casos en cinco años.


Rodríguez-Chavez, LL et al
Arch. Cardiol. Méx. [online]. 2010, vol.80, n.2, pp. 100-107. ISSN 1405-9940.
Resumen
Introducción: Para disminuir la lista de espera para la cirugía cardiaca electiva, en 1999 el Instituto Nacional de Cardiología Ignacio Chávez inició un programa de vía rápida para casos de muy bajo riesgo quirúrgico. En 2004, este programa se extendió a pacientes con riesgo intermedio.Objetivos: Estudio prospectivo, descriptivo, para evaluar las características clínicas y demográficas de los pacientes del programa de vía rápida en cirugía cardiaca electiva. También se analizaron la estancia hospitalaria, mortalidad, complicaciones y reingresos. Métodos: De marzo de 2004 a febrero de 2009 incluimos pacientes adultos con indicación de cirugía cardiaca y con riesgo quirúrgico de bajo a intermedio, con requisitos preoperatorios completos antes del internamiento. Resultados: De un total de 598 pacientes ingresados al programa, se analizaron 533, con edad de 47 ± 14 años, 62.5% mujeres. Se clasificaron en cuatro grupos: valvulares (68%), congénitos (25%), isquémicos (5%) y mixtos (2%). Los promedios de días de estancia hospitalaria fueron: preoperatoria 1.9, terapia tres, postoperatoria en piso 6.9 y total 11.9 días. Se evidenció que 17.8 % estuvieron más de 14 días por: reoperaciones, complicaciones pulmonares, arritmias, o infecciones. La mortalidad fue de 4.1% y hubo 2.8% de reingresos en los primeros tres meses posteriores a la cirugía. Conclusiones: Este programa conduce a bajos índices de mortalidad, estancia hospitalaria y reingresos.
Palabras llave : Cirugía cardiaca electiva; Vía rápida; Complicaciones de cirugía cardiaca y estancia intrahospitalaria; México.


http://www.scielo.org.mx/pdf/acm/v80n2/v80n2a7.pdf



Análisis de los factores de riesgo para la falla del protocolo de vía rápida

Risk factor analysis for fast track protocol failure.

Kiessling AH, Huneke P, Reyher C, Bingold T, Zierer A, Moritz A.

Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany. cardiac.surgeon@dr-kiessling.com

J Cardiothorac Surg. 2013 Mar 15;8:47. doi: 10.1186/1749-8090-8-47.



http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608078/pdf/1749-8090-8-47.pdf



Tiempo de estancia en la UCI después de la cirugía cardíaca:¿Es imposible encontrar un modelo de predicción universal?

Length of intensive care unit stay following cardiac surgery: is it impossible to find a universal prediction model?
Widyastuti Y, Stenseth R, Wahba A, Pleym H, Videm V.
Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
Interact Cardiovasc Thorac Surg. 2012 Nov;15(5):825-32. doi: 10.1093/icvts/ivs302. Epub 2012 Jul 24.
Abstract
OBJECTIVES: Accurate models for prediction of a prolonged intensive care unit (ICU) stay following cardiac surgery may be developed using Cox proportional hazards regression. Our aims were to develop a preoperative and intraoperative model to predict the length of the ICU stay and to compare our models with published risk models, including the EuroSCORE II. METHODS: Models were developed using data from all patients undergoing cardiac surgery at St. Olavs Hospital, Trondheim, Norway from 2000-2007 (n = 4994). Internal validation and calibration were performed by bootstrapping. Discrimination was assessed by areas under the receiver operating characteristics curves and calibration for the published logistic regression models with the Hosmer-Lemeshow test. RESULTS: Despite a diverse risk profile, 93.7% of the patients had an ICU stay <2 days, in keeping with our fast-track regimen. Our models showed good calibration and excellent discrimination for prediction of a prolonged stay of more than 2, 5 or 7 days. Discrimination by the EuroSCORE II and other published models was good, but calibration was poor (Hosmer-Lemeshow test: P < 0.0001), probably due to the short ICU stays of almost all our patients. None of the models were useful for prediction of ICU stay in individual patients because most patients in all risk categories of all models had short ICU stays (75th percentiles: 1 day). CONCLUSIONS: A universal model for prediction of ICU stay may be difficult to develop, as the distribution of length of stay may depend on both medical factors and institutional policies governing ICU discharge.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480596/pdf/ivs302.pdf



