http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=62409&origen=notiweb&dia_suplemento=lunes
Identificado el mecanismo que graba el miedo en el cerebro
Bajo la sombra de los rascacielos de Manhattan, muy cerca de los 20.000 cadáveres sepultados en un viejo cementerio oculto bajo el Washington Square Park, se encuentra el laboratorio del miedo. Allí, bajo las órdenes del neurocientífico y rockero estadounidense Joseph LeDoux, trabaja una quincena de investigadores para intentar comprender por qué, por ejemplo, una persona se queda paralizada al ver a un perro, traumatizada por un huracán o muda al intentar hablar en público. Uno de los miembros de esta brigada de élite del miedo, empotrada en el Centro para la Ciencia Neural de la Universidad de Nueva York, es el neurocientífico español Lorenzo Díaz-Mataix, que acaba de identificar los mecanismos cerebrales que convierten las experiencias desagradables en recuerdos imborrables durante años.
Díaz-Mataix se ha sumergido en el cráneo de cientos de ratas. En lo más profundo de sus cerebros, como en los de los seres humanos, se esconde la amígdala, una región del tamaño de una almendra en las personas a la que la comunidad científica señala como almacén del miedo. Presuntamente, en ella se guardan durante décadas los recuerdos de las vivencias traumáticas sufridas a lo largo de la vida. Y por ella el grupo de rock de LeDoux se llama The Amygdaloids. Es el minúsculo archivo del terror en el kilo y medio de cerebro humano.
En 2010, salió a la luz el caso de una mujer estadounidense de 44 años con la amígdala completamente dañada por una rarísima enfermedad genética. La mujer, conocida como SM para preservar su anonimato, era incapaz de sentir miedo. Un grupo de investigadores encabezado por el psicólogo Justin Feinstein, de la Universidad de Iowa, siguió su pista durante más de 20 años. Rodearon a SM de serpientes y arañas venenosas, vieron con ella películas de terror como El resplandor y El silencio de los corderos, la acompañaron a sanatorios abandonados supuestamente habitados por fantasmas. Y nada. La mujer sin amígdala ni siquiera sintió miedo cuando, caminando de noche por un parque solitario, un yonqui le puso un cuchillo en la garganta y masculló: "Te voy a rajar...". SM siguió andando como escuchara La Traviata. Ahora, Díaz-Mataix ha iluminado ese enigmático cajón de recuerdos que es la amígdala cerebral. Su investigación parte de una hipótesis postulada en 1949 por el psicólogo canadiense Donald Hebb y sugerida hace más de un siglo por el nobel español Santiago Ramón y Cajal. "Dos células o sistemas de células que están repetidamente activas al mismo tiempo tenderán a convertirse en 'asociadas', de manera que la actividad de una facilitará la de la otra", dejó escrito Hebb en su libro La organización de la conducta. O, expresado de manera más simplificada, las neuronas de la amígdala del cerebro humano que se excitan eléctricamente tras el ataque de un perro permanecen conectadas durante años. Sus puentes eléctricos se refuerzan. Ese sería el esqueleto del recuerdo.
El equipo de Díaz-Mataix ha demostrado que la teoría de Hebb es cierta, al menos parcialmente, en los complejos cerebros de los mamíferos. Su experimento, cuyos resultados se publican en la revista científica PNAS,Proceedings of the National Academy of Sciences, es una versión sofisticada del célebre perro de Pávlov, aquel can ruso que se acostumbró a escuchar un metrónomo (sustituido por una campanita en el imaginario colectivo) antes de comer y ya salivaba cada vez que escuchaba el tic tac aunque no hubiera alimento. El investigador español, en tándem con Josh Johansen, del Instituto RIKEN de Ciencias del Cerebro en Japón, sometió a decenas de ratas a un pitido de 20 segundos rematado por una descarga eléctrica de medio segundo. A partir de entonces, las ratas se quedaban paralizadas cada vez que escuchaban ese sonido. En su cerebro quedó grabado el miedo al chispazo. Ahí empezó la sofisticación del experimento, gracias a una técnica conocida como optogenética. Los investigadores instalaron genes de algas sensibles a la luz a bordo de virus, que funcionan como taxis microscópicos, y los inyectaron en los cráneos de las ratas. Una vez insertados en las neuronas de los roedores, los genes eran capaces de producir una proteína que funciona como un interruptor de la célula, activándola o desactivándola en función de ráfagas de luz láser enviadas por los científicos.
Las ratas con la amígdala cerebral apagada eran incapaces de recordar el chispazo y carecían de conexiones reforzadas entre sus neuronas. Al mismo tiempo, activar las amígdalas de ratas que no habían sufrido la pequeña electrocución servía para generar miedo al pitido sin necesidad de ningún tipo de shock. En este último caso, según los autores, era necesario que se activaran también los receptores de noradrenalina, una molécula cerebral implicada en los procesos de atención. Sin esta activación, no había aprendizaje. "Con una sola descarga eléctrica asociada a un pitido, las ratas ya recuerdan la experiencia toda su vida. El cerebro hace esto para afrontar los peligros. Un animal necesita aprender con una sola oportunidad, porque quizá no tenga otra", explica el neurocientífico.
El despacho del también español Luis de Lecea, profesor de Psiquiatría en la Universidad de Stanford (EE.UU.), se encuentra a escasos 15 metros del laboratorio en el que se desarrolló la optogenética en 2004. Desde allí, De Lecea ha sido testigo de cómo esta técnica ha revolucionado la investigación del cerebro humano. Las teorías de Hebb ya se habían prácticamente confirmado "con rodajas de cerebro" de roedores en el laboratorio, pero los experimentos de Díaz-Mataix son "una demostración elegante" en mamíferos vivos, a juicio de De Lecea. El neurocientífico español dibuja las posibles aplicaciones de sus hallazgos. "En los enfermos con estrés postraumático, ansiedad o incluso depresión, su cerebro no es capaz de aprender que lo que una vez fue peligroso ya no lo es, y siguen respondiendo de forma exagerada", señala. Personas que han vivido guerras, accidentes graves, violaciones o catástrofes naturales siguen sintiendo miedo y estrés una vez pasado el peligro.
