viernes, 26 de abril de 2013

ebooks. Alerta











El número de lectores de ebooks crece un 280 por ciento en dos años
ecodiario
El número de lectores de libros digitales o ebooks ha registrado un incremento del 280 por ciento respeto a los niveles que se registraban hace dos años, cuando el porcentaje ascendía al 5,86 por ciento. MADRID, 23 (EUROPA PRESS). En concreto, del 5 ...
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Día del Libro: rosas, e-books y apps
TICbeat (blog)
Con motivo del Día Internacional del Libro, distintos agentes del sector han puesto en marcha iniciativas que promueven el acceso legal a los e-books a través de promociones y descuentos. Durante todo el día, Amazon permitirá a los lectores de Kindle ...
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TICbeat (blog)

Así ha cambiado el hábito de la lectura con las «tablets» y los «e ...
ABC.es
De acuerdo a sus cifras, la facturación de eBooks o libros digitales (contenidos) en España se ha multiplicado por seis en 2012, frente a los dos millones de euros registrados en 2011. Por otra parte, en lo que va de año el aumento acumulado ha sido ...
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Cómo evitar la piratería de los eBooks
InfoBAE.com
DRM (digital rights management) es un sistema que pretende restringir la copia no autorizada deeBooks y también de otros bienes digitales como películas y música. Digo pretende porque no lo logra. La causa de esto es algo llamado Agujero Analógico: ...
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Cómo conseguir e-books gratis legalmente
androidsis (blog)
Continuando con la celebración del día de libro, hoy día de Sant jordi os queremos recomendar la manera de conseguir e-books gratis, o libros electrónicos de una manera legal y totalmente gratuita. Para ello, nuestro compañeros de Todo e-Readers han ...
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androidsis (blog)

El número de lectores de 'ebooks' se cuadruplica
Diario de Sevilla
El porcentaje de lectores de ebooks se ha multiplicado casi por cuatro en dos años, pero esto apenas ha afectado a lectura de libros tradicionales, lo que implica que están surgiendo lectores mixtos, consumidores de literatura tanto en formato ...
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Gandia celebra la Setmana del Llibre con presentaciones y talleres ...
Las Provincias
A lo largo de la semana, se han programado también una serie de charlas formativas, tituladas Los E-readers y los E-books, para alumnos de a partir de 3º de ESO. Los alumnos podrán manipular y practicar con los dispositivos disponibles en la biblioteca.
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De cines y libros - Diario de Sevilla
Diario de Sevilla
Triunfan los ebooks y desde los años 70 los cines fueron cerrando, sustituidos por los multicines que después fueron reemplazados por las multisalas de los centros comerciales. El disfrute en casa de las películas sin pérdida de calidad es un hecho ...
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Los libros digitales crecerán en un 23 por ciento en el próximo trienio
eldia.es
... de la Asociación Multisectorial de Empresas de la Electrónica, Tecnologías de la Información y Comunicación revela que la edición ha alcanzo el pasado año los 201 millones de euros de facturación, de los cuales 72,6 fueron aportados por los e-books.
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Blogs 1 resultado nuevo de E-Books


El minidocumental viaja hacia las fronteras del `e-book´ – Literatura ...
según David González | aviondepapel.tv
Joan Planas y Ana Salvá recorren Asia para rodar, fotografiar y relatar los testimonios de personas anónimas en su web documental `Buscando Historias´. Financian con `crowdfunding´ este proyecto web multimedia -híbrido entre el ...
Tecnología Noticias, vídeos...

eBooks - PlanetadeLibros.com
Colecciones. (Fuera de colección) · Novela romántica · Áncora & Delfin · Autores Españoles e Iberoamericanos · Para Dummies. Los eBooks más destacados ...
www.planetadelibros.com/seleccion-editorial-ebooks-5.html
El número de lectores de ebooks crece un 280 por ... - Eldiario.es
El número de lectores de libros digitales o ebooks ha registrado un incremento del 280 por ciento respeto a los niveles que se registraban hace dos años, ...
www.eldiario.es/.../numero-lectores-ebooks-crece-ciento_0_12...
Celebra el día del libro con varios eBooks gratuitos - Todo eReaders
Hoy 23 de abril se celebra el Día del Libro y con motivo de esta celebración muchos periódicos, librerías o editoriales están ofreciendo un gran número.
www.todoereaders.com/celebra-el-dia-del-libro-con-varios-eb...
JOSE MANUEL DA NETA PRIETO MARTINEZ: libros, eBooks ...
Comprar libros y eBooks de JOSE MANUEL DA NETA PRIETO MARTINEZ en tu librería onlinecasadellibro.com.
www.casadellibro.com/libros-ebooks/jose...da.../20088038
Sorteo de ebooks para el día del libro - Todo eReaders
Y queremos organizar un pequeño sorteo para regalar unos ebooks. Para participar tan solo tienes que twittear lo siguiente (acuérdate de cambiar las palabras ...
www.todoereaders.com/sorteo-de-ebooks-para-el-dia-del-libro...

