Controversias en Ablactación y Desarrollo de Alergia a Alimentos

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

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

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



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

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

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


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

http://youtu.be/CjusYr10wOg

TRATAMIENTO CON PRP/ DR JORGE ROMO

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

http://youtu.be/p9_ROtoUbjM

Anesthetic implications of robotic gynecologic surgery

Implicaciones anestésicas de la cirugía ginecológica robótica


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

Abstract

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

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

Más dexmedetomidina/More dexmedetomidine

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


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




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

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



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

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


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



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

Fracturas Supracondíleas Humerales en Pacientes Pediátricos

Fracturas Supracondíleas Humerales en Pacientes Pediátricos

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

Dexmedetomidina espinal/Spinal dexmedetomidine

Eficacia de dexmedetomidina intratecal versus dexmedetomidina con fentanilo intratecales en pacientes con cirugía abdominal mayor por cáncer


Efficacy of intrathecally administered dexmedetomidine versus dexmedetomidine with fentanyl in patients undergoing major abdominal cancer surgery.
Mohamed AA, Fares KM, Mohamed SA.
Pain Physician. 2012 Jul-Aug;15(4):339-48.
Abstract
BACKGROUND: Most of the clinical experience gained in the use of intrathecal alpha-2- adrenoceptor agonists has been described with clonidine. Human studies using a combination of intrathecal dexmedetomidine and local anesthetics are lacking. OBJECTIVES: A safety investigation and comparison of the analgesic efficacy of intrathecally administered dexmedetomidine or dexmedetomidine combined with fentanyl in patients undergoing major abdominal cancer surgery. STUDY DESIGN: A randomized, double-blind trial.SETTING:
Academic medical center. METHODS: Ninety patients were randomly assigned to receive intrathecally either 10 mg bupivacaine 0.5% (control group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine (dexmedetomidine group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine and 25 μg fentanyl (dexmedetomidine= group, n = 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 24 hours. RESULTS: The mean intraoperative heart rate was significantly reduced in the dexmedetomidine group (P < 0.05) and the dexmedetomidine= group (P < 0.05) compared with the control group. Also, there was a significant reduction in mean intraoperative systolic and diastolic blood pressure in the dexmedetomidine group (P < 0.05) and the dexmedetomidine= group (P < 0.05) compared with the control group, with no significant differences in postoperative hemodynamics or sedation scores among all the study groups. The mean visual analog scale scores showed a significant reduction immediately and at 12 hours postoperatively in both the dexmedetomidine and dexmedetomidine= groups compared to the control group. The mean time of the first analgesic request was significantly prolonged in the dexmedetomidine group (3.30 ± 0.87 hours, P < 0.01) and the dexmedetomidine= group (5.41 ± 1.23 hours, P < 0.01) compared with the control group (0.23 ± 0.11 hours). Moreover, postoperative tramadol consumption was significantly reduced in the dexmedetomidine (142.85 ± 13.04 mg, P < 0.01) and the dexmedetomidine= (131.25 ± 11.96 mg, P < 0.01) groups, compared with the control group (310.0 ± 12.08 mg). No significant serious adverse effects were recorded during the study. LIMITATIONS: This study is limited by its sample size. CONCLUSION: Dexmedetomidine 5 μg given intrathecally improves the quality and the duration of postoperative analgesia and also provides an analgesic sparing effect in patients undergoing major abdominal cancer surgery. Furthermore, the addition of intrathecal fentanyl 25 μg has no valuable clinical effect.
http://www.painphysicianjournal.com/2012/august/2012;15;339-348.pdf