La comunidad científica internacional trabaja desde hace unos años en intentar borrar esos malos recuerdos. Se basan en un proceso conocido como reconsolidación de la memoria. "Cada vez que un recuerdo sale a la luz, se pone en un estado frágil que hace que el cerebro pueda añadir cosas relevantes", apunta Díaz-Mataix. Cuando se abre el baúl de los recuerdos es el momento de modificarlos. Si, por ejemplo, alguien va en un coche escuchando a todo volumen la canción Balada Boa de Gusttavo Lima y se estampa contra un árbol, cada vez que escuche el estribillo 'Tchê tcherere tchê tchê' tendrá pavor. "Sin embargo, si cada vez que la víctima va a un bar a tomar algo ponen esa canción, el cerebro recupera el recuerdo y aprende que ya no es negativa. Eso es la reconsolidación", añade el investigador. Este proceso se puede facilitar con fármacos que actúan sobre los receptores de noradrenalina, como el propranolol, que ya se suministró a víctimas del atentado del 11 de marzo de 2004 en Madrid. Los síntomas de su trastorno de estrés agudo remitieron en el 64% de los casos, según un estudio de la mutua Ibermutuamur.
Para Díaz-Mataix, es muy posible que el proceso para almacenar recuerdos desagradables que han observado sea en realidad un mecanismo general del sistema nervioso para generar otro tipo de recuerdos, ya sean de asco, ira o alegría. "El problema es cómo estudiar estas emociones primarias en una rata", lamenta. Si tiene razón, será todavía más cierta aquella sentencia de Ramón y Cajal: "Todo hombre puede ser, si se lo propone, escultor de su propio cerebro".
Autor: Manuel Ansede
Heparina tópica versus tratamiento convencional en las quemaduras agudas. estudio comparativo
Topical heparin versus conventional treatment in acute burns: A comparative study.
Masoud M, Wani AH, Darzi MA.
Indian J Burns [serial online] 2014 [cited 2014 Dec 15];22:43-50.
Abstract
Background: In order to alleviate pain, reduce scarring, and to improve the overall outcome in burn patients multitude of novel agents are being utilized. In this regard, heparin has been introduced because of its research proven role in burn wound management. Objective:The objective was to evaluate, whether the addition of heparin, administered only topically, could improve burn treatment. Materials and Methods: The subjects in this study were 40 consecutive burn patients with 10-20% burns, randomly allocated to heparin group (H-group) (20) and control group (C-group) (20). Results: All patients in the H-group were receiving analgesics on demand only from the 2 nd week onwards. This was in contrast to the C-group wherein 35% patients received twice daily dosage of analgesics in the 2 nd week of their treatment. When compared to the average hospital stay of 18.3 days in the C-group, patients belonging to the H-group had an average hospital stay of 12.3 days (P < 0.05). Conclusions: The current comparative study demonstrates that heparin significantly decreases the requirement of analgesics and the time required to prepare a burn wound for grafting. Besides as compared to silver sulfadiazine dressings, heparin appears to be cost-effective.
Keywords: Burn, conventional burn treatment, topical heparin
http://www.ijburns.com/downloadpdf.asp?issn=0971-653X;year=2014;volume=22;issue=1;spage=43;epage=50;aulast=Masoud;type=2
http://www.ijburns.com/text.asp?2014/22/1/43/147002
Prutito post quemaduras
Postburn pruritus: A practical review.
Ahuja RB, Chatterjee P.
Indian J Burns [serial online] 2014 [cited 2014 Dec 15];22:13-21.
Abstract
The incidence of postburn pruritus is reported to vary between 80% and 100% and the persistence of itching leads to disabling symptoms such as sleep disturbance, anxiety, and disruption of daily activities. Recently, a few small randomized controlled trials by investigators have focused our attention to the neurobiology and molecular mechanisms of the postburn pruritus and the role of centrally acting agents in its treatment. It is now recognized that the central nervous system develops aberrant autonomous activity that causes maintenance of pruritic symptoms into a chronic state. This practical review on the topic aims to rationalize and simplify the current treatment options, through emerging and available evidence, to enable the physician to make an even better informed choice. While antihistamines and massage therapy will continue to be effective first-line strategy for most clinicians, the promising results in controlled studies obtained with gabapentin/pregabalin to ameliorate pruritic symptoms in a predictable fashion in burns patients have caused a paradigm shift in the therapeutic approach. Tailoring the drug therapy to the severity of symptoms leads to more successful therapy of this vexing malady and current evidence supports the use of gabapentin/pregabalin in patients with moderate to severe postburn pruritus (visual analog scale score >5) as the first line, even if as an "off label" indication. Other treatment modalities like doxepin, ondansetron, or transcutaneous electrical nerve stimulation may have applications on a case to case basis. However, massage therapy should continue to be an adjunct with all other modalities.
Keywords: Antihistamines, early itch, gabapentin, late itch, post burn itch, post burn pruritis, pregabalin
http://www.ijburns.com/downloadpdf.asp?issn=0971-653X;year=2014;volume=22;issue=1;spage=13;epage=21;aulast=Ahuja;type=2
http://www.ijburns.com/text.asp?2014/22/1/13/146996
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Cardioprotección anestésica
Anesthetic cardioprotection: the role of adenosine.
Bonney S, Hughes K, Eckle T.
Curr Pharm Des. 2014;20(36):5690-5.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119865/pdf/nihms-568853.pdf
Miocardioprotección por anestésicos volátiles. Revisión de la literatura actual
Volatile anaesthetic myocardial protection: a review of the current literature.
Lin E, Symons JA.
HSR Proc Intensive Care Cardiovasc Anesth. 2010;2(2):105-9.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484611/pdf/hsrp-02-105.pdf
El miocardio hipercolesterolémico es vulnerable al daño por isquemia-reperfusión y referactario a la protección inducida por sevoflurano
Hypercholesterolemic myocardium is vulnerable to ischemia-reperfusion injury and refractory to sevoflurane-induced protection.
Xu Y, Ma LL, Zhou C, Zhang FJ, Kong FJ, Wang WN, Qian LB, Wang CC, Liu XB, Yan M, Wang JA.
PLoS One. 2013 Oct 4;8(10):e76652. doi: 10.1371/journal.pone.0076652. eCollection 2013.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790738/pdf/pone.0076652.pdf
Comparación del efecto cardioprotector del preacondicionamiento farmacológico con anestésicos halogenados: sevoflurano versus isoflurano in vivo
DRES. MARCELO DANIEL ESPIÑEIRA ISABELLA, RAFAEL MILA GARCÍA, MANUEL ALBERTI CORREA, HÉCTOR PÍRIZ ABIB.