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

X Curso de Ortopedia Pediátrica / México, 2013

Tumor de Células gigantes / ortopedia

Aquí la última plática de La Mixta por este 2013, Tumor de Células Gigantes, ponente: Dr. José Humberto Rodríguez Franco, (B Rguez Franco)

http://youtu.be/VPLTkZj5jf4

Embarazo de alto riesgo

Anestesia en una parturienta con transplante renal


Anesthesia for parturient with renal transplantation.
Parikh BK, Shah VR, Bhosale G.
Department of Anaesthesia and Critical Care, Institute of Kidney Diseases and Research Centre, Civil Hospital Campus, Ahmedabad, Gujarat, India.
J Anaesthesiol Clin Pharmacol. 2012 Oct;28(4): 524-7.
Abstract
Management of successful pregnancy after renal transplantation is a unique challenge to nephrologist, obstetrician, and anesthesiologist, as these patients have altered physiology and are immune-compromised. We present the anesthetic management of three postrenal transplant patients scheduled for cesarean section. While conducting such cases, cardiovascular status, hematological status, and function of transplanted kidney should be assessed thoroughly. Side effects of immunosuppressant drugs and their interaction with anesthetic agents should be taken into consideration. Main goal of anesthetic management is to maintain optimum perfusion pressure of renal allograft to preserve its function.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511957/






Embarazo después de transplante de hígado: revisión de evolución y recomendaciones de manejo

Pregnancy following liver transplantation: review of outcomes and recommendations for management.
Parhar KS, Gibson PS, Coffin CS.
Division of General Internal Medicine, University of Calgary, Calgary, Alberta.
Can J Gastroenterol. 2012 Sep;26(9):621-6.
Abstract
Liver transplantation is considered to be the treatment of choice for end-stage liver disease and its success has led to an increase in the number of female liver transplant recipients who are of childbearing age. Several key issues that are noted when counselling patients who are consideringpregnancy following liver transplantation include the optimal timing of pregnancy, optimal contraception methods and the management of immunosuppression during pregnancy. The present review summarizes the most recent literature so that the clinician may address these issues with their patient and enable them to make informed decisions about pregnancy planning. The authors review recent studies examining maternal and fetal outcomes, and the rates of complications including risk of graft rejection. Subsequently, the authors provide recommendations for counselling prospective mothers and the management of the pregnant liver transplant recipient.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3441170/pdf/cjg26621.pdf


Cardiomiopatía periparto: revisión de la literatura
Peripartum cardiomyopathy: review of the literature.
Bhakta P, Biswas BK, Banerjee B.
Department of Anesthesiology, Barnes-Jewish Hospital South, Washington University School of Medicine, 660 S Euclid Avenue, St. Louis, MO, USA.
Yonsei Med J. 2007 Oct 31;48(5):731-47.
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but serious form of cardiac failure affecting women in the last months of pregnancy or early puerperium. Clinical presentation of PPCM is similar to that of systolic heart failure from any cause, and it can sometimes be complicated by a high incidence of thromboembolism. Prior to the availability of echocardiography, diagnosis was based only on clinical findings. Recently, inclusion of echocardiography has made diagnosis of PPCM easier and more accurate. Its etiopathogenesis is still poorly understood, but recent evidence supports inflammation, viral infection and autoimmunity as the leading causative hypotheses. Prompt recognition with institution of intensive treatment by a multidisciplinary team is a prerequisite for improved outcome. Conventional treatment consists of diuretics, beta blockers, vasodilators, and sometimes digoxin and anticoagulants, usually in combination. In resistant cases, newer therapeutic modalities such as immunomodulation, immunoglobulin and immunosuppression may be considered. Cardiac transplantation may be necessary in patients not responding to conventional and newer therapeutic strategies. The role of the anesthesiologist is important in perioperative and intensive care management. Prognosis is highly related to reversal of ventricular dysfunction. Compared to historically higher mortality rates, recent reports describe better outcome, probably because of advances in medical care. Based on current information, future pregnancy is usually not recommended in patients who fail to recover heart function. This article aims to provide a comprehensive updated review of PPCM covering etiopathogeneses, clinical presentation and diagnosis, as well as pharmacological, perioperative and intensive care management and prognosis, while stressing areas that require further research.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628138/pdf/ymj-48-731.pdf