Estudio comparativo de dexmedetomidina y fentanilo intratecales como adyuvantes de bupivacaína
A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine.
Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK.
Department of Anaesthesia, Chhatrapati Shahuji Maharaj Medical University, Uttar Pradesh, Lucknow, India.
J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):339-43. doi: 10.4103/0970-9185.83678.
Abstract
BACKGROUND: Various adjuvants have been used with local anesthetics in spinal anesthesia to avoid intraoperative visceral and somatic pain and to provide prolonged postoperative analgesia. Dexmedetomidine, the new highly selective α2-agonist drug, is now being used as a neuraxial adjuvant. The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of dexmedetomidine or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine. MATERIALS AND METHODS: Sixty patients classified in American Society of Anesthesiologists classes I and II scheduled for lower abdominal surgeries were studied. Patients were randomly allocated to receive either 12.5 mg hyperbaric bupivacaine plus 5 μg dexmedetomidine (group D, n = 30) or 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl (group F, n = 30) intrathecal. RESULTS: Patients in dexmedetomidine group (D) had a significantly longer sensory and motor block time than patients in fentanyl group (F). The mean time of sensory regression to S1 was 476±23 min in group D and 187±12 min in group F (P<0.001). The regression time of motor block to reach modified Bromage 0 was 421±21 min in group D and 149±18 min in group F (P<0.001). CONCLUSIONS: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability, and reduced demand for rescue analgesics in 24 h as compared to fentanyl.
KEYWORDS: Bupivacaine, dexmedetomidine, fentanyl, spinal anaesthesia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161458/



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

Bibliotecas. Alerta

La Biblioteca 'Mariano de Pano' recoge 600 kilos de alimentos
Europa Press
Esta recolecta es el resultado de la iniciativa que emprendió hace poco más de seis meses la Obra Social y Cultural de Caja Inmaculada y que consiste en eliminar las sanciones por demora en la devolución del material de la biblioteca, a cambio de que ...
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La Biblioteca Foral expone 'Bizkaia desbordada' con motivo del ...
Europa Press
La Biblioteca Foral expondrá 'Bizkaia desbordada' por el treinta aniversario de las inundaciones de agosto 1983. La exposición mostrará en la sala Noble una selección de más de dos centenares de imágenes de unas de las inundaciones más graves de la ...
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Primera biblioteca asistida con energía solar de Chile, gracias a la ...
ECOticias.com
Los paneles solares instalados en el techo de la biblioteca proveerán de energía eléctrica para los diferentes usos dentro del lugar. El proyecto solar producirá aproximadamente 2.200 KWh/año de energía limpia y renovable proveniente del sol, la cual ...
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Biblioteca rodante recorrerá SLRC
El Imparcial.com
Comentarios. SAN LUIS RÍO COLORADO, Sonora(PH) Como parte de las actividades de fomento a la lectura que está realizando el Centro Cultural Héctor Chávez Fontes, llegará a San Luis Río Colorado, laBiblioteca Rodante; informó Mildret Ángel Avalos.
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Biblioteca Popular “Francisco Hernández López Jordán”
Diario El Argentino
Biblioteca Popular “Francisco Hernández López Jordán”. Cartelera cultural de julio 23/7: Velada Infantil. Hora 16: ¡Ya llegan! ¡Ya están! El mago Baiuka e Ivana /trayendo alegría y magia /con su gracia particular. Vení a divertirte con tus papis y tus ...
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Biblioteca Pública - El negocio de los "Niños futbolistas", una ...
RTVE
Biblioteca Pública - El negocio de los "Niños futbolistas", una investigación de Juan Pablo Meneses, en "Un idioma sin fronteras". 22 jul 2013. El fútbol o la droga son dos de las escasas posibilidades que tienen muchos niños latinoamericanos para ...
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Caso 'Biblioteca': imputado el secretario interventor del ...
Vega Media Press
Tras conocer a través de varios medios de comunicación regionales la imputación del Secretario Interventor del Ayuntamiento de Librilla por parte del Juez Instructor del Caso Biblioteca, el cual afirma que “su responsabilidad nace precisamente por no ...
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Incendio en la biblioteca municipal
Sin Mordaza
Vale la pena mencionar que algunos meses atrás el edificio había sido atacado mediante pintadas que censuraban el nombre que designa a la biblioteca. Las fuerzas policiales se encuentran investigando la posible relación entre ambos hechos.
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Biblioteca de verano: poemas de verano
SER Madrid Sur noticias
Biblioteca de verano: poemas de verano. La poesía es uno de los géneros literarios que mejor permite expresar (y compartir) los sentimientos más íntimos del ser humano, sentimientos que en verano tenemos a flor de piel y que el poeta Santiago Gómez ...
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La biblioteca de imagenes no funciona correctamente - Comunidad ...
hola!! porfavor necesito ayuda un problema q tngo les explico: cuando abro mi equipo y al ir a imagenes dice el siguiente mensaje: "pictures.library-ms.dejo de ...
answers.microsoft.com/.../34a31b85-62e9-4bc2-9772-8735e4...
Novelas Rojas: Biblioteca R-Z
Biblioteca R-Z. La cuenta de la biblioteca R-Z ha sido temporalmente bloqueada. .. No tengo idea si será activada pronto, así que en caso que de aquí a ...
novelas-rojas.blogspot.com/2013/07/biblioteca-r-z.html