REV URUG CARDIOL 2007; 22: 116-122
http://www.suc.org.uy/revista/v22n2/pdf/rcv22n2_6.pdf
Disfunción diastólica con anestésicos y cardioprotección con halogenados
Dr. Carlos Vargas-Trujillo
Revista Mexicana de Anestesiología Vol. 35. Supl. 1 Abril-Junio 2012
pp S46-S55
http://www.medigraphic.com/pdfs/rma/cma-2012/cmas121b3.pdf
Acondicionamiento farmacológico tardío con anestésicos volátiles después de la cirugía cardíaca.
Late pharmacologic conditioning with volatile anesthetics after cardiac surgery.
Steurer MP, Steurer MA, Baulig W, Piegeler T, Schläpfer M, Spahn DR, Falk V, Dreessen P, Theusinger OM, Schmid ER, Schwartz D, Neff TA, Beck-Schimmer B.
Crit Care. 2012 Oct 14;16(5):R191. doi: 10.1186/cc11676.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682293/pdf/cc11676.pdf
Efecto cardioprotector del sevoflurano y propofol durante anestesia y el período postoperatorio en cirugía coronaria. Estudio doble ciego randomizado
Cardioprotective effect of sevoflurane and propofol during anaesthesia and the postoperative period in coronary bypass graft surgery: a double-blind randomised study.
Soro M, Gallego L, Silva V, Ballester MT, Lloréns J, Alvariño A, García-Perez ML, Pastor E, Aguilar G, Martí FJ, Carratala A, Belda FJ.
Eur J Anaesthesiol. 2012 Dec;29(12):561-9. doi: 10.1097/EJA.0b013e3283560aea.
http://journals.lww.com/ejanaesthesiology/pages/articleviewer.aspx?year=2012&issue=12000&article=00005&type=abstract
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Tratamiento prehospitalario inicial en trauma de cráneo. Actualización
Pre-hospital and initial management of head injury patients: An update.
Chowdhury T1, Kowalski S1, Arabi Y2, Dash HH3.
Saudi J Anaesth. 2014 Jan;8(1):114-20. doi: 10.4103/1658-354X.125971.
Abstract
BACKGROUND:Most of the bad outcomes in patients with severe traumatic brain injury (TBI) are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on "Prehospital Management" published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006. METHODS: A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic, was conducted. RESULTS: Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficultairway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided. CONCLUSION: Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.
KEYWORDS: Evidence; pre-hospital management; secondary brain injury; traumatic brain injury
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2014;volume=8;issue=1;spage=114;epage=120;aulast=Chowdhury;type=2
Manejo de la hipertensión intracraneal en los niños con trauma cerebral
Management of raised intracranial pressure in children with traumatic brain injury
Kukreti V, Mohseni-Bod H, Drake J..
J Pediatr Neurosci [serial online] 2014 [cited 2014 Dec 23];9:207-15.
Increased intracranial pressure (ICP) is associated with worse outcome after traumatic brain injury (TBI). The current guidelines and management strategies are aimed at maintaining adequate cerebral perfusion pressure and treating elevated ICP. Despite controversies, ICP monitoring is important particularly after severe TBI to guide treatment and in developed countries is accepted as a standard of care. We provide a narrative review of the recent evidence for the use of ICP monitoring and management of ICP in pediatric TBI.
Keywords: Craniectomy, intracranial pressure, traumatic brain injury
brain injury.
http://www.pediatricneurosciences.com/text.asp?2014/9/3/207/147572
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Hemotransfusión en pacientes con trauma cerebral. Un protocolo de revisión sistemática.
Red blood cell transfusion in patients with traumatic brain injury: a systematic review protocol.
Boutin A, Chassé M, Shemilt M, Lauzier F, Moore L, Zarychanski R, Lacroix J, Fergusson DA, Desjardins P, Turgeon AF1.
Syst Rev. 2014 Jun 18;3:66. doi: 10.1186/2046-4053-3-66.
Abstract
BACKGROUND: Anemia is a prevalent condition in critically ill patients and red blood cell transfusions are frequent. Although transfusions at low hemoglobin levels have been shown to be associated with equivalent or better outcomes than higher hemoglobin thresholds, clinical equipoise persists in patients with traumatic brain injury considering their susceptibility to secondary cerebral insults such as those from hypoxemia. METHODS: Our objectives are to estimate the frequency of red blood cell transfusion in patients with traumatic brain injury and to evaluatetransfusion thresholds, determinants and outcomes associated with transfusion strategies.We will conduct a systematic review of cohort studies and randomized controlled trials of patients with traumatic brain injury. We will search MEDLINE, Embase, BIOSIS and the Cochrane Library for eligible studies. Two independent reviewers will screen all identified references. Studies including adult patients with traumatic brain injury reporting data on red blood cell transfusions will be eligible. We will collect data on baseline demographics, trauma characteristics, hemoglobin thresholds, bloodtransfusions and clinical outcomes (mortality, length of stay, complications, and so on). Two independent reviewers will extract data using a standardized form. We will pool cumulative incidences using DerSimonian and Lair random-effect models after a Freeman-Tukey transformation to stabilize variances. We will pool risk ratios or mean differences with random-effect models and Mantel-Haenszel or inverse variance methods in order to evaluate the association between red blood cell transfusion and potential determinants or outcomes. Sensitivity and subgroup analysis according to timing of red blood cell transfusion, traumatic brain injury severity, year of conduction of the study, risk of bias, notably, are planned. DISCUSSION: We expect to observe high heterogeneity in the proportion of transfused patients across studies and that the global proportion will be similar to the frequency observed in the general medical critically ill population. Our systematic review will allow us to better describe and understand current transfusion practices in patients with traumatic brain injury, a clinical population in which liberal transfusions are still advocated in the absence of evidence-based data.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090399/pdf/2046-4053-3-66.pdf
Hemotransfusión en la UCI neurológica
Red blood cell transfusion in the neurological ICU.
Kumar MA.
Neurotherapeutics. 2012 Jan;9(1):56-64. doi: 10.1007/s13311-011-0094-5.
