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sábado, 25 de febrero de 2012

Bloqueo neuromuscular residual


Bloqueo neuromuscular residual: lecciones no aprendidas. Parte I: definiciones, incidencia y efectos fisiológicos del bloqueo residual neuromuscular.
Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block.
Murphy GS, Brull SJ.
Department of Anesthesiology, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA. dgmurphy2@yahoo.com
Anesth Analg. 2010 Jul;111(1):120-8. Epub 2010 May 4
Abstract
In this review, we summarize the clinical implications of residual neuromuscular block. Data suggest that residual neuromuscular block is a common complication in the postanesthesia care unit, with approximately 40% of patients exhibiting a train-of-four ratio <0.9. Volunteer studies have demonstrated that small degrees of residual paralysis (train-of-four ratios 0.7-0.9) are associated with impaired pharyngeal function and increased risk of aspiration, weakness of upper airway muscles and airway obstruction, attenuation of the hypoxic ventilatory response (approximately 30%), and unpleasant symptoms of muscle weakness. Clinical studies have also identified adverse postoperative events associated with intraoperative neuromuscular management. Large databased investigations have identified intraoperative use of muscle relaxants and residual neuromuscular block as important risk factors in anesthetic-related morbidity and mortality. Furthermore, observational and randomized clinical trials have demonstrated that incomplete neuromuscular recovery during the early postoperative period may result in acute respiratory events (hypoxemia and airway obstruction), unpleasant symptoms of muscle weakness, longer postanesthesia care unit stays, delays in tracheal extubation, and an increased risk of postoperative pulmonary complications. These recent data suggest that residual neuromuscular block is an important patient safety issue and that neuromuscular management affects postoperative outcomes.
http://www.anesthesia-analgesia.org/content/111/1/120.full.pdf+html
 
 Bloqueo neuromuscular residual: lecciones no aprendidas. Parte II: métodos para reducir los riesgos de debilidad residual
Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness.
Brull SJ, Murphy GS.
Department of Anesthesiology, Mayo Clinic College of Medicine, 4500 San Pablo Rd., Jacksonville, FL 32224, USA. SJBrull@me.com
Anesth Analg. 2010 Jul;111(1):129-40. Epub 2010 May 4.
Abstract
The aim of the second part of this review is to examine optimal neuromuscular management strategies that can be used by clinicians to reduce the risk of residual paralysis in the early postoperative period. Current evidence has demonstrated that frequently used clinical tests of neuromuscular function (such as head lift or hand grip) cannot reliably exclude the presence of residual paralysis. When qualitative (visual or tactile) neuromuscular monitoring is used (train-of-four [TOF], double-burst, or tetanic stimulation patterns), clinicians often are unable to detect fade when TOF ratios are between 0.6 and 1.0. Furthermore, the effect of qualitative monitoring on postoperative residual paralysis remains controversial. In contrast, there is strong evidence that acceleromyography (quantitative) monitoring improves detection of small degrees (TOF ratios >0.6) of residual blockade. The use of intermediate-acting neuromuscular blocking drugs (NMBDs) can reduce, but do not eliminate, the risk of residual paralysis when compared with long-acting NMBDs. In addition, complete recovery of neuromuscular function is more likely when anticholinesterases are administered early (>15-20 minutes before tracheal extubation) and at a shallower depth of block (TOF count of 4). Finally, the recent development of rapid-onset, short-acting NMBDs and selective neuromuscular reversal drugs that can effectively antagonize deep levels of blockade may provide clinicians with novel pharmacologic approaches for the prevention of postoperative residual weakness and its associated complications.
http://www.anesthesia-analgesia.org/content/111/1/129.full.pdf+html
 
Bloqueo residual postoperatorio en la unidad de cuidado postanestésico más de dos horas después de la administración de dosis única de atracurio para intubación
Postoperative residual block in postanesthesia care unit more than two hours after the administration of a single intubating dose of atracurium.
Varposhti MR, Heidari SM, Safavi M, Honarmand A, Raeesi S.
Assistant Professor of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2011 May;16(5):651-7.
Abstract
BACKGROUND: Residual neuromuscular blockade continues to be a clinical problem after surgical procedures. The purpose of this study was to determine the incidence of residual paralysis in the postanesthesia care unit (PACU) after a single intubating dose of twice of the 95% estimated dose (ED95) of a nondepolarizing muscle relaxant with an intermediate duration of action. METHODS: Two hundred and sixteen patients scheduled for elective surgery under general anaesthesia requiring tracheal intubation were included in the study. They received a single intubating dose of intravenous atracurium (0.5 mg/kg) to facilitate tracheal intubation. At the end of surgery, if train of four (TOF)-ratio was ≤ 0.9, neostigmine 40 μg/kg intravenously was given. If TOF-ratio was ≥ 0.9, no neostigmine was given. Also, in awake patients with TOF > 0.9, residual neuromuscular paralysis was evaluated by using clinical tests such as head lift test and tongue depressor test. RESULTS: TOF was less than 0.9 in 48 (22.2%) patients while after 120 minutes, no patients had TOF less than 0.9. Of 33 patients whose operation lasted less than 120 minutes, 4 patients had TOF less than 0.9 at the end of surgery. There was no case of hypoventilation or hypoxia at PACU. The incidence of negative value in clinical tests was high.
CONCLUSIONS: Our study gave the impression that more than two hours between the administration of a single intubating dose of an intermediate-acting nondepolarizing muscle relaxant (atracurium) and arrival to the PACU can probably guarantee the lack of a residual paralysis.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214377/?tool=pubmed
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Anestesiología y Medicina del Dolor
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Este aporte es cortesía del dr Máximo Cuadros


