Obesidad / Imagen del mes/Image of the month

La obesidad es un tema muy importante en salud pública, y se ha convertido en un patógeno significativo en todo el mundo, primordialmente en las zonas desarrolladas. Afecta a todas las edades, y en los niños y adolescentes es particularmente importante establecer medidas de prevención. En 2008 se estimó que había 502 millones de personas obesas en el mundo, y la OMS menciona que para esta década serán 700 millones de obesos en todo el mundo.  La obesidad se acompaña de múltiples enfermedades comunes con resultados letales, siendo la muerte prematura y la calidad de vida dos temas de capital importancia. El manejo del obeso mórbido grave es muy complejo y las Unidades de Cuidado Intensivo se enfrentan a este reto con frecuencia creciente. Se envían algunas imágenes y artículos sobre este apasionante tema. Obesity is a major public health issue, that has become a significant pathogen worldwide, primarily in developed areas. It affects all ages, and in children and adolescents is particularly important to establish preventive measures. In 2008 it was estimated that there were 502 million obese people in the world, and WHO says that this decade will be 700 million obese worldwide. Obesity is associated with many common diseases with lethal results, being premature death and quality of life two issues of paramount importance. The management of severe morbid obesity is very complex and Intensive Care Units are facing this challenge with increasing frequency. Some images and articles on this fascinating subject are sent. Incremento de los servicios de salud por los pacientes obesos sometidos a cirugía de urgencia. Estudio retrospectivo Increased health services use by severely obese patients undergoing emergency surgery: a retrospective cohort study. Küpper S, Karvellas CJ, Khadaroo RG, Widder SL; Acute Care and Emergency Surgery (ACES) Group. Can J Surg. 2015 Feb;58(1):41-7. doi: 10.1503/cjs.003914. PDF El efecto de la obesidad sobre la evolución en pacientes con ventilación mecánica en una unidad de cuidados intensivos médicos. The effect of obesity on outcomes in mechanically ventilated patients in a medical intensive care unit.  Lee CK, Tefera E, Colice G. Respiration. 2014;87(3):219-26. doi: 10.1159/000357317. Epub 2014 Jan 23. PDF El paciente obeso en terapia intensiva Carlos Lovesio Libro Virtual Intramed PDF Síndrome de obesidad e hipoventilación en terapia intensiva Eduardo Borsini, Florencia Ballestero , Miguel Blasco, Sebastián Chapela , Emiliano Descotte , Florencia Lascar , Julio Chertcoff Revista Americana de Medicina Respiratoria Vol 14 Nº 4 - Diciembre 2014 PDF Papel de la endoscopía en los pacientes bariátricos quirúrgicos Role of endoscopy in the bariatric surgery of patients. De Palma GD, Forestieri P. World J Gastroenterol. 2014 Jun 28;20(24):7777-84. doi: 10.3748/wjg.v20.i24.7777. PDF Reducción significativa de eventos hipóxicos en pacientes con obesidad mórbida sometidos a endoscopia digestiva: predictores y efecto de la práctica. Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect. Goudra BG, Singh PM, Penugonda LC, Speck RM, Sinha AC. J Anaesthesiol Clin Pharmacol. 2014 Jan;30(1):71-7. doi: 10.4103/0970-9185.125707. PDF Manejo de sospecha de fuga anastomótica después de bypass gástrico en Y de Roux Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Jacobsen HJ, Nergard BJ, Leifsson BG, Frederiksen SG, Agajahni E, Ekelund M, Hedenbro J, Gislason H. Br J Surg. 2014 Mar;101(4):417-23. doi: 10.1002/bjs.9388. PDF Ventilación protectiva perioperatoria en obesos Perioperative lung protective ventilation in obese patients. Fernandez-Bustamante A, Hashimoto S, Serpa Neto A, Moine P, Vidal Melo MF, Repine JE. BMC Anesthesiol. 2015 Apr 25;15(1):56. [Epub ahead of print] PDF Restricción respiratoria y presiones pleural y esofágicas elevadas en la obesidad mórbida Respiratory restriction and elevated pleural and esophageal pressures in morbid obesity. Behazin N1, Jones SB, Cohen RI, Loring SH. J Appl Physiol (1985). 2010 Jan;108(1):212-8. doi: 10.1152/japplphysiol.91356.2008. Epub 2009 Nov 12. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Libros sobre obesidad/Books on obesity