Abstract
Red blood cell transfusion (RBCT) is a common therapy used in the intensive care unit to treat anemia. However, due to deleterious side effects and questionable efficacy, the clinical benefit of RBCT in patients who are not actively bleeding is unclear. The results of randomized controlled trials suggest there is no benefit to a liberal transfusion practice in general critical care populations. Whether the results of these trials are applicable to brain injured patients is unknown, as patients with primary neurological injury were excluded. This article reviews the efficacy and complications of RBCT, as well as the relationship between RBCT and its outcome in both the general intensive care unit and neurologically critically ill populations.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271158/pdf/13311_2011_Article_94.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
El hombre que lucha mientras los libros arden / por Jorge Fernández Díaz
A veces la muerte más horrible se empeña en parecer poética. Hace unos días un escritor de Sevilla murió intentando salvar su biblioteca del fuego. Sucedió en el pequeño pueblo de Bormujos, y el hombre era pintor, poeta, novelista y erudito. Se llamaba Rafael de Cózar, un filólogo hispánico, estudioso de la vanguardia y amigo personal de Arturo Pérez-Reverte, quien lo homenajea cómicamente en algunos capítulos del capitán Alatriste. Dicen que el incendio se debió a un cortocircuito y que el profesor tomó un extintor e intentó proteger desesperadamente de las llamas a sus 9000 libros. La sorda y rápida batalla sucedió un viernes por la noche, y resultó en vano: Rafael murió asfixiado y el fuego devoró ese tesoro incalculable. Los libros, que fueron su vida, arden en el santuario, y el lector impenitente expira con ellos.
El episodio nos estremece porque lleva cifrada la fatal pasión de quienes alguna vez hemos entrevisto, como diría Borges, el paraíso bajo la forma de una biblioteca. Y porque esta muerte suena heroica y crepuscular en un mundo que se digitaliza, pierde su memoria histórica para vivir un presente vacuo y eterno, y reemplaza al libro por la telefonía móvil. También porque esa luctuosa desgracia recuerda que a todos los navegantes nos espera nuestro iceberg. Son las reglas del juego. Pérez-Reverte suele comprar para sus amigos, en un pequeño local junto a Puerta Cerrada de Madrid, una semiesfera de cristal que al sacudirla produce efecto de nevada y que lleva en su interior un Titanic en miniatura. Tengo uno de esos souvenires en mi propia biblioteca, y a veces cuando levanto la vista para buscar un adjetivo me encuentro con esa advertencia cariñosa.
Cierta noche un grupo de periodistas culturales lo invitó a cenar un cocido, y Arturo les llevó de regalo unas cuantas esferas. Ustedes son la orquesta del Titanic, les advirtió en la sobremesa. "En tiempos como los de ahora, cuando los periódicos reducen las páginas de Cultura a la mínima expresión, y además las ocupan en el último diseño del calamar al dátil deconstruido en sake por Ferrán Adriá y a desfiles de la colección de primavera de Danti y Tomanti, la existencia de los que no se resignan y siguen dispuestos a contarle a la gente la historia de los libros que se publican, las exposiciones que se inauguran y la música que es posible escuchar, me parece más necesaria que nunca". Y después agregó: "El mundo para el que muchos de nosotros fuimos educados hace medio siglo ya no existe. Y los suplementos culturales son la música de la orquesta que suena, no para adormecer conciencias, sino como compañía y alivio de muchos. Como último bastión. Como analgésico que no quita la causa irremediable del dolor, pero la alivia".
Unos años atrás visité una escuela carenciada, ubicada en un suburbio peligroso, y la maestra me pidió que les explicara a sus alumnos por qué debían abrazar la lectura. Parecía una tarea sencilla, pero a mí me temblaban las piernas. Dije buenos días y me paré como pude frente a ellos: algunos ya tenían cara patibularia y la mayoría, al borde de la abulia y la marginalidad, parecía desinteresada de todo. Vacilé uno segundos. Les conté que mi vieja también provenía del hambre y que a pesar de su falta de instrucción había tenido un momento de enorme lucidez; hizo algo que muchas madres instruidas y pudientes no son capaces de hacer: me regaló la Colección Robin Hood. Ni ella ni yo sabíamos que con ese gesto me estaba obsequiando un universo; la chance de vivir muchas otras vidas y de no sentir nunca más la soledad.
Los chicos no parecían muy impresionados por esa argumentación. Y entonces me desesperé y les dije (con perdón) lo único que me salió de adentro: "¿Saben qué? Lean para que no los caguen". Fue como si un relámpago los atravesara. Los desconectados hijos de la indiferencia y la pobreza abrieron de pronto los ojos y se conectaron. Che, parece que los libros salvan. Sí, los libros siguen salvando.
Tal vez los defensores de estos pequeños asuntos, en un planeta que se desliza por la agrafía y por la tiranía de lo visual y de lo fácil, seamos criaturas en vías de extinción. Náufragos que juegan cartas con angustiada dignidad mientras suena la orquesta del Titanic. Acaso hombres y mujeres desesperados luchando contra el fuego, munidos del inútil extintor, tratando de salvar vanamente de las llamas lo que más amamos..
Fuente: http://www.lanacion.com.ar/1755377-el-hombre-que-lucha-mientras-los-libros-arden
Daniel Diaz / Bibliotecario Argentino
Anemia y su tratamiento en pacientes graves
Anemia y transfusión de de eritrocitos en pacientes graves
Anemia and red blood cell transfusion in critically ill cardiac patients.
Du Pont-Thibodeau G1, Harrington K1, Lacroix J1.
Ann Intensive Care. 2014 Jun 2;4:16. doi: 10.1186/2110-5820-4-16. eCollection 2014.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085735/pdf/2110-5820-4-16.pdf
Anemia, sangrado, y hemotransfusión en UCI. Causas, riesgos, costos y nuevas estrategias
Anemia, bleeding, and blood transfusion in the intensive care unit: causes, risks, costs, and new strategies.
McEvoy MT1, Shander A.
Am J Crit Care. 2013 Nov;22(6 Suppl):eS1-13; quiz eS14. doi: 10.4037/ajcc2013729.
http://ajcc.aacnjournals.org/content/22/6/eS1.full.pdf
Impacto de la eritropoyetina en pacientes de UCI
Impact of erythropoietin on intensive care unit patients.
Jelkmann I1, Jelkmann W.
Transfus Med Hemother. 2013 Oct;40(5):310-8. doi: 10.1159/000354128. Epub 2013 Aug 16.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822273/pdf/tmh-0040-0310.pdf
Guías de tratamiento de la anemia y transfusión de sangre en adultos graves
Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients.
Retter A1, Wyncoll D, Pearse R, Carson D, McKechnie S, Stanworth S, Allard S, Thomas D, Walsh T; British Committee for Standards in Haematology.
Br J Haematol. 2013 Feb;160(4):445-64. doi: 10.1111/bjh.12143. Epub 2012 Dec 27.
http://onlinelibrary.wiley.com/doi/10.1111/bjh.12143/pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Efecto de dosis sub hipnóticas de propofol y midazolam para nausea y vomito durante anestesia raquídea para cesárea
Effect of Sub hypnotic Doses of Propofol and Midazolam for Nausea and Vomiting During Spinal Anesthesia for Cesarean Section.