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En este día..


ON THIS DAY

On This Day: February 25

Updated February 24, 2012, 1:28 PM
Go to Index »
NYT Front Page
On Feb. 25, 1870, Hiram R. Revels, R-Miss., became the first black member of the United States Senate as he was sworn in to serve out the unexpired term of Jefferson Davis.
On Feb. 25, 1888, John Foster Dulles, the American Secretary of State from 1953-1959, was born. Following his death on May 24, 1959, his obituary appeared in The Times.

On This Date

BY THE ASSOCIATED PRESS
1570Pope Pius V excommunicated England's Queen Elizabeth I.
1836Inventor Samuel Colt patented his revolver.
1870Hiram Revels, a Mississippi Republican, was sworn in as the first black member of the U.S. Senate.
1901United States Steel Corp. was incorporated by J.P. Morgan.
1913The 16th Amendment to the U.S. Constitution, giving Congress the power to levy and collect income taxes, was declared in effect.
1943Beatles guitarist George Harrison was born in Liverpool, England.
1950"Your Show of Shows" debuted on NBC.
1956Soviet leader Nikita Khrushchev harshly criticized the late Josef Stalin in a speech before a Communist Party congress in Moscow.
1964Cassius Clay (who later changed his name to Muhammad Ali) became the world heavyweight boxing champion by defeating Sonny Liston in Miami Beach.
1986President Ferdinand E. Marcos fled the Philippines after 20 years of rule in the wake of a tainted election. Corazon Aquino assumed the presidency.
1990Nicaraguans voted in an election that led to victory for opponents of the ruling Sandinistas.
1991An Iraqi Scud missile hit a U.S. barracks in Dhahran, Saudi Arabia, killing 28 Americans during the Persian Gulf War.
1999A jury in Jasper, Texas, sentenced white supremacist John William King to death for the dragging death of James Byrd Jr., an African-American man.

Current Birthdays

BY THE ASSOCIATED PRESS
Rashida Jones, Actress (“Parks and Recreation,” “The Office”)
Actress Rashida Jones ("Parks and Recreation," "The Office") turns 36 years old today.
AP Photo/Evan Agostini
Chelsea Handler, Comedian
Comedian Chelsea Handler turns 37 years old today.
AP Photo/Chris Pizzello
1919Monte Irvin, Baseball Hall of Famer, turns 93
1937Bob Schieffer, Broadcast journalist, turns 75
1942Karen Grassle, Actress ("Little House on the Prairie"), turns 70
1949Jack Handey, Author, former TV writer ("Saturday Night Live"), turns 63
1958Jeff Fisher, Football coach, turns 54
1965Veronica Webb, Actress, turns 47
1966Alexis Denisof, Actor ("Angel"), turns 46
1966Tea Leoni, Actress, turns 46
1967Carrot Top, Comedian, turns 45
1971Sean Astin, Actor ("Lord of the Rings" movies), turns 41
1973Julio Iglesias Jr., Singer, turns 39

Historic Birthdays

John Foster Dulles2/25/1888 - 5/24/1959American Secretary Of State (1953-59).Go to obituary »
75Johann Philipp Krieger 2/25/1649 - 2/7/1725
German composer
85Carlo Goldoni 2/25/1707 - 2/6/1793
Italian dramatist
78Pierre-Auguste Renoir 2/25/1841 - 12/3/1919
French painter
86Benedetto Croce 2/25/1866 - 11/20/1952
Italian historian, humanist, and philosopher
48Enrico Caruso 2/25/1873 - 8/2/1921
Italian operatic tenor
96Vyacheslav M. Molotov 2/25/1890 - 11/8/1986
Russian statesman and foreign minister
75Dame Myra Hess 2/25/1890 - 11/25/1965
English pianist
79Marcel Paul Pagnol 2/25/1895 - 4/18/1974
French writer and film producer/director
76Anthony Burgess 2/25/1917 - 11/22/1993
English novelist and critic
78Barney Ewell 2/25/1918 - 4/4/1996
American Olympic sprinter
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Abordaje terapéutico del insomnio y otras actualidades médicas



Abordaje terapéutico del insomnio

F. López de Castro, O. Fernández Rodríguez, M.A. Mareque Ortega y L. Fernández Agüero




10.1016/j.semerg.2011.11.003


http: www.elsevier.es sites default files elsevier eop S % % .pdfDescargar PDF.