jueves, 25 de abril de 2013

Anestesia regional en neonatos/Regional anesthesia in neonates



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



Anestesia regional en el neonato


Regional anaesthesia and analgesia in the neonate
Per-Arne Lönnqvist, MD, DEAA, FRCA, PhD, Professor of Paediatric
Anaesthesia &; Intensive Care, Senior Consultant
http://web.clas.ufl.edu/users/msscha/PremedCSS/analgesics_infants.pdf

Consideraciones anestésicas en emergencias quirúrgicas neonatales
Anaesthetic consideration for neonatal surgical emergencies.
Pani N, Panda CK.
Indian J Anaesth [serial online] 2012 [cited 2013 Mar 9];56:463-9.
A newborn requires constant vigilance, rapid recognition of the events and swift intervention during anaesthesia. The anaesthetic considerations in neonatal surgical emergencies are based on the physiological immaturity of various body systems, poor tolerance of the anaesthetic drugs, associated congenital disorders and considerations regarding the use of high concentration of oxygen. The main goal is for titration of anaesthetics to desired effects, while carefully monitoring of the cardiorespiratory status. The use of regional anaesthesia has shown to be safe and effective. Advancements in neonatology have resulted in the improvement of the survival of the premature and critically ill newborn babies. Most of the disorders previously considered as neonatal surgical emergencies in the past no longer require immediate surgery due to new technology and new methods of treating sick neonates. This article describes the common neonatal surgical emergencies and focuses on factors that affect the anaesthetic management of patients with these disorders.
Keywords: Anaesthesia, emergency surgeries, neonate
http://www.ijaweb.org/text.asp?2012/56/5/463/103962


Manejo anestésico para laparotomía urgente en un neonato con artrogriposis congénita múltiple

Anesthetic management of a neonate with arthrogryposis multiplex congenita for emergency laparotomy.
Chowdhuri R, Samui S, Kundu AK.
Department of Anesthesiology, R.G.Kar Medical College, Kolkata, India.
J Anaesthesiol Clin Pharmacol. 2011 Apr;27(2):244-6. doi: 10.4103/0970-9185.81831.
Abstract
Arthrogryposis multiplex congenita is a rare disease, characterized by non-progressive, multiple joint contractures since birth. Anesthetic issues include difficult intravenous access, difficult airway management and regional anesthesia. We report the anesthetic management of a six-day-old neonate presenting to the emergency with features of intestinal obstruction, who was detected for the first time to have arthrogryposis multiplex congenita. General anesthesia along with caudal analgesia for peroperative and postoperative pain relief was used. There was an episode of intraoperative hyperthermia, which was tackled successfully. The child had an uneventful post-anesthesia recovery.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127309/




Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Anestésicos, Pre-condicionamiento y Protección Cerebral

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




Anestésicos, Pre-condicionamiento y Protección Cerebral
Rogean Rodrigues Nunes, Gastao Fernandes Duval Neto, Julio Cesar Garcia de Alencar, Suyane Benevides Franco, Nayanna Quezado de Andrade, Danielle Maia Holanda Dumaresq, Sara Lucia Cavalcante
Rev Bras Anestesiol. 2013;63(1):119-138
Justificativa y objetivos: Diversos estudios han demostrado el pre-condicionamiento cerebral como un mecanismo protector frente a una situacion de estres. Estan descritos algunos factores determinantes del PC, como tambien la neuroproteccion proporcionada por los agentes anestésicos y no anestesicos. Contenido: Se hizo la revision con base en los principales articulos de la literatura que engloban la fi siopatologia de la isquemia-reperfusion y la lesion neuronal, y los factores no farmacológicos (infl amacion, glucemia y temperatura), y farmacologicos relacionados con el cambio de la respuesta a la isquemia-reperfusion, ademas de la neuroproteccion inducida por el uso de los anestesicos. Conclusiones: El cerebro tiene la capacidad de protegerse contra la isquemia cuando se le estimula. La elucidación de ese mecanismo posibilita la aplicacion de sustancias inductoras del precondicionamiento cerebral, como algunos anestesicos, otros farmacos y medidas no farmacologicas, como la hipotermia, con el fi n de inducir la tolerancia a las lesiones isquemicas.
http://www.scielo.br/pdf/rba/v63n1/es_v63n1a11.pdf 