Rasooli S, Moslemi F, Khaki A.
Anesth Pain Med. 2014 Sep 16;4(4):e19384. doi: 10.5812/aapm.19384. eCollection 2014.
Abstract
BACKGROUND: Spinal anesthesia has been associated with intraoperative nausea and vomiting (IONV), especially during cesarean section, which is attributed to several mechanisms. OBJECTIVES: In the present study, therapeutic and preventive properties of sub hypnotic dose midazolam and propofol and their effects on the occurrence and severity of intraoperative nausea and vomiting during elective cesarean section under spinal anesthesia were evaluated. PATIENTS AND METHODS: In a randomized, double-blind, and placebo-controlled clinical trial, 90 parturients, ASA class I and II, aged 20-30 years, who undergone spinal anesthesia for cesarean section were randomly allocated to one of three groups receiving midazolam (1 mg bolus and 0.1 mg/kg/hr, n=30), propofol (20 mg bolus and 0.1 mg/kg/hr, n = 30), and placebo (saline, n=30) intravenously (IV) immediately after umbilical cord clamping. Bupivacaine hydrochloride (10 mg) was used for induction of the anesthesia. Patients' hemodynamics was monitored at 3-minute intervals. Furthermore, intraoperative and post-delivery emetic episodes, severity of emesis, scores of sedation and ephedrine consumption were recorded. RESULTS: The incidence of nausea, retching, and vomiting was significantly higher in the control group compared to propofol and midazolam groups. Overall, PONV (postoperative nausea and vomiting) in midazolam group was as low as propofol group without any significant hemodynamic changes as seen in placebo group or even with propofol group. CONCLUSIONS: Subhypnotic doses of midazolam or propofol are effective in the prevention of nausea and vomiting during and after cesarean section with spinal anesthesia and does not significantly influence hemodynamic of the patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205801/pdf/aapm-04-04-19384.pdf
Efecto sobre el Apgar y evolución neonatal cambiando de combinación de fenilefrina y efedrina a fenilefrina sola como vasoconstrictor profiláctico durante raquia en cesárea
The effects on Apgar scores and neonatal outcomes of switching from a combination of phenylephrine and ephedrine to phenylephrine alone as a prophylactic vasopressor during spinal anesthesia for cesarean section.
Jeon JY, Lee IH, Jee YS, Lee PM, Park SI, Yoon HJ.
Korean J Anesthesiol. 2014 Jul;67(1):38-42. doi: 10.4097/kjae.2014.67.1.38. Epub 2014 Jul 29.
Abstract
BACKGROUND: Ephedrine, unlike phenylephrine, has a dose-related propensity to depress fetal pH during spinal anesthesia during cesareansection. A low arterial umbilical cord pH has a strong association with neonatal mortality and morbidity. The purpose of this retrospective study was to investigate influences of vasopressor change on Apgar scores and adverse neonatal outcomes in cesarean section. METHODS: In obstetric anesthesia, we changed the prophylactic vasopressor from a combination of phenylephrine and ephedrine to phenylephrine alone in 2000. We evaluated the impact of vasopressor change on Apgar scores (1 and 5 min), incidence of Apgar score < 7 (1 and 5 min), neonatal seizure, continuous positive airway pressure (CPAP), intermittent positive pressure ventilation (IPPV), intraventricular hemorrhage (IVH), periventricular leucomalacia (PVL), and hypoxic ischemic encephalopathy (HIE) in low-risk elective cesarean sections during a period when the combination of phenylephrine and ephedrine was used (2008-2009, two years) and the period of phenylephrine use alone (2011-2012, two years). RESULTS: There were no differences in Apgar scores (1 and 5 min), the incidence of 5 min Apgar score < 7, neonatal seizure, CPAP, IPPV, IVH, PVL, and HIE between the two time periods. However, the incidence of 1 min Apgar < 7 was decreased during the period of phenylephrine use compared with the period of phenylephrine and ephedrine use (P = 0.002).
CONCLUSIONS: Conversion from a combination of phenylephrine and ephedrine to phenylephrine alone as a prophylactic anti-hypotensive drug during spinal anesthesia for cesarean section in low-risk pregnancy may be associated with a significant decrease in the incidence of 1 min Apgar < 7. KEYWORDS: Apgar score; Cesarean section; Ephedrine; Neonatal outcomes; Phenylephrine; Spinal anesthesia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121492/pdf/kjae-67-38.pdf
Efectos pulmonares de bupivacaína y ropivacaína en parturientas bajo anestesia espinal para cesárea electiva
Pulmonary effects of bupivacaine and ropivacaine in parturients undergoing spinal anesthesia for elective cesarean delivery.
Geng G, Li W, Huang S.
Int J Clin Exp Med. 2014 May 15;7(5):1417-21. eCollection 2014.
Abstract
To study the change of maternal pulmonary function when ropivacaine and bupivacaine were used in spinal anesthesia for cesarean section, 40 ASA physical status I and II parturient scheduled to undergo cesarean section were randomly divided into bupivacaine and ropivacaine groups. Bupivacaine 9 mg and ropivacaine 14 mg were intrathecal injected respectively. FVC, FEV1 and PEFR were measured with spirometry beforeanesthesia and 2 h after intrathecal injection. Anesthesia level, the degree of motor block and VAS were also recorded. RESULTS:
The final level of sensory blockade was not different between groups. Forced vital capacity was significantly decreased with bupivacaine (3.0 ± 0.4 L to 2.7 ± 0.3 L, P < 0.05) and ropivacaine (2.9 ± 0.4 L to 2.5 ± 0.4 L, P < 0.05) while there were no difference between two groups. Forced expiratory volume during the first second and Peak expiratory flow rate were not decreased in each group. The degree of motor block in group R was less than group B at 2 h after intrathecal injection. CONCLUSIONS: Decreases in maternal pulmonary function tests were similar following spinal anaesthesia with bupivacaine or ropivacaine forcesarean section. The clinical maternal effects of these alterations appeared negligible.
KEYWORDS: Bupivacaine; anesthesia; cesarean-section; pulmonary function; ropivacaine
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4073766/pdf/ijcem0007-1417.pdf
Influencia del momento de administración de cristaloides sobre la hipotensión materna durante raquia para cesárea. Precarga vs co-carga
Influence of the timing of administration of crystalloid on maternal hypotension during spinal anesthesia for cesarean delivery: preload versus coload.
Oh AY1, Hwang JW1, Song IA2, Kim MH3, Ryu JH1, Park HP4, Jeon YT1, Do SH1.