Obesidad infantil Childhood Obesity Edited by Sevil Ari Yuca, ISBN 978-953-51-0374-5, 248 pages, Publisher: InTech, Chapters published March 28, 2012 under CC BY 3.0 license DOI: 10.5772/1151 This book aims to provide readers with a general as well as an advanced overview of the key trends in childhood obesity. Obesity is an illness that occurs due to a combination of genetic, environmental, psychosocial, metabolic and hormonal factors. The prevalence of obesity has shown a great rise both in adults and children in the last 30 years. It is known that one third of children who are obese in childhood and 80% of adolescents who are obese in their adolescent years continue to be obese later in life. Obesity is an important risk factor in serious illnesses such as heart disease, hyperlipidemia, hyperinsulinemia, hypertension and early atherosclerosis. Libro/Book Cirugía bariátrica y metabólica avanzada Advanced Bariatric and Metabolic Surgery Edited by Chih-Kun Huang, ISBN 978-953-307-926-4, 336 pages, Publisher: InTech, Chapters published February 29, 2012 under CC BY 3.0 license DOI: 10.5772/1066 Bariatric surgery has gained importance in the last 20 years because of the high prevalence of global obesity, and the vast understating of the physiological and pathological aspects of obesity and associated metabolic syndromes. This book has been written by a number of highly outstanding authors and pioneering bariatric surgeons from all over the world. The intended audience for this book includes all medical professionals involved in caring for bariatric patients. The chapters cover the choice of operation, preoperative preparation including psychological aspect, postoperative care and management of complication. It also extends to concept and result of metabolic surgery and scarless bariatric surgery. Libro/Book  Fundamentos y controversias en cirugía bariátrica Essentials and Controversies in Bariatric Surgery Edited by Chih-Kun Huang, ISBN 978-953-51-1726-1, 152 pages, Publisher: InTech, Chapters published October 01, 2014 under CC BY 3.0 license DOI: 10.5772/57007 Bariatric surgery has been proved to be clinically effective and economically viable for obese people when compared to non-surgical interventions. Advancement of minimally invasive surgery in the last 20 years has made the safety and reliability widely accepted by the public and government systems. Bariatric surgery not only proves its efficacy in marked long-term weight loss, but also aids in achieving substantial improvement or remission of co-morbidities. In this book, we review the fundamental knowledge of bariatric surgery, including preoperative nutrition, selection, and surgical complication. In the second part, new emerging and novel procedures are thoroughly described and discussed. Unquestionably, this book will offer you essentials as well as the latest concepts of bariatric and metabolic surgery. Libro/Book

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Medwave. Hemos completado la edición correspondiente al mes de Abril 2015, los artículos incluídos son los siguientes

Hemos completado la edición correspondiente al mes de Abril 2015, los artículos incluídos son los siguientes.


EDITORIAL

La evidencia y la región - ¿conversan o colisionan?
Vivienne C. Bachelet

Medwave 2015 Abr;15(3):e6127
http://dx.doi.org/10.5867/medwave.2015.03.6127


ESTUDIOS PRIMARIOS

Estudio de asociación familiar entre las alteraciones de los potenciales evocados N200/P300 y el fenotipo clínico en familias cubanas con esquizofrenia paranoide
Seidel Guerra López, Migdyrai Martín Reyes, maría de los Ángeles Pedroso Rodríguez, Adnelys Reyes Berazain, Raúl Mendoza Quiñones, Tania Martha Bravo Collazo, Thais Días de Villarvilla, María Julia Machado Cano, María Antonieta Bobés León (Multinacional)

Medwave 2015 Abr;15(3):e6112
http://dx.doi.org/10.5867/medwave.2015.03.6112


Estudio transversal sobre tabaquismo y su relación con valores espirométricos en estudiantes de tercer año de medicina
Victor Hugo Fernández, Mariela Edith Beligoy, Yessica Vanesa Lima, Pablo Federico Barissi (Argentina)