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


AINES y corazón/Nonsteroidal Anti-Inflammatory and cardiovascular risk

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



Diclofenaco prolonga la repolarización del músculo ventricular con daño en la repolarización de reserva 
Diclofenac prolongs repolarization in ventricular muscle with impaired repolarization reserve.
Kristóf A, Husti Z, Koncz I, Kohajda Z, Szél T, Juhász V, Biliczki P, Jost N, Baczkó I, Papp JG, Varró A, Virág L.
Division of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary.
PLoS One. 2012;7(12):e53255. doi: 10.1371/journal.pone.0053255. Epub 2012 Dec 31.
Abstract
BACKGROUND: The aim of the present work was to characterize the electrophysiological effects of the non-steroidal anti-inflammatory drug diclofenac and to study the possible proarrhythmic potency of the drug in ventricular muscle. METHODS: Ion currents were recorded using voltage clamp technique in canine single ventricular cells and action potentials were obtained from canine ventricular preparations using microelectrodes. The proarrhythmic potency of the drug was investigated in an anaesthetized rabbit proarrhythmia model. RESULTS: Action potentials were slightly lengthened in ventricular muscle but were shortened in Purkinje fibers by diclofenac (20 µM). The maximum upstroke velocity was decreased in both preparations. Larger repolarization prolongation was observed when repolarization reserve was impaired by previous BaCl(2) application. Diclofenac (3 mg/kg) did not prolong while dofetilide (25 µg/kg) significantly lengthened the QT(c) interval in anaesthetized rabbits. The addition of diclofenac following reduction of repolarization reserve by dofetilide further prolonged QT(c). Diclofenac alone did not induce Torsades de Pointes ventricular tachycardia (TdP) while TdP incidence following dofetilide was 20%. However, the combination of diclofenac and dofetilide significantly increased TdP incidence (62%). In single ventricular cells diclofenac (30 µM) decreased the amplitude of rapid (I(Kr)) and slow (I(Ks)) delayed rectifier currents thereby attenuating repolarization reserve. L-type calcium current (I(Ca)) was slightly diminished, but the transient outward (I(to)) and inward rectifier (I(K1)) potassium currents were not influenced. CONCLUSIONS: Diclofenac at therapeutic concentrations and even at high dose does not prolong repolarization markedly and does not increase the risk of arrhythmia in normal heart. However, high dose diclofenac treatment may lengthen repolarization and enhance proarrhythmic risk in hearts with reduced repolarization reserve.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534043/pdf/pone.0053255.pdf
 
  
Nuevas acciones de los AINES sobre los canales iónicos vasculares: La contabilización de los efectos secundarios cardiovasculares e identificación de nuevas aplicaciones terapéuticas. 
Novel Actions of Nonsteroidal Anti-Inflammatory Drugs on Vascular Ion Channels: Accounting for Cardiovascular Side Effects and Identifying New Therapeutic Applications.
Brueggemann LI, Mani BK, Mackie AR, Cribbs LL, Byron KL.
Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Maywood, Illinois.
Mol Cell Pharmacol. 2010;2(1):15-19.
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used medications for the treatment of both acute and chronic pain. Selective cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib (Celebrex(®)), rofecoxib (Vioxx(®)), and diclofenac, have been among the most widely prescribed NSAIDs because they prevent the generation of prostaglandins involved in inflammation and pain, but avoid some of the gastrointestinal complications associated with less selective COX-1/COX-2 inhibitors. In 2004, rofecoxib (Vioxx(®)) was voluntarily withdrawn from the market because of adverse cardiovascular side effects. This led to an explosion of research into the cardiovascular effects of the 'coxibs', which revealed differential cardiovascular risk profiles among the members of this drug class. The differential risk profiles may relate to the tendency of some of the drugs to elevate blood pressure (BP). An important component of BP regulation is dependent on the contractile state of vascular smooth muscle cells (VSMCs), which is controlled to a large extent by the activities of KCNQ (Kv7 family) potassium channels and L-type calcium channels. Our recently published data indicate that celecoxib, but not rofecoxib or diclofenac, at therapeutically relevant concentrations, acts as a Kv7 potassium channel activator and a calcium channel blocker, causing relaxation of VSMCs and decreasing vascular tone. These vasorelaxant ion channel effects may account for the differential cardiovascular risk profiles among the different COX-2 inhibitors. We further speculate that these properties may be exploited for therapeutic benefit in the treatment of cardiovascular diseases or other medical conditions.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915785/pdf/nihms-184534.pdf 