BMC Anesthesiol. 2014 May 16;14:36. doi: 10.1186/1471-2253-14-36. eCollection 2014.
Abstract
BACKGROUND:Prophylactic fluid preloading before spinal anesthesia has been a routine procedure to prevent maternal hypotension duringcesarean delivery. Unlike colloid, timing of infusion of crystalloid may be important because of its short stay in intravascular space. We hypothesized that crystalloid loading just after intrathecal injection compared to preload would be more effective in preventing maternal hypotension......
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4052336/pdf/1471-2253-14-36.pdf
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Efecto de la infusión pre-emptiva de sulfato de magnesio sobre el alivio del dolor postoperatorio en cesárea electiva
Effect of pre-emptive magnesium sulfate infusion on the post-operative pain relief after elective cesarean section.
Rezae M, Naghibi K, Taefnia AM.
Adv Biomed Res. 2014 Aug 19;3:164. doi: 10.4103/2277-9175.139127. eCollection 2014.
Abstract
BACKGROUND:The aim of this study was to evaluate the analgesic efficacy of pre-operative single dose of intravenous (I.V.) magnesium sulfate infusion in patients undergoing elective Cesarean section. MATERIALS AND METHODS:Seventy pregnant women who underwent elective Cesarean section were randomly divided into two groups. Before induction of anesthesia, the magnesium group (Group A) received magnesium sulfate 50 mg/kg I.V. in bolus dose. The control group (Group B) received the same volume of isotonic saline. The pain scores at rest and also upon movement were evaluated up to 24 h post-operatively and analgesic requirement was recorded during the first 24 h after operation. RESULTS: Cumulative analgesic consumption (24 h after operation was 11.2 ± 6.3 mg in group A vs. 13.9 ± 3.9 mg in group B). Post-operative pain scores (24 h after operation was 1.8 ± 2.1 in group A vs. 2.9 ± 1.2 in group B) and shivering incidents (8.57 in group A vs. 14.28 in group B) were significantly lower in Group A (P < 0.05). Mean arterial pressure just after intubation and during the immediate post-operative period was significantly lower in Group A (P < 0.05). CONCLUSION: Pre-operative intravenous magnesium sulfate infusion decrease post-operation pain and requirement of analgesia in Cesarean section. KEYWORDS:Cesarean section; magnesium sulfate; post-operative pain
http://www.advbiores.net/downloadpdf.asp?issn=2277-9175;year=2014;volume=3;issue=1;spage=164;epage=164;aulast=Rezae;type=2
Comparación de la eficiencia analgésica entre la infiltración de la herida y el bloqueo TAP guiado con ultrasonido después de cesárea con anestesia espinal
Comparison of analgesic efficiency between wound site infiltration and ultra-sound-guided transversus abdominis plane block after cesarean delivery under spinal anaesthesia.
Aydogmus M, Sinikoglu S, Naki M, Ocak N, Sanlı N, Alagol A.
Hippokratia. 2014 Jan;18(1):28-31.
Abstract
BACKGROUND: [corrected] Local anesthetic infiltration applied on the wound site or abdominal wall may be used for relieving postoperative pain after delivery by caesarean section. The aim of this study was to compare the analgesic efficiency of ultrasound (USG)-guided transversus abdominis plane (TAP) block with local anesthetic infiltration on a wound site. METHODS:This study was designed as a prospective randomized trial, and consisted of 70 pregnant women of American Society of Anesthesiologists (ASA) class I-II. Patients were randomized into Group I (wound site infiltration, n=35) and Group T (TAP block, n=35). Spinalanaesthesia was administered to all patients. In Group I, wound site infiltration was applied by the surgical team. In Group T, a USG-guided bilateral TAP block was applied. Patients' numeric pain scale (NPS) levels at 2, 6, 12 and 24(th) hours, after the operation (NPS0) and during mobilization were assessed. Postoperative complications, time to first analgesic request and patient satisfaction were recorded. RESULTS: The NPS0 values of Group T were found to higher and time to first analgesic request longer than those of Group I. The NPS values of Group I at 2, 6, 12, and 24(th) hours were found to be statistically significantly higher than those of Group T. CONCLUSIONS: According to our results, USG-guided TAP block might be superior to infiltration anaesthesia for postoperative pain management of patients who have had caesarean section and it provided longer-lasting and more efficient analgesia.
KEYWORDS: Ultrasound; cesarean section; infiltration anaesthesia; transversus abdominis plane block
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103037/pdf/hippokratia-18-28.pdf
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Libro sobre Neuroquímica
Book on Neurochemistry
Edited by Thomas Heinbockel, ISBN 978-953-51-1237-2, 414 pages, Publisher: InTech, Chapters published April 23, 2014 under CC BY 3.0 license
DOI: 10.5772/57074
Neurochemistry is a flourishing academic field that contributes to our understanding of molecular, cellular and medical neurobiology. As a scientific discipline, neurochemistry studies the role of chemicals that build the nervous system, it explores the function of neurons and glial cells in health and disease, it discovers aspects of cell metabolism and neurotransmission, and it reveals how degenerative processes are at work in the nervous system. Accordingly, this book contains chapters from a variety of topics that fall into the following broad sections: I. Neural Membranes and Intracellular Signaling, II. Neural Processing and Intercellular Signaling, III. Growth, Development and Differentiation, and IV. Neurodegenerative Diseases. The book presents comprehensive reviews in these different areas written by experts in their respective fields. Neurodegeneration and neuronal diseases are featured prominently and are a recurring theme throughout most chapters. This book will be a most valuable resource for neurochemists and other scientists alike. In addition, it will contribute to the training of current and future neurochemists and, hopefully, will lead us on the path to curing some of the biggest challenges in human health.
http://www.intechopen.com/books/neurochemistry
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El libro murió, pero persiste, como un zombi. Nunca se editó tanto como en la
actualidad: sin contar las ediciones digitales, la cantidad de ejemplares
impresos en papel supera todo lo conocido hasta ahora. Además, nunca se leyó
tanto como en nuestra época: no sólo porque somos muchos más de lo que nunca
fuimos antes, sino porque absolutamente todo está escrito. Además, nunca
dedicamos tanto tiempo a leer.
Sin embargo, y a pesar de la masificación de la lectura y del auge de la
edición, ya no se leen más libros. El libro como objeto se masifica, a la vez
que el libro como concepto ha desaparecido (o está desapareciendo y sólo
sobrevive en los márgenes de la cultura contemporánea).
El libro surgió hace 500 años. Fue uno de los más grandes inventos de la
humanidad. Permitió un avance formidable en el campo de la comunicación. Antes
del libro, la cultura tuvo soportes y formas de leer mucho más precarias.