Bibliotecas. Alerta

Biblioteca en honor al Comandante Supremo Hugo Chávez es ...
Venezolana de Televisión
Caracas, 21 de julio de 2013 (VTV).- “Estamos inaugurando una biblioteca para los trabajadores, para el conocimiento, para el saber de nuestros hijos, un homenaje al Comandante Supremo de esta Revolución por habernos abierto a nosotros la ...
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Cine, biblioteca y spa antes de subir al avión
Lanacion.com (Argentina)
Entre los resultados del estudio publicado por Skyscanner, el portal de búsquedas de vuelo europeo, los pasajeros también esperan encontrar entre las puertas de embarque cabinas para dormir,biblioteca, parque, áreas de estética y peluquería (sobre ...
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La directora de la Biblioteca Nacional, Ana Santos, pregonará el ...
El Norte de Castilla
La directora general de la Biblioteca Nacional, Ana Santos, será la pregonera de la Fiesta del Sinodal de Aguilafuente, que cada año conmemora la edición del primer libro impreso en España, encargado por el obispo Arias Dávila a Juan Parix. Así ha ...
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Devuelve un libro a la biblioteca después de 41 años porque «lee ...
ABC.es
Una cantidad simbólica, según el director de la biblioteca, quien se lamenta de que «cuando los usuarios no devuelven los libros nos vemos obligados a reponerlos». Estima que la multa por esta devolución tan tardía podría ascender a más de 280.000 ...
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Vuelven cantina la Biblioteca
El Meridiano de Córdoba
Según las versiones, la Biblioteca al llegar la madrugada parece un bar y no un centro de aprendizaje después de que los establecimientos públicos cierran. Nidia Suárez, quien ha sido testigo de las parrandas que se arman en los alrededores del lugar, ...
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La biblioteca pública ofrece talleres y cuentacuentos
El Periódico Extremadura
La biblioteca pública de Cáceres continúa con las actividades estivales dirigidas al público infantil, combinando cuentacuentos y talleres de creación artística. El martes, día 23, se celebrará un nuevo taller de modelado 'Jumping Clay' que en esta ...
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Trabajadores de Sintracerliv inauguraron biblioteca en honor a ...
El Nacional.com
El presidente del Sindicato Nacional de Trabajadores Cerveceros, Refresqueros y Vinícolas (Sintracerliv) y titular del Sindicato de Trabajadores de Empresas Polar, Frank Quijada, inauguró, junto a sus compañeros de labores, una biblioteca en honor al ...
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Sony permitirá acceder en cualquier PS4 a los juegos de nuestra ...
La Razón
Sony acaba de pronunciarse en referencia a la accesibilidad de la biblioteca de su futura videoconsola, PlayStation 4, y sobre la posibilidad de acceder a los títulos descargados en la plataforma desde cualquier máquina. 'Play As You Download' -juega ...
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Tianguis de artesanías en la Biblioteca Municipal Aries 67
El Sol del Istmo
Guillermina Flores García, líder de los artesanos que venden cada mes sus productos en el patio de laBiblioteca Municipal, se tuvieron que organizar para conseguir un espacio, ya que se les hace muy difícil andar individualmente por las calles vendiendo.
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Rastreando el tiempo
El Nacional.com
780x506 Transfomarción de la antigua estación de ferrocarril de Michigan, en Detroit, desde 1993 hasta 2001 | Camilo José Vergara; 780x506 Edificio de la antigua biblioteca pública de Camden, Nueva Jersey, captado por Vergara en 1992 | Camilo José ...
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Formación de Usuarios en la Biblioteca Escolar - Maestros ...
Los usuarios, son la razón de ser de toda biblioteca, especialmente la escolar; ya que sin éstos este lugar, espacio y/o programa, no tendría sentido alguno.
bibliotcaescolarpr.blogspot.com/.../formacion-de-usuarios-en-l...
¿Biblioteca del congreso bs as? - Yahoo! Respuestas
HOla!! ALguien sabe si la biblioteca del congreso está abierta los sábados por la noche hasta muuuy tarde? Necesito estar lejos de mi casa esta noche y no se ...
espanol.answers.yahoo.com/question/index?qid...
Se concreta traslado de biblioteca con el esfuerzo de trabajadores y ...
“Se trata de un viejo anhelo de construir la biblioteca central en el campus de Tandil y finalmente hemos finalizado la obra civil, se pudo adquirir el ...
www.unicen.edu.ar/.../se-concreta-traslado-de-biblioteca-con-e...
aplicacion para una tarjeta de la biblioteca del condado de forsyth
Llene este formulario y presente su identificación actual para comprobar su dirección e identidad. Puede ser la licencia de conducir de Carolina del Norte o la ...
www.forsyth.cc/library/.../LibraryApp_Kids4to17_Spanish.pd...
Un chelo en la biblioteca | RAE Informa
Hoy ha seguido el rodaje del vídeo institucional de la RAE, que servirá de presentación del futuro portal corporativo. La grabación musical, a cargo del ...
www.raeinforma.com/raeinforma/un-chelo-en-la-biblioteca/