Medwave 2015 Abr;15(3):e6124
http://dx.doi.org/10.5867/medwave.2015.03.6124


REVISIÓN CLÍNICA

Terapia de reemplazo con testosterona y cáncer de próstata: ¿la caída de un paradigma?
Octavio A. Castillo, Gastón López-Fontana, Ivar Vidal-Mora, José Daniel López Laur (Chile, Argentina)

Medwave 2015 Abr;15(3):e6115
http://dx.doi.org/10.5867/medwave.2015.03.6115


ARTÍCULO DE REVISIÓN

Plantas latinoamericanas como fuente de nuevos antineoplásicos, situación actual y nuevas oportunidades contra el cáncer
Eduardo Freddy Orrego Escobar (Chile)

Medwave 2015 Abr;15(3):e6121
http://dx.doi.org/10.5867/medwave.2015.03.6121


RESUMENES EPISTEMONIKOS

¿La aspirina reduce la recurrencia de eventos tromboembólicos idiopáticos después de completado el tratamiento anticoagulante?
Andrés Valenzuela, Andrés Aizman (Chile)

Medwave 2015 Abr;15(3):e6118
http://dx.doi.org/10.5867/medwave.2015.03.6118


¿Debe indicarse acetilcisteína para prevenir la nefropatía por contraste?
Ariel Izcovich, Gabriel Rada (Argentina, Chile)

Medwave 2015 Abr;15(3):e6122
http://dx.doi.org/10.5867/medwave.2015.03.6122


¿Es beneficiosa la profilaxis antibiótica en la pancreatitis aguda? - Primera actualización
Gabriel Rada, José Peña (Chile)
Medwave 2015 Abr;15(3):e6125
http://dx.doi.org/10.5867/medwave.2015.03.6125


¿Tienen un rol los digitálicos en la insuficiencia cardíaca crónica?
Carmen Rain, Gabriel Rada (Chile)

Medwave 2015 Abr;15(3):e6129
http://dx.doi.org/10.5867/medwave.2015.03.6129


PORTADA MEDWAVE
http://www.medwa

Obesidad y embarazo

IMC pre-embarazo y mortalidad por enfermedad cardiovascular. Estudios para el desarrollo y la salud del niño. Prepregnancy body mass index and cardiovascular disease mortality: the Child Health and Development Studies. Mongraw-Chaffin ML1, Anderson CA, Clark JM, Bennett WL. Obesity (Silver Spring). 2014 Apr;22(4):1149-56. doi: 10.1002/oby.20633. Epub 2013 Dec 4. PDF Efectos del IMC materno sobre las concentraciones de eritropoyetina en el cordón umbilical Effect of maternal body mass index on cord blood erthropoietin concentrations Barak S, Mimouni FB, Stern R, Cohen N, Marom R. J Perinatol. 2015 Jan;35(1):29-31. doi: 10.1038/jp.2014.140. Epub 2014 Aug 7. PDF Nutrición y embarazo después de cirugía bariátrica Nutrition and pregnancy after bariatric surgery. Kaska L, Kobiela J, Abacjew-Chmylko A, Chmylko L, Wojanowska-Pindel M, Kobiela P, Walerzak A, Makarewicz W, Proczko-Markuszewska M,Stefaniak T. ISRN Obes. 2013 Jan 30;2013:492060. doi: 10.1155/2013/492060. eCollection 2013. PDF Diagnóstico de obesidad materna y riesgo de parálisis cerebral en el niño Maternal diagnosis of obesity and risk of cerebral palsy in the child. Crisham Janik MD, Newman TB, Cheng YW, Xing G, Gilbert WM, Wu YW. J Pediatr. 2013 Nov;163(5):1307-12. doi: 10.1016/j.jpeds.2013.06.062. Epub 2013 Aug 6. PDF Superobesidad materna y evolución perinatal Maternal superobesity and perinatal outcomes. Marshall NE, Guild C, Cheng YW, Caughey AB, Halloran DR. Am J Obstet Gynecol. 2012 May;206(5):417.e1-6. doi: 10.1016/j.ajog.2012.02.037. Epub 2012 Mar 7. PDF Intervenciones para reducir y prevenir la obesidad en mujeres antes de la concepción y embarazadas. Revisión sistemática y meta-análisis Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: a systematic review and meta-analysis. Agha M, Agha RA, Sandell J. PLoS One. 2014 May 14;9(5):e95132. doi: 10.1371/journal.pone.0095132. eCollection 2014. PDF Efectos del bypass gástrico sobre la función reproductiva Effects of gastric bypass surgery on female reproductive function. Legro RS1, Dodson WC, Gnatuk CL, Estes SJ, Kunselman AR, Meadows JW, Kesner JS, Krieg EF Jr, Rogers AM, Haluck RS, Cooney RN. J Clin Endocrinol Metab. 2012 Dec;97(12):4540-8. doi: 10.1210/jc.2012-2205. Epub 2012 Oct 12. PDF