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

miércoles, 24 de abril de 2013

Bibliotecas. Alerta






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


Las diez bibliotecas públicas más asombrosas del planeta
Qué.es
Las bibliotecas suelen ser lugares muy tranquilos en los que es fácil olvidarse del ruidoso mundo que nos rodea, atrapados en la lectura de sus libros. Sin embargo, algunos de estos edificios compiten en belleza y originalidad con las obras que ...
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Las bibliotecas municipales de Ourense ofrecen talleres infantiles ...
La Voz de Galicia
Las actividades, que son totalmente gratuitas, se desarrollarán el lunes 25, el martes 26, el miércoles 27 y el lunes 1 de abril entre las once de la mañana y la una de la tarde y el único requisito es ser socio de la biblioteca, que tampoco tiene ...
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BIBLIOTECAS Defienden redefinir el papel de las bibliotecas para ...
Ideal Digital
Granada, 22 mar (EFE).- Investigadores de la Universidad de Granada defienden que las bibliotecasse adapten a la era de internet y cambien su papel, de forma que ofrezcan servicios como enseñar a los usuarios a iniciar un negocio, rellenar un ...
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Presentación de “Las Bibliotecas para la Sociedad” - Granada
El próximo miércoles, 20 de marzo, a las 12,30 horas en el Salón Rojo del Hospital Real, tendrá lugar la presentación de “Las Bibliotecas para la Sociedad” , ...
canal.ugr.es/.../63832-presentación-de-“las-bibliotecas-para-la-...


AulaSurURJC: La URJC cierra todas sus bibliotecas durante las ...
Fuenlabrada | José Luis Blanco.- Las bibliotecas de los campus de la Universidad Rey Juan Carlos permanecerán cerradas desde el día 23 de marzo hasta el ...
aulasururjc.blogspot.com/.../la-urjc-cierra-todas-sus-bibliotecas...


AulaSurURJC: Encuesta | ¿Qué piensa del cierre de las bibliotecas ...
Bernal Crespo (19, Ciencias del Mar). "Si fuese en mi universidad perjudicaría a algunas personas que no pueden estudiar en casa. La biblioteca es un recurso ...
aulasururjc.blogspot.com/.../encuesta-que-piensa-del-cierre-de...


Red de Bibliotecas del Instituto Cervantes - Google+ - Español ...
Español adecuado para no insultar en Recife: 22 de marzo - La Biblioteca Carmen de Burgos celebra una nueva tertulia cuyo objetivo es minimizar la brecha…
https://plus.google.com/.../posts/MV83UwEaKs5

AINES y riesgo CV/Nonsteroidal anti-inflammatory drugs and CV risk




Riesgo cardiovascular causa-específico asociado con los AINES entre los pacientes con infarto del miocardio. Un estudio a nivel nacional 
Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs among myocardial infarction patients--a nationwide study.
Olsen AM, Fosbøl EL, Lindhardsen J, Andersson C, Folke F, Nielsen MB, Køber L, Hansen PR, Torp-Pedersen C, Gislason GH.
Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark. amschjerning@gmail.com
PLoS One. 2013;8(1):e54309. doi: 10.1371/journal.pone.0054309. Epub 2013 Jan 30.
Abstract
BACKGROUND: Non steroidal anti-inflammatory drugs (NSAIDs) increase mortality and morbidity after myocardial infarction (MI). We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients. METHODS AND RESULTS: By individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark, patients aged >30 years admitted with first-time MI during 1997-2009 and their subsequent NSAID use were identified. The risk of three cardiovascular specific endpoints: cardiovascular death, the composite of coronary death and nonfatal MI, and the composite of fatal and nonfatal stroke, associated with NSAID use was analyzed by Cox proportional hazard analyses. Of 97,698 patients included 44.0% received NSAIDs during follow-up. Overall use of NSAIDs was associated with an increased risk of cardiovascular death (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.36-1.49). In particular use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with increased risk of cardiovascular death (HR 1.96 [1.79-2.15] and HR1.66 [1.44-1.91], respectively) with a dose dependent increase in risk. Use of ibuprofen was associated with increased risk of cardiovascular death (HR 1.34[1.26-1.44]), whereas naproxen was associated with the lowest risk of (e.g., HR 1.27[1.01-1.59].CONCLUSION: Use of individual NSAIDs is associated with different cause-specific cardiovascular risk and in particular rofecoxib and diclofenac were associated with increased cardiovascular morbidity and mortality. These results support caution with use of all NSAIDs in patients with prior MI.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559685/pdf/pone.
0054309.pdf 
  