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

Gama globulina IV en el manejo de Inmunodeficiencia e hipersensibilidad

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 13 de Noviembre 2013 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Gama globulina IV en el manejo de Inmunodeficiencia e hipersensibilidad ” por “Dr. Marco Antonio Yamasaky” Inmunólogo, Pediatra de la Cd. de México DF . 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/ gamaglobulina_iv/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia 

 6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.

Henrys

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

Sedación con dexmedetomidina/Dexmedetomidine for sedation

Dosis óptima de dexmedetomidina para sedación durante raquianestesia   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  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 Dexmedetomidina para sedación de pacientes de cirugía electiva bajo anestesia raquídea       Dexmedetomidine for sedation of patients undergoing elective surgery under regional anesthesia. Song J, Kim WM, Lee SH, Yoon MH. Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju, Korea. Korean J Anesthesiol. 2013 Sep;65(3):203-8. doi: 10.4097/kjae.2013.65.3.203. Epub 2013 Sep 25. Abstract BACKGROUND:Dexmedetomidine may be useful as a sedative agent. However, it has been reported that dexmedetomidine decreases systemic blood pressure, heart rate, and cardiac output in a dose-dependent manner. The purpose of this study was to determine the appropriate dose of intravenously administered dexmedetomidine for sedation. METHODS: Forty-five American Society of Anesthesiologists physical status I-II patients under spinal anesthesia received dexmedetomidine 1 µg/kg intravenously as a loading dose. The patients were randomly allocated to one of three groups for maintenance dose: Group A (0.25 µg/kg/hr), Group B (0.50 µg/kg/hr), and Group C (0.75 µg/kg/hr). The hemodynamic variables and the Ramsay Sedation Scale (RSS) score were recorded for all patients. The numbers of patients who developed hypotension, bradycardia, or inadequate sedation necessitating further drug treatment were also recorded. RESULTS: Systolic blood pressure, heart rate, and SpO2 were decreased, and RSS score was increased significantly at both 20 min and 40 min after injection of dexmedetomidine in the three study groups compared to baseline, without significant differences between the groups. The prevalence of hypotension, but not that of bradycardia or adjunctive midazolam administration, exhibited a positive correlation with the dose of dexmedetomidine. CONCLUSIONS: Intravenous injection of dexmedetomidine 1 µg/kg followed by continuous administration at infusion rates of 0.25, 0.50, or 0.75 µg/kg/hr produced adequate levels of sedation. However, there was a tendency for the incidence of hypotension to increase as the dose increased. To minimize the risk of hemodynamic instability, a dose of 0.25 µg/kg/hr may be the most appropriate for continuous administration of dexmedetomidine. KEYWORDS: Continuous dose, Dexmedetomidine, Regional anesthesia, Sedation http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790030/pdf/kjae-65-203.pdf Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Cuidado prehospitalario del trauma

Fase de implementación de un sistema multicéntrico prehospitalario de apoyo a paramédicos: posibilidades y viabilidad