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Ictericia y rechazo al pecho dos causas de destete incorrecto

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 6 de Mayo 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Ictericia y rechazo al pecho dos causas de destete incorrecto” por el “Dr. José María Paricio Talayero”, Pediatra de España. 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/ictercia_rechazo/

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
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Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx

mas sobre embarazo, obesidad y anestesia.

Obesidad y embarazo: implicancias anestésicas Claudio Nazar J, Javier Bastidas E, Maximiliano Zamora H, Héctor J. Lacassie. REV CHIL OBSTET GINECOL 2014; 79(6): 537 - 545 PDF Colocación de catéteres epidurales en parturientas obesas con el uso de una ecuación de la profundidad epidural antes de vizualización con ultrasonido Epidural catheter placement in morbidly obese parturients with the use of an epidural depth equation prior to ultrasound visualization. Singh S1, Wirth KM, Phelps AL, Badve MH, Shah TH, Sah N, Vallejo MC. ScientificWorldJournal. 2013 Jul 25;2013:695209. doi: 10.1155/2013/695209. eCollection 2013. PDF  Raquia para cesárea urgente en un obesa mórbida con eclampsia severa Spinal anaesthesia for emergency caesarean section in a morbid obese woman with severe preeclampsia. Longinus EN, Benjamin L, Omiepirisa BY. Case Rep Anesthesiol. 2012;2012:586235. doi: 10.1155/2012/586235. Epub 2012 Oct 14 PDF Retos anestésicos y obstétricos en obesidad mórbida y parto por cesárea. Estudio en el sureste Nigeriano Anaesthetic and obstetric challenges of morbid obesity in caesarean deliveries--a study in South-eastern Nigeria. Okafor UV, Efetie ER, Nwoke O, Okezie O, Umeh U. Afr Health Sci. 2012 Mar;12(1):54-7 PDF Cesárea en la obesa mórbida. Implicaciones prácticas y complicaciones Cesarean section in morbidly obese parturients: practical implications and complications. Machado LS. N Am J Med Sci. 2012 Jan;4(1):13-8. doi: 10.4103/1947-2714.92895. PDF Comparación aleatorizada controlada entre anestesia combinada epidural-espinal y raquia simple en embarazadas con obesidad mórbida. Tiempo para el inicio de la anestesia A randomized controlled comparison between combined spinal-epidural and single-shot spinal techniques in morbidly obese parturients undergoing cesarean delivery: time for initiation of anesthesia. Ross VH, Dean LS, Thomas JA, Harris LC, Pan PH. Anesth Analg. 2014 Jan;118(1):168-72. doi: 10.1213/ANE.0000000000000022. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Embarazo, obesidad y anestesia/Pregnancy, obesity and anaesthesia

No.1961                                                                                   Mayo 4, 2015