Riesgo cardiovascular con AINES: Revisión sistemática de estudios poblacionales observacionales controlados 
Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies.
McGettigan P, Henry D.
Hull York Medical School, Hull, United Kingdom.
PLoS Med. 2011 Sep;8(9):e1001098. doi: 10.1371/journal.pmed.1001098. Epub 2011 Sep 27.
Abstract
BACKGROUND: Randomised trials have highlighted the cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) in high doses and sometimes atypical settings. Here, we provide estimates of the comparative risks with individual NSAIDs at typical doses in community settings. METHODS AND FINDINGS: We performed a systematic review of community-based controlled observational studies. We conducted comprehensive literature searches, extracted adjusted relative risk (RR) estimates, and pooled the estimates for major cardiovascular events associated with use of individual NSAIDs, in different doses, and in populations with low and high background risks of cardiovascular events. We also compared individual drugs in pair-wise (within study) analyses, generating ratios of RRs (RRRs). Thirty case-control studies included 184,946 cardiovascular events, and 21 cohort studies described outcomes in >2.7 million exposed individuals. . CONCLUSIONS: This review suggests that among widely used NSAIDs, naproxen and low-dose ibuprofen are least likely to increase cardiovascular risk. Diclofenac in doses available without prescription elevates risk. The data for etoricoxib were sparse, but in pair-wise comparisons this drug had a significantly higher RR than naproxen or ibuprofen. Indomethacin is an older, rather toxic drug, and the evidence on cardiovascular risk casts doubt on its continued clinical use. Please see later in the article for the Editors' Summary.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181230/pdf/pmed.1
001098.pdf 
 
La duración del tratamiento con medicamentos anti-inflamatorios no esteroideos y el impacto en el riesgo de muerte e infarto de miocardio recurrente en pacientes con infarto de miocardio previo: un estudio de cohorte nacional 
Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study.
Schjerning Olsen AM, Fosbøl EL, Lindhardsen J, Folke F, Charlot M, Selmer C, Lamberts M, Bjerring Olesen J, Køber L, Hansen PR, Torp-Pedersen C, Gislason GH.
Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark. aols0073@geh.regionh.dk
Circulation. 2011 May 24;123(20):2226-35. doi: 10.1161/CIRCULATIONAHA.110.004671. Epub 2011 May 9.
Abstract
BACKGROUND: Despite the fact that nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated among patients with established cardiovascular disease, many receive NSAID treatment for a short period of time. However, little is known about the association between NSAID treatment duration and risk of cardiovascular disease. We therefore studied the duration of NSAID treatment and cardiovascular risk in a nationwide cohort of patients with prior myocardial infarction (MI). METHODS AND RESULTS: Patients ≥30 years of age who were admitted with first-time MI during 1997 to 2006 and their subsequent NSAID use were identified by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. Risk of death and recurrent MI according to duration of NSAID treatment was analyzed by multivariable time-stratified Cox proportional-hazard models and by incidence rates per 1000 person-years. Of the 83 677 patients included, 42.3% received NSAIDs during follow-up. There were 35 257 deaths/recurrent MIs. Overall, NSAID treatment was significantly associated with an increased risk of death/recurrent MI (hazard ratio, 1.45; 95% confidence interval, 1.29 to 1.62) at the beginning of the treatment, and the risk persisted throughout the treatment course (hazard ratio, 1.55; 95% confidence interval, 1.46 to 1.64 after 90 days). Analyses of individual NSAIDs showed that the traditional NSAID diclofenac was associated with the highest risk (hazard ratio, 3.26; 95% confidence interval, 2.57 to 3.86 for death/MI at day 1 to 7 of treatment). CONCLUSIONS: Even short-term treatment with most NSAIDs was associated with increased risk of death and recurrent MI in patients with prior MI. Neither short- nor long-term treatment with NSAIDs is advised in this population, and any NSAID use should be limited from a cardiovascular safety point of view.
http://circ.ahajournals.org/content/123/20/2226.full.pdf 