Antes de la imprenta, se leía y debatía en grupo, en voz alta, entre otras cosas
porque cada ejemplar costaba una fortuna. Ese tipo de lectura (que se extendió
desde Grecia hasta la Edad Media) no permitía imaginar historias en las que los
personajes tuvieran intimidad: para eso fue necesario que se masificara la
lectura silenciosa y se la realizara de manera individual. Esa experiencia hizo
posibles el Martín Fierro, Oliver Twist y el Ulises.
¿Qué implicaba un libro? Un mundo cerrado. Con un principio y un fin. Un mundo
completo entre dos tapas. Por cierto, ya en el libro había un anuncio de esa
otra forma de leer: la intertextualidad, que permitía leer entre libros,
conectar mundos diversos, sospechar que quizás el universo estaba abierto. Pero
para que la intertextualidad funcionara era necesario una mínima (no tan mínima)
erudición. No cualquiera era capaz de abrir un libro y saber conectarlo con
otros.
El libro no es un objeto: es una tecnología (que quedó obsoleta), una idea, una
forma de leer y una forma de estar en el mundo. Ahora nos queda el objeto, pero
vacío de sentido. Vivimos conectados todo el tiempo: ya no leemos mundos
cerrados (menos aún, entre dos tapas). Conectamos fragmentos. Leer, ahora, es
una sucesión de conexiones inconexas. Pasamos de un texto a un video, de un MP3
a una imagen: sin solución de continuidad.
Todas esas discusiones sobre los precios de los libros digitales y los derechos
de autor de los de papel pertenecen al pasado, aunque aun muevan un mercado de
miles de millones. Lo importante hoy es la forma en que ahora leemos: vivimos
conectando fragmentos de distinto tipo y soporte hasta cuando soñamos.
Internet y la vida digital nos hizo seres anfibios: vivimos en el mundo de los
átomos, pero mirando pantallas que nos colocan en el mundo virtual. Sin darnos
cuenta, somos distintos de los que éramos hace 20 años: somos los que ya no
podemos leer de la misma forma en como se hacía hasta fines del siglo XX.
Somos la simiente de la lectura tal como se la verá en el futuro próximo. Ese
futuro en el que vivir y leer serán la misma experiencia. Como ya sucede ahora.
El autor es crítico cultural.
Fuente: http://www.lanacion.com.ar/1754320-cuentos-de-navidad-la-esperanza-de-lo-m
"La biblioteca es el lugar del ejercicio público de la razón" Gabriel Naudé
Revisión clínica. Población especial. Enfermedades graves en el embarazo
Clinical review: Special populations--critical illness and pregnancy.
Neligan PJ, Laffey JG.
Crit Care. 2011 Aug 12;15(4):227. doi: 10.1186/cc10256.
Abstract
Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia.Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liverenzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387584/pdf/cc10256.pdf
Evaluación prospectiva de la morbilidad y mortalidad materna en pacientes post-cesárea admitidos en la unidad de cuidados intensivos post-anestesia.
Prospective evaluation of maternal morbidity and mortality in post-cesarean section patients admitted to postanesthesia intensive care unit.
Harde M, Dave S, Wagh S, Gujjar P, Bhadade R, Bapat A.
J Anaesthesiol Clin Pharmacol. 2014 Oct;30(4):508-513.
Abstract
BACKGROUND AND AIMS:Critical illness may complicate any pregnancy. Timely intensive care management of critically ill obstetric patients has better outcomes than expected from the initial severity of illness. The aim was to study the indications of transfer of post-cesarean section patients to post-anesthesia intensive care unit (PACU). (PACU transfer indicated that the patient required intensive care). MATERIALS AND METHODS: This was a prospective observational study carried out in the PACU of a tertiary care teaching public hospital over a period of 2 years. Sixty-one postoperative lower segment cesarean section (LSCS) females admitted consecutively in PACU were studied. The study included obstetric PACU utilization rate, intensive care unit interventions, outcome of mother, Acute Physiology and Chronic Health Evaluation (APACHE II) score, and its correlation with mortality. RESULTS: Postanesthesia intensive care unit admission rate was 2.8% and obstetric PACU utilization rate was 3.22%. Of 61 patients, four had expired. Obstetric indications (67.2%) were the most common cause of admission to PACU. Among the obstetric indications hemorrhage (36.1%) was found to be a statistically significant indication for PACU admission followed by hypertensive disorder of pregnancy (29.5%). Cardiovascular disease (16.4%) was the most common nonobstetric indication for PACU transfer and was associated with high mortality. The observed mortality was 6.557%, which was lower than predicted mortality by APACHE II Score. CONCLUSION: Obstetric hemorrhage, hypertensive disorders of pregnancy and cardiovascular diseases are the leading causes of PACU admission in post LSCS patients. Prompt provision of intensive care to critically ill obstetric patients can lead to a significant drop in maternal morbidity and mortality.
KEYWORDS: Acute Physiology and Chronic Health Evaluation II; caesarean section; postanesthesia intensive care unit.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234787/
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2014;volume=30;issue=4;spage=508;epage=513;aulast=Harde;type=2
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Papel de la unidad de cuidado postanestésico en el manejo de las pacientes obstétricas de alto riesgo
The role of the post-anaesthesia care unit in the management of high-risk obstetric patients.
Kostopanagiotou G, Kalimeris K, Pandazi A, Salamalekis G, Chrelias C, Matsota P.
Arch Med Sci. 2011 Feb;7(1):123-6. doi: 10.5114/aoms.2011.20616. Epub 2011 Mar 8.
Abstract
INTRODUCTION:High-risk obstetric patients in the immediate postpartum period are frequently admitted to the intensive care unit, but the necessity of this practice has recently been doubted. Herein we describe the efficiency of utilizing the post-anaesthesia care unit (PACU) as an intermediateintensive care facility for those patients. MATERIAL AND METHODS: We retrospectively described the reasons for admission, duration of stay, the anaesthetic used, main interventions and outcome for all obstetric admissions in the PACU during a period of 4 years in a university hospital. RESULTS: During the 4-year period 47 women were admitted to the PACU after delivery. The frequency of admission to the PACU was 15.3 per 1000 deliveries, while obstetric cases represented 4.4 per 1000 admissions to the PACU. The majority represented caesarean sections (81%). The main reasons for admission to the PACU were haemorrhage (49%), cardiovascular problems (19%) and preeclampsia/eclampsia (17%). Mean length of stay in the PACU was 14.5 ±11.6 h, being significantly less in women having received epidural anaesthesia (8.2 ±5.6 h) compared to those who delivered with general anaesthesia (19.0 ±13.6 h, p < 0.05). General anaesthesia was used in 85% of cases in which emergency delivery was indicated, but only in 27% of cases without emergency indications for delivery (p < 0.01). No death or admission to the intensive care unit occurred during the study period. CONCLUSIONS: The PACU can offer an intermediate intensive care facility for high-risk obstetric patients, thus reducing unnecessary admissions to the intensive care unit.