¿Es la investigación ultrasónica del diámetro transverso traqueal razonable para la evaluación de vía aérea difícil en la embarazada? Estudio prospectivo comparativo. Is ultrasonic investigation of transverse tracheal air shadow diameter reasonable for evaluation of difficult airwayin pregnant women: A prospective comparative study. Turkay Aydogmus M1, Erkalp K2, Nadir Sinikoglu S3, Usta TA4, O Ulger G5, Alagol A6. Pak J Med Sci. 2014 Jan;30(1):91-5. doi: 10.12669/pjms.301.3972. Abstract OBJECTIVE: The aim of this study was to compare clinical screening tests (modified Mallampati score, Cormack-Lehane score, thyromental distance, and sternomental distance) with ultrasonic measurements of the upper airway in predicting difficult intubation in pregnant women whose Body Mass Index (BMI) is higher and lower than 30 kg m-2. METHODS: This study was designed as a prospective observational trial, and consisted of 40 pregnant women of American Society of Anesthesiologists (ASA) 1-2 groups. Patients with a BMI lower than 30 kg m-2 were included in Group 1 (n=20), and patients with a BMI higher than 30 kg m-2 were included in Group 2 (n=20). In the supine position with head in mild extension, the diameter of the transverse tracheal air shadow in the subglottic area of the front neck was measured using ultrasonography. Modified Mallampati score, Cormack-Lehane score, thyromental distance and sternomental distance measurements were recorded. RESULTS: No statistically significant difference was detected between groups regarding mean age, mean number of pregnancy, ASA scores and comorbid disease. Mean body weight (p=0.0001) and mean pre-pregnancy weight (p=0.0001) were significantly higher in Group 2. There was no statistically significant difference between groups regarding mean modified Mallampati score, thyromental distance, sternomental distance measurements, Cormack-Lehane score, and mean ultrasonic measurements. CONCLUSION: It was found that BMI higher or lower than 30 kg m-2 has no effect on ultrasonic measurements and clinical airway tests. We thought that ultrasonic measurement could not give us valuable information in obese or non-obese pregnant women. KEYWORDS: Pregnancy; airway evaluation; body mass index; diameter of transverse tracheal air shadow; obesity; ultrasonography PDF Consideraciones anestésicas en parturientas con obesidad y apnea obstructiva del sueño Anesthetic considerations of parturients with obesity and obstructive sleep apnea. Ankichetty SP1, Angle P, Joselyn AS, Chinnappa V, Halpern S. J Anaesthesiol Clin Pharmacol. 2012 Oct;28(4):436-43. doi: 10.4103/0970-9185.101895. Abstract Obstructive sleep apnea (OSA) is characterized by upper airway collapse and obstruction during sleep. It is estimated to affect nearly 5% of the general female population. Obesity is often associated with OSA. The physiological changes associated with pregnancy may increase the severity of OSA with a higher risk of maternal and fetal morbidity. However, very few parturients are diagnosed during pregnancy. These undiagnosed parturients pose great challenge to the attending anaesthesiologist during the perioperative period. Parturients at risk should be screened for OSA, and if diagnosed, treated. This review describes the anaesthetic concerns in obese parturients at risk for OSA presenting to the labor and delivery unit. KEYWORDS: Obesity; obstructive sleep apnea management; perioperative period; pregnancy PDF Parturientas con obesidad mórbida. Retos para el anestesiólogos, incluyendo el manejo de la vía aérea en obstetricia.¿Que hay de nuevo? Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new? Rao DP, Rao VA. Indian J Anaesth. 2010 Nov;54(6):508-21. doi: 10.4103/0019-5049.72639. Abstract The purpose of this article is to review the fundamental aspects of obesity, pregnancy and a combination of both. The scientific aim is to understand the physiological changes, pathological clinical presentations and application of technical skills and pharmacological knowledge on this unique clinical condition. The goal of this presentation is to define the difficult airway, highlight the main reasons for difficult or failed intubation and propose a practical approach to management Throughout the review, an important component is the necessity for team work between the anaesthesiologist and the obstetrician. Certain protocols are recommended to meet the anaesthetic challenges and finally concluding with "what is new?" in obstetric anaesthesia. KEYWORDS: Adipocyte; complications; difficult airway; morbidly obese; parturient; regional; team work PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Ketamina en Cesárea/Ketamine in C-section

No.1952                                                                                   Abril 25, 2015