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


martes, 23 de abril de 2013

Núcleo ceruleus/Locus coeruleus

                         http://www.smo.edu.mx/jornada2013/sociales.htm#DE

Las neuronas noradrenérgicas en el núcleo ceruleus contribuyen al dolor neuropático 
Noradrenergic neurons in the locus coeruleus contribute to neuropathic pain.
Brightwell JJ, Taylor BK.
Department of Pharmacology, School of Medicine, Tulane University, New Orleans, LA 70112, USA.
Neuroscience. 2009 Apr 21;160(1):174-85. doi: 10.1016/j.neuroscience.2009.02.023. Epub 2009 Feb 14.
Abstract
Current theories of neuropathic hypersensitivity include an imbalance of supraspinal inhibition and facilitation. Our overall hypothesis is that the locus coeruleus (LC), classically interpreted as a source of pain inhibition, may paradoxically result in facilitation after tibial and common peroneal nerve transection (spared sural nerve injury--SNI). We first tested the hypothesis that non-noxious tactile hind paw stimulation of the spared sural innervation territory increases neuronal activity in the LC in male rats. We observed a bilateral increase in the stimulus-evoked expression of transcription factors Fos and phosphorylated CREB (pCREB) in LC after SNI but not sham surgery; these markers of neuronal activity correlated with the intensity of tactile allodynia. We next tested the hypothesis that noradrenergic neurons contribute to the development of neuropathic pain. To selectively destroy these neurons, we delivered antidopamine-beta-hydroxylase saporin (anti-DbetaH-saporin) into the i.c.v. space 2 weeks before SNI. We found that anti-DbetaH-saporin, but not an IgG-saporin control, reduced behavioral signs of tactile allodynia, mechanical hyperalgesia, and cold allodynia from 3 to 28 days. after SNI. Our final experiment tested the hypothesis that the LC contributes to the maintenance of neuropathic pain. We performed SNI, waited 2 weeks for maximal allodynia and hyperalgesia to develop, and then administered the local anesthetic lidocaine (4%) directly into the LC parenchyma. Lidocaine reduced all behavioral signs of neuropathic pain in a reversible manner, suggesting that the LC contributes to pain facilitation. We conclude that, in addition to its well-known inhibition of acute and inflammatory pain, the LC facilitates the development and maintenance of neuropathic pain in the SNI model. Further studies are needed to determine the facilitatory pathways emanating from the LC.
Plasticidad molecular y celular inducida por opioides en las neuronas catecolaminérgicas del área tegmentaria ventral y el locus ceruleus  
Opiate-induced molecular and cellular plasticity of ventral tegmental area and locus coeruleus catecholamine neurons.
Mazei-Robison MS, Nestler EJ.
Fishberg Department of Neuroscience and Friedman Brain Institute, Mount Sinai School of Medicine, New York, New York, USA.
Cold Spring Harb Perspect Med. 2012 Jul;2(7):a012070
. doi: 10.1101/cshperspect.a012070.
Abstract
The study of neuronal adaptations induced by opiate drugs is particularly relevant today given their widespread prescription and nonprescription use. Although much is known about the acute actions of such drugs on the nervous system, a great deal of work remains to fully understand their chronic effects. Here, we focus on longer-lasting adaptations that occur in two catecholaminergic brain regions that mediate distinct behavioral actions of opiates: ventral tegmental area (VTA) dopaminergic neurons, important for drug reward, and locus coeruleus (LC) noradrenergic neurons, important for physical dependence and withdrawal. We focus on changes in cellular, synaptic, and structural plasticity in these brain regions that contribute to opiate dependence and addiction. Understanding the molecular determinants of this opiate-induced plasticity will be critical for the development of better treatments for opiate addiction and perhaps safer opiate drugs for medicinal use.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385942/pdf/cshperspectmed-ADD-a012070.pdf 