KEYWORDS:complications of pregnancy; maternal morbidity and mortality
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258694/pdf/AMS-7-1-123.pdf
Evolución fetomaterna en mujeres con preeclampsia severa que se someten a cesárea con anestesia general o espinal
Fetomaternal outcome in severe preeclamptic women undergoing emergency cesarean section under either general or spinal anesthesia.
Chattopadhyay S, Das A, Pahari S.
J Pregnancy. 2014;2014:325098. doi: 10.1155/2014/325098. Epub 2014 Apr 17.
Abstract
This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5%) patients underwent spinal anesthesia (SA) and 27 (15.5%) patients had general anesthesia (GA). Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P < 0.001). Patients receiving GA had a higher mortality (25.9% versus 1.4%; P < 0.001). The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P < 0.01) and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P < 0.05). To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016895/pdf/JP2014-325098.pdf
¿Por las pacientes obstétricas van a la UCI? Estudio de 3 años?
Why do obstetric patients go to the ICU? A 3-year-study.
Chawla S, Nakra M, Mohan S, Nambiar BC, Agarwal R, Marwaha A.
Med J Armed Forces India. 2013 Apr;69(2):134-7. doi: 10.1016/j.mjafi.2012.08.033. Epub 2012 Dec 1
Abstract
BACKGROUND: Pregnant women are at risk to develop complications due to illness related to pregnancy or due to aggravation of pre-existing disease. These patients also require critical care and ICU admissions in some cases. To determine the current spectrum of diseases in an obstetric population resulting in admission to the intensive care unit (ICU) at a tertiary care hospital. METHODS:A retrospective case series study and analysis of data from obstetric patients admitted for critical care management. RESULTS:0.26% of the total obstetric patients admitted to the hospital required ICU admissions. 46% of patients were admitted to ICU for ventilator support. Pre-eclampsia and obstetrical hemorrhage were the common diagnosis for these patients. CONCLUSION: Critically ill obstetric patients require a team approach of the obstetrician, anesthesiologist and intensive care specialist for the optimal care of these patients.
KEYWORDS:Critical care in obstetrics; Eclampsia; ICU admissions; Maternal mortality; Obstetrical hemorrhage
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862664/pdf/main.pdf
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Cardiomiopatía periparto
Cardiomiopatía periparto
Peripartum cardiomyopathy .
Said H, Sobhi A.
Ain-Shams J Anaesthesiol [serial online] 2014 [cited 2014 Dec 13];7:480-4.
http://www.asja.eg.net/downloadpdf.asp?issn=1687-7934;year=2014;volume=7;issue=4;spage=480;epage=484;aulast=Said;type=2
http://www.asja.eg.net/text.asp?2014/7/4/480/145670
Cardiomiopatía periparto. Revisión y guías prácticas
Peripartum cardiomyopathy: review and practice guidelines.
Johnson-Coyle L1, Jensen L, Sobey A; American College of Cardiology Foundation; American Heart Association.
Am J Crit Care. 2012 Mar;21(2):89-98. doi: 10.4037/ajcc2012163.
http://ajcc.aacnjournals.org/content/21/2/89.full.pdf
Importancia de la ecocardiografía transesofágica en cardiopatía periparto en cesárea con anestesia regional
Importance of transesophageal echocardiography in peripartum cardiomyopathy undergoing lower section cesarean section under regional anesthesia.
Kapoor PM, Goyal S, Irpachi K, Smita B.
J Anaesthesiol Clin Pharmacol. 2014 Jul;30(3):427-9. doi: 10.4103/0970-9185.137287.
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2014;volume=30;issue=3;spage=427;epage=429;aulast=Kapoor;type=2
Cardiodmiopatía periparto. Programa Europeo Observacional
Peripartum cardiomyopathy: Euro Observational Research Program.
Hoes MF, van Hagen I, Russo F, Van Veldhuisen DJ, Van den Berg MP, Roos-Hesselink J, van Spaendonck-Zwarts KY, van der Meer P.
Neth Heart J. 2014 Sep;22(9):396-400. doi: 10.1007/s12471-014-0573-5.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160455/pdf/12471_2014_Article_573.pdf
La miocardiopatía periparto. Un rompecabezas más cerca de la solución
Peripartum cardiomyopathy: A puzzle closer to solution.
Fett JD.
World J Cardiol. 2014 Mar 26;6(3):87-99. doi: 10.4330/wjc.v6.i3.87.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964190/pdf/WJC-6-87.pdf
Correlación entre cardiomiopatía periparto y anticuerpos contra receptores cardiovasculares
The correlation between peripartum cardiomyopathy and autoantibodies against cardiovascular receptors.
Liu J, Wang Y, Chen M, Zhao W, Wang X, Wang H, Zhang Z, Zhang J, Xu L, Chen J, Yang X, Zhang L.
PLoS One. 2014 Jan 23;9(1):e86770. doi: 10.1371/journal.pone.0086770. eCollection 2014.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900643/pdf/pone.0086770.pdf
Manejo anestésico de la cardiomiopatía periparto usando técnica de extensión de volumen epidural. Serie de casos
Anaesthetic management of peripartum cardiomyopathy using "epidural volume extension" technique: a case series.
Tiwari AK, Agrawal J, Tayal S, Chadha M, Singla A, Valson G, Tomar GS.
Ann Card Anaesth. 2012 Jan-Mar;15(1):44-6. doi: 10.4103/0971-9784.91481.
http://www.annals.in/downloadpdf.asp?issn=0971-9784;year=2012;volume=15;issue=1;spage=44;epage=46;aulast=Tiwari;type=2
Miocardiopatía periparto
Diego Felipe Polanía Ardila, Solón Navarrete Hurtado, Edgar Mariano Acuña Osorio, Rafael Alberto Álvarez Rosero
Rev Insuf Cardiaca 2009
http://www.insuficienciacardiaca.org/pdf/4_vol4_09/177-%20Miocardiopatia.pdf
http://www.scielo.org.ar/pdf/ic/v4n4/v4n4a06.pdf
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