Más de dolor crónico postoperatorio/Postoperative chronic pain

Transición de dolor agudo a dolor crónico postoperatorio: factores de riesgo y factores protectores


Transition from acute to chronic postsurgical pain: risk factors and protective factors.
Katz J, Seltzer Z.
Department of Psychology, York University, Toronto, ON, Canada.jkatz@yorku.ca
Expert Rev Neurother. 2009 May;9(5):723-44. doi: 10.1586/ern.09.20.
Abstract
Most patients who undergo surgery recover uneventfully and resume their normal daily activities within weeks. Nevertheless, chronic postsurgical pain develops in an alarming proportion of patients. The prevailing approach of focusing on established chronic pain implicitly assumes that information generated during the acute injury phase is not important to the subsequent development of chronic pain. However, a rarely appreciated fact is that every chronic pain was once acute. Here, we argue that a focus on the transition from acute to chronic pain may reveal important cues that will help us to predict who will go on to develop chronic pain and who will not. Unlike other injuries, surgery presents a unique set of circumstances in which the precise timing of the physical insult and ensuing pain are known in advance. This provides an opportunity, before surgery, to identify the risk factors and protective factors that predict the course of recovery. In this paper, the epidemiology of chronic postsurgical pain is reviewed. The surgical, psychosocial, socio-environmental and patient-related factors that appear to confer a greater risk of developing chronic postsurgical pain are described. The genetics of chronic postsurgical pain are discussed with emphasis on known polymorphisms in human genes associated with chronic pain, genetic studies of rodent models of pain involving surgical approaches, the importance of developing accurate human chronic postsurgical pain phenotypes and the expected gains for chronic postsurgical pain medicine in the post-genomic era. Evidence is then reviewed for a preventive multimodal analgesic approach to surgery. While there is some evidence that chronic postsurgical pain can be minimized or prevented by an analgesic approach involving aggressive perioperative multimodal treatment, other studies fail to show this benefit. The transition of acute postoperative pain to chronic postsurgical pain is a complex and poorly understood developmental process, involving biological, psychological and social-environmental factors.
http://www.expert-reviews.com/doi/pdf/10.1586/ern.09.20