  
Núcleo Coeruleus. Neurotransmisores, Funciones y Patología. 
Dr. Mauricio Valenzuela-Harrington, Dr. Vicente Negrete-Díaz, Dr. Antonio Rodríguez-Moreno
Anestesia en México 2007;19:155-166.
El Nucleus Coeruleus es la principal fuente de noradrenalina en el sistema nervioso central. Este complejo nuclear debido a sus aferencias y eferencias está involucrado en diversas y variadas funciones. Además está involucrado en diversas enfermedades y alteraciones del sistema nervioso central cuando su funcionamiento no es correcto. En esta revisión se describen estas funciones del nucleus coeruleus así como la forma en que participa en enfermedades del sistema nervioso tales como Enfermedad de Alzheimer, Parkinson, Depresión y estrés y su papel en procesos de drogodependencia y síndrome de abstinencia.
Palabras claves: Locus Coeruleus, noradrenalina, neuromodulador, receptores a y b adrenérgicos.
http://www.anestesiaenmexico.org/RAM9/RAM2007-19-3/007.pdf 


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










Casos de interés/Interesting cases

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


Como médicos, y en especial como especialistas en medicina perioperatoria podemos enfrentar pacientes con patologías poco frecuentes como la miastenia gravis, la hipertermia maligna, el síndrome del corazón roto, feocromocitomas y muchas otras entidades raras. Cada mes le enviaremos una serie de informe de casos con patologías poco frecuentes que esperamos le sean de utilidad.

As physicians, as well as specialists in perioperative medicine, we confront patients with rare diseases such as myasthenia gravis, malignant hyperthermia, broken heart syndrome, pheochromocytomas and many other rare entities. Each month we will send to you a series of case report articles with rare diseases, that we hope will be useful.

Como especialistas em medicina perioperatória pode tratar pacientes com doenças raras, como a miastenia gravis, hipertermia maligna, síndrome do coração partido, feocromocitomas e muitas outras entidades raras. Cada mês vamos enviar uma série de relatos de casos com doenças raras, que esperamos que seja útil. 
Ceguera cortical transitoria despues de cirugía de columna presentándose como signo inicial de trombofilia hereditaria 
Transient cortical blindness after spinal surgery as initial presenting sign of hereditary thrombophilia.
Tugcu B, Araz-Ersan B, Eren G, Selçuk H, Yigit U.
Indian J Ophthalmol [serial online] 2013 [cited 2013 Mar 21];61:139-40. 

Cortical blindness is a rare complication of spine surgery, and is followed by a period of recovery due to resolution of inflammation and edema around the lesion and to the re-activation of partially damaged perilesional tissue. Bilateral occipital abnormalities caused by hypotension, ischemia and infarction are associated with poor prognosis. Herein, we report complete recovery of a case with cortical blindness, despite having an ischemic infarct.
Síndrome de Tapia despues de laminoplastía cervical. Reporte de un caso 
Tapia's syndrome following cervical laminoplasty -A case report-.
Lim KJ, Kim MH, Kang MH, Lee HM, Park EY, Kwon KJ, Lee SK, Choi H, Moon HS.
Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Anyang, Korea.
Korean J Anesthesiol. 2013 Feb;64(2):172-4. doi: 10.4097/kjae.2013.64.2.172. Epub 2013 Feb 15.
Abstract
Tapia's syndrome is the palsy of the 10th and 12th cranial nerves, resulting in ipsilateral paralysis of the vocal cord and tongue. It is a rare complication which is related to the anesthetic airway management and positioning of the patient's head during the surgery. We describe a patient with a postoperative unilateral Tapia's syndrome, after general anesthesia, with uncomplicated endotracheal intubation. The patient's symptoms improved gradually for three months.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581789/pdf/kjae-64-172.pdf
 
 
Megaesófago: Un reto para los anestesiólogos 
Megaesophagus: A challenge for anesthesiologists.
Tewari P, Gupta D.
Ann Card Anaesth [serial online] 2013 [cited 2013 Jan 2];16:61-2
A fifty-nine-year male farmer presented with a history of low grade dysphagia, both for solids and liquids for twenty-five years that progressively increased in severity. He had lost weight significantly in recent years and developed spontaneous regurgitation of liquids and food content, heart burn, chest pain after eating and cough. Chest X-ray (PA-view) showed a large curvilinear, radio-opaque density lesion occupying medial 2/3 rd of right hemi thorax with Ryle's tube within the shadow suggesting a large dilated esophagus. This was not silhouetting the right cardiac border suggesting posterior mediastinal mass; moreover, there was no mediastinal shift. Barium swallow confirmed achalasia-cardia with huge, more than 10 cm in diameter, pouch of esophagus with lower constricted part. The patient did not show any cardiac compromise but lung function tests showed reduced inspiratory and forced vital capacity (60%) and borderline Peak Expiratory Flow Rate (70%). The laboratory investigations were within normal limits. He was planned for transhiatal esophagectomy (THO) with cervical esophago-gastrotomy (OG) and feeding jejunostomy (FJ). He was given one week of rigorous chest physiotherapy under guidance of professional therapists
http://www.annals.in/text.asp?2013/16/1/61/105374