Implementation phase of a multicentre prehospital telemedicine system to support paramedics: feasibility and possible limitations.
Bergrath S, Czaplik M, Rossaint R, Hirsch F, Beckers SK, Valentin B, Wielpütz D, Schneiders MT, Brokmann JC.
Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany. sbergrath@ukaachen.de
Scand J Trauma Resusc Emerg Med. 2013 Jul 11;21:54. doi: 10.1186/1757-7241-21-54.
Abstract
BACKGROUND: Legal regulations often limit the medical care that paramedics can provide. Telemedical solutions could overcome these limitations by remotely providing expert support. Therefore, a mobile telemedicine system to support paramedics was developed. During the implementation phase of this system in four German emergency medical services (EMS), the feasibility and possible limitations of this system were evaluated. METHODS:After obtaining ethical approval and providing a structured training program for all medical professionals, the system was implemented on three paramedic-staffed ambulances on August 1st, 2012. Two more ambulances were included subsequently during this month. The paramedics could initiate a consultation with EMS physicians at a teleconsultation centre. Telemedical functionalities included audio communication, real-time vital data transmission, 12-lead electrocardiogram, picture transmission on demand, and video streaming from a camera embedded into the ceiling of each ambulance. After each consultation, telephone-based debriefings were conducted. Data were retrieved from the documentation protocols of the teleconsultation centre and the EMS. RESULTS: During a one month period, teleconsultations were conducted during 35 (11.8%) of 296 emergency missions with a mean duration of 24.9 min (SD 12.5). Trauma, acute coronary syndromes, and circulatory emergencies represented 20 (57%) of the consultation cases. Diagnostic support was provided in 34 (97%) cases, and the administration of 50 individual medications, including opioids, was delegated by the teleconsultation centre to the paramedics in 21 (60%) missions (range: 1-7 per mission). No medical complications or negative interpersonal effects were reported. All applications functioned as expected except in one case in which the connection failed due to the lack of a viable mobile network. CONCLUSION: The feasibility of the telemedical approach was demonstrated. Teleconsultation enabled early initiation of treatments by paramedics operating under the real-time medical direction. Teleconsultation can be used to provide advanced care until the patient is under a physician's care; moreover, it can be used to support the paramedics who work alone to provide treatment in non-life-threatening cases. Non-availability of mobile networks may be a relevant limitation. A larger prospective controlled trial is needed to evaluate the rate of complications and outcome effects.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599067/pdf/1757-7241-21-9.pdf





La adherencia a las guías y protocolos en el ámbito de la atención pre-hospitalaria y de emergencia: una revisión sistemática.

Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review.
Ebben RH, Vloet LC, Verhofstad MH, Meijer S, Mintjes-de Groot JA, van Achterberg T.
Research group for Acute Care, Faculty of Health and Social Studies, HAN University of Applied Sciences, Verlengde Groenestraat 75, Nijmegen 6525 EJ, The Netherlands. Remco.Ebben@han.nl
Scand J Trauma Resusc Emerg Med. 2013 Feb 19;21:9. doi: 10.1186/1757-7241-21-9.
Abstract
A gap between guidelines or protocols and clinical practice often exists, which may result in patients not receiving appropriate care. Therefore, the objectives of this systematic review were (1) to give an overview of professionals' adherence to (inter)national guidelines and protocols in the emergency medical dispatch, prehospital and emergency department (ED) settings, and (2) to explore which factors influencing adherence were described in studies reporting on adherence. PubMed (including MEDLINE), CINAHL, EMBASE and the Cochrane database for systematic reviews were systematically searched. Reference lists of included studies were also searched for eligible studies. Identified articles were screened on title, abstract and year of publication (≥1990) and were included when reporting on adherence in the eligible settings. Following the initial selection, articles were screened full text and included if they concerned adherence to a (inter)national guideline or protocol, and if the time interval between data collection and publication date was <10 years. Finally, articles were assessed on reporting quality. Each step was undertaken by two independent researchers. Thirty-five articles met the criteria, none of these addressed the emergency medical dispatch setting or protocols. Median adherence ranged from 7.8-95% in the prehospital setting, and from 0-98% in the ED setting. In the prehospital setting, recommendations on monitoring came with higher median adherence percentages than treatment recommendations. For both settings, cardiology treatment recommendations came with relatively low median adherence percentages. Eight studies identified patient and organisational factors influencing adherence. The results showed that professionals' adherence to (inter)national prehospital and emergency department guidelines shows a wide variation, while adherence in the emergency medical dispatch setting is not reported. As insight in influencing factors for adherence in the emergency care settings is minimal, future research should identify such factors to allow the development of strategies to improve adherence and thus improve quality of care.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710491/pdf/1757-7241-21-54.pdf