Dolor crónico postoperatorio

Chronic post-surgical pain.
Akkaya T, Ozkan D.
1st. Department of Anesthesiology and Pain Unit, Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey.taylanakkaya@yahoo.com
Agri. 2009 Jan;21(1):1-9.
Abstract
Chronic postsurgical pain (CPSP) has lately become a neglected phenomenon. However, in recent years, investigations of the possible risk factors (type of surgery, preoperative pain, acute postoperative pain, and psychological and genetic factors) have also gained as much importance as the clinical problem. CPSP is not only observed following major surgery, but also following minor surgical procedures, such as hernia and vasectomy. Definitive data regarding the incidence of CPSP have not been obtained yet, since it is difficult to develop standard methods to resolve this difficult and complicated clinical picture. Many different medications, such as gabapentin, ketamine, venlafaxine, lidocaine, tramadol, and steroids have been tested in addition to multimodal analgesic techniques for the management of CPSP. Hence, preventive analgesia is a broader application of preemptive analgesia that includes any preoperative analgesic regimen able to control the sensitivity induced by pain.
http://www.journalagent.com/pubmed/linkout.asp?ISSN=1300-0012&PMID=19357994



Lesiones resultado de posiciones durante cirugía: incidencia y factores de riesgo


Injuries resulting from positioning for surgery: incidence and risk factors
Menezes S, Rodrigues R, Tranquada R, Müller S, Gama K, Manso T.
Serviço de Anestesiologia. Hospital Central do Funchal. Funchal. Portugal.
Acta Med Port. 2013 Jan-Feb;26(1):12-6. Epub 2013 Apr 24.
Abstract
Introduction: The appropriate surgical positioning is an essential step that is often underestimated, but must be considered, because can lead to serious but preventable injury. The objective of this study is to evaluate the incidence of injury due to surgical positioning, as well as try to identify their risk factors. Materials and Methods: Prospective study held for one year and included patients from different surgical specialties proposed for elective surgery. Patients were evaluated prior to surgery and exclusion criteria were: age < 18 years, American Society of Anesthesiologists - ASA score > III neuropathy or neuromuscular disease documented. Were considered injuries resulting from the positioning: erythema not reversible under digital pressure and/or persistent > 30 minutes, severe pain on pressure points and not related to the surgical site (Visual Analogue Scale - VAS = 7) and peripheral nerve injury. We evaluated the following variables: sex, age, Body Mass Index, ASA classification, anesthetic technique, type of positioning, duration of surgery and its relationship with postoperative injury. Results: Of the 172 patients included in the study, perioperative lesions were identified in 12.2%, but five of these patients had more than one lesion (pain on pressure point + neuropathy). About 9.9% complained of severe pain (Visual Analogue Scale - VAS = 7) on pressure points, 4.7% presented peripheral neuropathy and 0.6% had erythema that did not yield to the digital pressure. In the group that developed lesions, no significant difference with regard to age, sex, anesthetic technique, duration of surgery and positioning was found. Concerning to ASA classification, it was found that ASA II and III patients had a higher incidence of lesion (90.5%) compared with patients ASA I (9.5%), p < 0.05. The Body Mass Index > 30 Kg / m2 showed also statistically significant association with the development of postoperative injury, p < 0.001. In separate analysis of neuropathic injury was found that Body Mass Index > 30 Kg / m2 was associated with the occurrence of neuropathy, p < 0.05. Concerning the remaining variables and their relation with postoperative neuropathy, it wasn't found a statistically significant relationship. Conclusion: The scientific evidence for prevention of injuries in the perioperative period, including the neuropathy is limited. The postoperative evaluation of patients is essential because it allows early recognition of lesions and its documentation and guidance.
http://www.actamedicaportuguesa.com/revista/index.php/amp/article/