  
Síndrome de Sturge-Weber con manifestaciones oculares extremas y asociación rara con agioma de la vía aérea superior con dificultad anticipada para el manejo de la vía aérea             
Sturge-Weber-Syndrome with extreme ocular manifestation and rare association of upper airway angioma with anticipated difficult airway.
Wong HS, Abdul Rahman R, Choo SY, Yahya N.
Universiti Kebangsaan Malaysia Medical Centre, Department of Opthalmology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia. whs1975@gmail.com
Med J Malaysia. 2012 Aug;67(4):435-7.
Abstract
We report a rare case of an 18 year old girl with Sturge-Weber syndrome, she had extensive facial port wine stains, right bupthalmos and advanced glaucoma involving both eyes. She underwent right eye glaucoma drainage device surgery under general anaesthesia, and had a difficult intubation due to extensive angiomatous like soft tissue swelling at her upper airway. This report highlights the importance of being aware of the need for continuous follow-up in Sturge-Weber syndrome patients as this syndrome can lead to blindness due to advance glaucoma and the awareness of possible difficult intubation for this group of patients
http://www.e-mjm.org/2012/v67n4/Sturge-Weber-Syndrome.pdf 

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


BPD para cesárea/Epidural block for C-section



Comparación de los efectos maternos y neonatales de bupivacaína más fentanil y ropivacaína más fentanil durante operación cesárea 
Comparison of the maternal and neonatal effects of bupivacaine plus fentanyl and ropivacaine plus fentanyl during cesarean delivery.
Canan U, Örnek D, Kilci O, Dönmez F, Gamli M, Dikmen B.
Niger J Clin Pract [serial online] 2013 [cited 2013 Apr 6];16:195-200.
Abstract
Purpose: The aim of the present study was to compare the anesthetic efficacy, and fetal and maternal effects of 7.5 mg (1 ml) intrathecal 0.75% hyperbaric ropivacaine + 25 μg (0.5 ml) fentanyl versus 5 mg (l ml) intrathecal 0.5% hyperbaric bupivacaine + 25 μg (0.5 ml) fentanyl in elective cesarean delivery. Materials and Methods: The study included 40 ASA I-II cases scheduled for cesarean delivery that were randomized into two groups of 20 cases each. Cases in the RF group were administered 0.75% hyperbaric ropivacaine + 25 μg (0.5 ml) fentanyl and those in the BF group were administered 5 mg (l ml) hyperbaric bupivacaine + 25 μg (0.5 ml) fentanyl into the spinal space. The time until spinal anesthesia in the T4 dermatome, overall duration of analgesia, hemodynamic parameters, Apgar score of newborns at 1-5 min, fetal blood gas values (pH, PO2, PCO2, HCO3−, and BE), maternal side effects, the degree of motor block, maternal need for ephedrine, objective pain scale score, and patient satisfaction were recorded in each group. Results: There were no significant differences between the groups in terms of the parameters evaluated (P > 0.05). Conclusion: In elective cesarean delivery, the combinations of bupivacaine + fentanyl or ropivacaine + fentanyl exhibited similar anesthetic efficacy, and fetal and maternal effects.
Keywords: Bupivacaine, cesarean, opioid, ropivacaine.
http://www.njcponline.com/text.asp?2013/16/2/195/110154


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


PCA transdérmica en dolor agudo postoperatorio


PCA transdérmica en dolor agudo postoperatorio

Transdermal PCA in acute postoperative pain

Anesthesiology News March 2013

http://www.anesthesiologynews.com/download/SR1230_WM.pdf

Bibliotecas. Alerta



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Junot Díaz, finalista en premios de Bibliotecas Americanas
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El Gobierno premia a cinco bibliotecas de la provincia dentro del ...
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