Vía aérea prehospitalaria/Prehospital airway

Uso del tubo laríngeo en para cardiaco fuera del hospital por paramédicos noruegos  Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway. Sunde GA, Brattebø G, Odegården T, Kjernlie DF, Rødne E, Heltne JK. Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. geir.arne.sunde@helse-bergen.no Scand J Trauma Resusc Emerg Med. 2012 Dec 18;20:84. doi: 10.1186/1757-7241-20-84. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547736/pdf/1757-7241-20-84.pdf Determinación prehospitalaria de la colocación del tubo traqueal en daño grave de cabeza   Prehospital determination of tracheal tube placement in severe head injury. Grmec S, Mally S. Source Emergency Medical Service, Prehospital Unit, Maribor, Slovenia. Emerg Med J. 2004 Jul;21(4):518-20. Abstract OBJECTIVES: The aim of this prospective study in the prehospital setting was to compare three different methods for immediate confirmation of tubeplacement into the trachea in patients with severe head injury: auscultation, capnometry, and capnography. METHODS: All adult patients (>18 years) with severe head injury, maxillofacial injury with need of protection of airway, or polytrauma were intubated by an emergency physician in the field. Tube position was initially evaluated by auscultation. Then, capnometry and capnography was performed (infrared method). Emergency physicians evaluated capnogram and partial pressure of end tidal carbon dioxide (EtCO(2)) in millimetres of mercury.Determination of final tube placement was performed by a second direct visualisation with laryngoscope. Data are mean (SD) and percentages. RESULTS: There were 81 patients enrolled in this study (58 with severe head injury, 6 with maxillofacial trauma, and 17 politraumatised patients). At the first attempt eight patients were intubated into the oesophagus. Afterwards endotracheal intubation was undertaken in all without complications. The initial capnometry (sensitivity 100%, specificity 100%), capnometry after sixth breath (sensitivity 100%, specificity 100%), and capnography after sixth breath (sensitivity 100%, specificity 100%) were significantly better indicators for tracheal tube placement than auscultation (sensitivity 94%, specificity 66%, p<0.01). CONCLUSION: Auscultation alone is not a reliable method to confirm endotracheal tube placement in severely traumatised patients in the prehospitalsetting. It is necessary to combine auscultation with other methods like capnometry or capnography. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726371/pdf/v021p00518.pdf   Manejo de vía aérea en trauma maxilofacial. Estudio retrospectivo de 177 casos   Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases. Raval CB, Rashiduddin M. Department of Anesthesia, Al-Nahdha Hospital, Muscat, Oman. Saudi J Anaesth. 2011 Jan;5(1):9-14. doi: 10.4103/1658-354X.76476. Abstract BACKGROUND: Airway management in maxillofacial injuries presents with a unique set of problems. Compromised airway is still a challenge to the anesthesiologist in spite of all modalities available. Maxillofacial injuries are the result of high-velocity trauma arising from road traffic accidents, sport injuries, falls and gunshot wounds. Any flaw in airway management may lead to grave morbidity and mortality in prehospital or hospital settings and as well as for reconstruction of fractures subsequently. METHODS: One hundred and seventy-seven patients of maxillofacial injuries, operated over a period of one and half years during July 2008 to December 2009 in Al-Nahdha hospital were reviewed. All patients were reviewed in depth with age related type of injury, etiology and techniques of difficult airway management. RESULTS: The major etiology of injuries were road traffic accidents (67%) followed by sport (15%) and fall (15%). Majority of patients were young in the age group of 11-30 years (71 %). Fracture mandible (53%) was the most common injury, followed by fracture maxilla (21%), fracture zygoma (19%) and pan-facial fractures (6%). Maxillofacial injuries compromise mask ventilation and difficult airway due to facial fractures, tissue edema and deranged anatomy. Shared airway with the surgeon needs special attention due to restrictions imposed during surgery. Several methods available for securing the airway, both decision-making and performance, are important in such circumstances. Airway secured by nasal intubation with direct visualization of vocal cords was the most common (57%), followed by oral intubation (17%). Other methods like tracheostomy and blind nasal intubation was avoided by fiberoptic bronchoscopic nasal intubation in 26% of patients. CONCLUSION:The results of this study indicated that surgically securing the airway by tracheostomy should be revised compared to other available methods. In the era of rigid fixation of fractures and the possibility of leaving the patient without wiring an open mouth and alternative techniques like fiberoptic bronchoscopic intubation, it is unnecessary to carry out tracheostomy for securing the airway as frequently as in the past. KEYWORDS: Difficult airway, fiberoptic bronchoscopic intubation, maxillofacial injuries, tracheostomy http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101764/ Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org