view/4006/3204



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

Colegio Mexicano de Ortopedia y Traumatología. Congreso Internacional Artroscopia y medicina del Fútbol, México 2013

http://www.teleformula.com.mx/notas.asp?Idn=336846
http://www.extremodeportivo.com/nacional/doctores-mejoraran-cuidado-a-futbolistas/

Con el aval de la FIFA y el apoyo de la Liga MX, doctores especialistas en lesiones y temas futbolísticos celebrarán un Congreso en septiembre próximo en Cancún, con la presencia de los médicos de los 18 equipos de Primera División, así como de Confederaciones como CONCACAF, UEFA y CONMEBOL......

CMO. Cong/Inter Artroscopia y medicina del Fútbol Promueve Liga MX especialización médica http://t.co/8JCV7nd1vn pic.twitter.com/KZBkwbqC8Q
— Victor Ravens (@bibliomanazteca) July 19, 2013

Más de burnout y anestesia/More on burnout and anesthesia

Síndrome de Burnout, una enfermedad de la posmodernidad.


Dra. Yusvisaret Palmer Morales
Anestesia en México 2009;21(1);23-25.
Resumen
El síndrome de Burnout, también llamado síndrome de agotamiento profesional o síndrome del hospital enfermo, es un síndrome debido al estrés crónico y sostenido que se presenta en el personal de la salud, que mantiene contacto estrecho con las personas. El médico anestesiólogo por las características de su especialidad, el alto grado de responsabilidad que tiene, las cargas de trabajo, los diferentes horarios, el constante estrés al que está sometido, es candidato a presentar el síndrome de Burnout, por lo que se hace necesario que el médico anestesiólogo conozca las diferentes fases que presenta el síndrome que son agotamiento emocional, cinismo y perdida del logro profesional, para que las pueda identificar, y solicitar apoyo en caso necesario.
Palabras calve: Síndrome de Burnout, síndrome de agotamiento profesional, anestesiólogos.
http://www.anestesiaenmexico.org/RAM9/RAM2009-21-1/006.pdf


Prevalencia del síndrome de Burnout en residentes y médicos de base de anestesiología del Hospital General de México
Dra. María de los Ángeles Garduño-Juárez
Revista Mexicana de Anestesiología Vol. 31. Supl. 1, Abril-Junio 2008 pp S259-S262
El presente trabajo de investigación se enfoca en determinar los factores que predisponen con mayor frecuencia y se asocian al síndrome de desgaste profesional, que en las últimas décadas ha tomado mayor relevancia en el ámbito laboral. Este síndrome representa pérdidas considerables tanto en el ámbito personal como en el profesional, los cuales se ven gravemente perjudicados.
http://www.medigraphic.com/pdfs/rma/cma-2008/cmas081bg.pdf


Haciendo un buen trabajo y conseguir algo bueno de ello: el estrés y el bienestar en la anesthesia.

Doing a good job and getting something good out of it: on stress and well-being in anaesthesia.
Larsson J, Sanner M.
Department of Public Health and Caring Sciences, University of Uppsala, Box 564, 751 22 Uppsala, Sweden. jan@trolin.net
Br J Anaesth. 2010 Jul;105(1):34-7. doi: 10.1093/bja/aeq125. Epub 2010 Jun 3.
Abstract
The anaesthetist's work, aimed at giving safe anaesthesia to patients, can do both harm and good to the anaesthetist. Research on stress in anaesthesia has traditionally focused on how the negative effects of stress can be avoided and much effort has been put into improving anaesthetists' work environment to reduce the level of stress. In this review, however, we give attention instead to what the individual anaesthetist can do to improve his or her well-being at work. Stress is, and will remain, an inevitable aspect of the anaesthetist's occupation but, as for any professional working in a stressful environment, adaptive coping can make a big difference in outcome. The choice between construing a difficult clinical situation as threat or challenge is important here because of the difference in the resulting stress response. The anaesthetist can reduce the stress effect of a potentially stressful situation by thinking of it in a new way, by redefining it through reappraisal. We describe here some lines of thought that experienced anaesthetists use to buffer the effects of work stress on physical health and mental well-being. By reframing a situation, they can reduce its stress content even if the problem at hand cannot be successfully solved. Trainee anaesthetists, who experience much stress at work and are at risk of burnout, would benefit from learning about these coping strategies.
http://bja.oxfordjournals.org/content/105/1/34.full.pdf