Palpitaciones en situación de estrés

E. Pablos-Herrero, A.M. Fabra-Noguera y M.E. Montserrat-Izquierdo




10.1016/j.semerg.2011.12.002


http: www.elsevier.es sites default files elsevier eop S % % .pdfDescargar PDF 





Actualización en Medicina de Familia. Talasemias

Goñi Murillo, MC; Galindo Vergara, C; Goñi Murillo, A
Publicado en Semergen. 2008;34:138-42. - vol.34 núm 03
Leer en: English
Descargar PDF en: Español

Resumen

Las talasemias son un grupo heterogéneo de alteraciones congénitas, cuya característica común es un defecto en la síntesis de una o varias de las cadenas de globina. Cada talasemia recibe el nombre de la cadena que deja de sintetizarse. Las más comunes son la β-talasemia, α-talasemia y βδ-talasemia. La forma más frecuente en España es la β-talasemia menor, aunque su distribución es muy irregular. Son trastornos hereditarios con un patrón de herencia autosómica dominante. Es importante diagnosticar las talasemias (incluso las formas asintomáticas o con muy poca expresividad clínica), para poder hacer un adecuado consejo genético y prevenir la aparición de casos graves de talasemia.
Palabras clave anemia, microcitosis, talasemia, Atención Primaria.




Nuevas alternativas en el tratamiento del síndrome de hombro doloroso

Esparza Miñana, J.M.; Londoño Parra, M.; Villanueva Pérez, V.L.; De Andrés Ibáñez, J.
Publicado en Semergen.2012; 38 :40-3 - vol.38 núm 01
Leer en: English
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Resumen
El dolor de hombro es una consulta frecuente en la práctica clínica en atención primaria. El tratamiento habitual se basa en antiinflamatorios no esteroideos (AINE), reposo, rehabilitación y como alternativa inyección local en la articulación. En el caso de dolores resistentes encontramos las técnicas de radiofrecuencia (RF) sobre el nervio supraescapular.
La radiofrecuencia puede emplearse de 2 formas: RF convencional, aplicando elevadas temperaturas al tejido seleccionado con el objetivo de producir una neurolisis térmica y RF pulsada en que las temperaturas son más bajas y producen un bloqueo temporal no destructivo, siendo esta última la técnica más habitual en el abordaje del hombro.
Aun cuando el mecanismo de acción analgésico de la radiofrecuencia es desconocido, recientes estudios han demostrado que es una técnica segura, efectiva y duradera. La radiofrecuencia del nervio supraescapular es una alternativa válida, eficaz y con escasas complicaciones en el tratamiento del hombro doloroso resistente al resto de terapias.

Palabras clave Hombro. Nervio supraescapular. Radiofrecuencia. Dolor crónico.
 


Sinergia en la analgesia tratada con ibuprofeno y codeína

López-Durán, J.L.; Frías-Iniesta, J.
Publicado en Semergen.2012; 38 :24-32 - vol.38 núm 01
Leer en: English
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Resumen
Una de las principales características de una buena combinación farmacológica es la sinergia. Existe en el mercado, desde hace relativamente poco tiempo, una nueva combinación analgésica de ibuprofeno, un antiinflamatorio no esteroideo (AINE) muy usado en la práctica médica diaria por su buen cociente de eficacia y seguridad, y codeína, un opiáceo menor muy utilizado como segundo escalón analgésico en combinación. Hemos realizado una revisión en MEDLINE de los principales estudios publicados en la literatura médica en cuanto a eficacia y seguridad de ambos principios activos por separado, para finalizar con una aproximación tanto de la experiencia clínica mostrada en estudios con combinaciones analgésicas en general, como en las hipótesis de un posible sinergismo entre AINE y opiáceos.

Palabras clave Ibuprofeno. Codeina. Sinergismo
 
Atte.
Dr.Máximo Cuadros Chávez




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Actualización del uso de anticonceptivos en el tratamiento de la endometriosis


Actualización del uso de anticonceptivos en el tratamiento de la endometriosis

R. Triano-Sánchez y L. de Prado-Prieto


10.1016/j.semerg.2011.09.004

http: www.elsevier.es sites default files elsevier eop S % % .pdfDescargar PDF
 
Atte.
Dr.Máximo Cuadros Chávez
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