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

Sedación en UCI/ICU sedation

Optimizando el uso sostenido de sedación en paciente con ventilación mecánica: centrándose en la seguridad


Optimizing sustained use of sedation in mechanically ventilated patients: focus on safety.
Arnold HM, Hollands JM, Skrupky LP, Mice ST.
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
Curr Drug Saf. 2010 Jan;5(1):6-12.
Abstract
Optimizing sustained use of ICU sedation in mechanically ventilated patients requires careful consideration of drug-specific characteristics (E.G. pharmacokinetics), consideration of potential adverse effects in susceptible patients, and utilization of sedation-minimizing strategies. In the era of anxiolytic dosing protocols adjusted to specific patient behaviors as defined by sedation scales in conjunction with daily interruption, midazolam is a reasonable option for long-term sedation. Propofol is an appealing agent for ICU sedation due to it's pharmacokinetic profile and a reduced propensity to result in prolonged sedation. However, care should be taken to monitor for potential devastating adverse effects including hypertriglyceridemia and propofol-related infusion syndrome (PRIS). Dexmedetomidine unreliably provides adequate sedation at doses currently approved by the FDA, though upward titration of dexmedetomidine coupled with rescue benzodiazepines and/or fentanyl appears to be safe and comparable to benzodiazepines in the achievement of light to moderate Richmond Agitation Sedation Scale (RASS) goals. Clinicians should closely monitor patients receiving dexmedetomidine for hemodynamic-altering bradycardia. Strategies that promote frequent patient assessment with corresponding sedative dose minimization have demonstrated the benefits of limiting oversedation. Implementation of a sedation protocol requires careful consideration of ICU resources and staffing such that efforts made are sustainable and will be safe and effective for the patient population affected.


http://www.eurekaselect.com/70525/article


Dexmedetomidina vs midazolam para sedación en pacientes graves: estudio randomizado

Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial.
Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG; SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group. Collaborators (66)
Torres Boden M, Ceraso D, Raimondi A, Gonzalez M, Shehabi Y, Turner A, Ernest D, Dobb G, Dias F, Rocha M, Baruzzi A, da Silva I, Rezende E, Margolin G, Feldman J, Tillinghast J, Geller E, Singla N, Dexter J, Jones K, Tang J, Cheng E, Douglas I, Fulda G, Herr D, Anderson L, Kett D, Basile J, Silverboard H, Cowen J, Margolis B, Whitten P, Simpson S, Bradley J, Koura F, Conrad S, Shanholtz C, Kahn R, Riker R, Bekemeyer W, Simonds D, Morrow L, Littman J, Shander A, Cuibotaru R, Dicpinigaitis P, George L, Groth M, Carpati C, Kaufman D, Wilson J, Ordal J, Schoenhals J, Haupt M, Hoyt J, Flume P, Handshoe D, Pugazhenthi M, Ramsay M, Cardenas V, Minkowitz H, Fujii T, Baker A, Henderson S, Freebairn R, McHugh G.
University of Vermont College of Medicine, USA. rikerr@mmc.org
JAMA. 2009 Feb 4;301(5):489-99. doi: 10.1001/jama.2009.56. Epub 2009 Feb 2
Abstract
CONTEXT: Gamma-aminobutyric acid receptor agonist medications are the most commonly used sedatives for intensive care unit (ICU) patients, yet preliminary evidence indicates that the alpha(2) agonist dexmedetomidine may have distinct advantages. OBJECTIVE: To compare the efficacy and safety of prolonged sedation with dexmedetomidine vs midazolam for mechanically ventilated patients. DESIGN, SETTING, AND PATIENTS: Prospective, double-blind, randomized trial conducted in 68 centers in 5 countries between March 2005 and August 2007 among 375 medical/surgical ICU patients with expected mechanical ventilation for more than 24 hours. Sedation level and delirium were assessed using the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the ICU. INTERVENTIONS: Dexmedetomidine (0.2-1.4 microg/kg per hour [n = 244]) or midazolam (0.02-0.1 mg/kg per hour [n = 122]) titrated to achieve light sedation (RASS scores between -2 and +1) from enrollment until extubation or 30 days. MAIN OUTCOME MEASURES: Percentage of time within target RASS range. Secondary end points included prevalence and duration of delirium, use of fentanyl and open-label midazolam, and nursing assessments. Additional outcomes included duration of mechanical ventilation, ICU length of stay, and adverse events. RESULTS: There was no difference in percentage of time within the target RASS range (77.3% for dexmedetomidine group vs 75.1% for midazolam group; difference, 2.2% [95% confidence interval {CI}, -3.2% to 7.5%]; P = .18). The prevalence of delirium during treatment was 54% (n = 132/244) in dexmedetomidine-treated patients vs 76.6% (n = 93/122) in midazolam-treated patients (difference, 22.6% [95% CI, 14% to 33%]; P < .001). Median time to extubation was 1.9 days shorter in dexmedetomidine-treated patients (3.7 days [95% CI, 3.1 to 4.0] vs 5.6 days [95% CI, 4.6 to 5.9]; P = .01), and ICU length of stay was similar (5.9 days [95% CI, 5.7 to 7.0] vs 7.6 days [95% CI, 6.7 to 8.6]; P = .24). Dexmedetomidine-treated patients were more likely to develop bradycardia (42.2% [103/244] vs 18.9% [23/122]; P < .001), with a nonsignificant increase in the proportion requiring treatment (4.9% [12/244] vs 0.8% [1/122]; P = .07), but had a lower likelihood of tachycardia (25.4% [62/244] vs 44.3% [54/122]; P < .001) or hypertension requiring treatment (18.9% [46/244] vs 29.5% [36/122]; P = .02). CONCLUSIONS: There was no difference between dexmedetomidine and midazolam in time at targeted sedation level in mechanically ventilated ICU patients. At comparable sedation levels, dexmedetomidine-treated patients spent less time on the ventilator, experienced less delirium, and developed less tachycardia and hypertension. The most notable adverse effect of dexmedetomidine was bradycardia.
http://jama.jamanetwork.com/article.aspx?articleid=183300




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

Enfermedad por Reflujo en niños mayores y adolescentes

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 24 de Julio 2013 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia:“Enfermedad por Reflujo en niños mayores y adolescentes” por el “Dr. José Luis Martínez Orozco“ Gastroenterólogo Pediatra, de la Cd de Fresno Ca USA. La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador

http://connectpro60196372.adobeconnect.com/r3s5shk4vm8/

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


Henrys


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

Bibliotecas. Alerta

Biblioteca Ayacucho presentará novedad literaria en el Congreso ...
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Mis Vacaciones en la Biblioteca llega a Vicente Guerrero
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Vampire Academy Spain: La Biblioteca de St. Vladimir
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Un impresionante dominó hecho con libros en la biblioteca de Seattle
Hoy os traigo un vídeo de esos que sé que os gustan, y es que no es para menos. Se trata de una iniciativa de la Seattle Public Library, que ha t...
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[Burgos] V ANIVERSARIO Biblioteca Anarquista La Maldita ...
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