Efecto de dosis bajas de ketamina sobre el dolor postoperatorio después de cesárea con raquia. Estudio clínico randomizado The effect of low-dose intravenous ketamine on postoperative pain following cesarean section with spinal anesthesia: a randomized clinical trial. Rahmanian M1, Leysi M1, Hemmati AA2, Mirmohammadkhani M3. Oman Med J. 2015 Jan;30(1):11-6. doi: 10.5001/omj.2015.03. Abstract OBJECTIVES: Low-dose ketamine has been considered a good substitute for opioids for controlling postoperative pain. The purpose of this study was to determine the effect of low-dose intravenous ketamine following cesarean section with spinal anesthesia on postoperative pain and its potential complications. METHODS: One hundred and sixty pregnant women volunteered to participate in this randomized controlled trial. Participants were randomly divided into two groups (n=80 for each group). Five minutes after delivery, the experimental group received 0.25mg/kg ketamine while the control group received the same amount of normal saline. RESULTS: There was a significant difference between the two groups in the severity of pain at one, two, six, and 12 hours following surgery. Postoperative pain was significantly less severe in the experimental group. Compared to the control group, the experimental group felt pain less frequently and therefore asked for analgesics less often. On average, the number of doses of analgesics used for the participants in the experimental group was significantly less than the number of doses used for the control group. Analgesic side effects (including nausea, itching, and headache) were not significantly different between the two groups. However, vomiting was significantly more prevalent in the control group and hallucination was more common in the experimental group. CONCLUSION: We conclude that administration of low doses of ketamine after spinal anesthesia reduces the need for analgesics and has fewer side effects than using opioids. Further studies are required to determine the proper dose of ketamine which offers maximum analgesic effect. Furthermore, administration of low-dose ketamine in combination with other medications in order to minimize its side effects warrants further investigation. KEYWORDS: Anesthesia, Spinal; Cesarean Section; Ketamine; Pain, Postoperative PDF  Efectos analgésicos de ketamina intravenosa durante raquia en embarazadas programadas para cesárea. Estudio clínico randomizado Analgesic Effects of Intravenous Ketamine during Spinal Anesthesia in Pregnant Women Undergone Caesarean Section; A Randomized Clinical Trial. Behdad S1, Hajiesmaeili MR, Abbasi HR, Ayatollahi V, Khadiv Z, Sedaghat A. Anesth Pain Med. 2013 Sep;3(2):230-3. doi: 10.5812/aapm.7034. Epub 2013 Sep 1. Abstract BACKGROUND: Suitable analgesia after cesarean section helps mothers to be more comfortable and increases their mobility and ability to take better care of their infants. OBJECTIVES: Pain relief properties of ketamine prescription were assessed in women with elective cesarean section who underwent spinal anesthesia with low dose intravenous ketamine and midazolam and intravenous midazolam alone. PATIENTS AND METHODS:Sixty pregnant women scheduled for spinal anesthesia for cesarean section were randomized into two study groups.Ketamine (30 mg) + midazolam (1 mg = 2CC) or 1mg midazolam (2CC) alone, was given immediately after spinal anesthesia. Pain scores at first, second and third hours after CS operation, analgesic requirement and drug adverse effects were recorded in all patients. RESULTS: Ketamine group had significant pain relief properties in compare with control group in first hours after cesarean section (0.78 ± 1.09 vs. 1.72 ± 1.22, VAS score, P = 0.00). Total dose of meperidine consumption in women of ketamine group was significantly lower than women of control group (54.17 ± 12.86 vs. 74.44 ± 33.82 mg, P = 0.02). There were no significant drug side effects in participated patients. CONCLUSIONS: Intravenous low-dose ketamine combined with midazolam for sedation during spinal anesthesia for elective Caesarean sectionprovides more effective and long lasting pain relief than control group. KEYWORDS: Analgesia; Anesthesia, Spinal; Cesarean Section; Ketamine; Pain Clinics PDF Efectos de dosis bajas de ketamina en la analgesia post cesárea con anestesia subaracnoidea The Effect of Low-dose Ketamine on Post-caesarean Delivery Analgesia after Spinal Anesthesia. Han SY1, Jin HC, Yang WD, Lee JH, Cho SH, Chae WS, Lee JS, Kim YI. Korean J Pain. 2013 Jul;26(3):270-6. doi: 10.3344/kjp.2013.26.3.270. Epub 2013 Jul 1. Abstract BACKGROUND: Ketamine, an N-methyl-D-aspartate receptor antagonist, might play a role in postoperative analgesia, but its effect on postoperative pain after caesarean section varies with study design. We investigated whether the preemptive administration of low-dose intravenous ketamine decreases postoperative opioid requirement and postoperative pain in parturients receiving intravenous fentanyl with patient-controlled analgesia (PCA) following caesarean section. METHODS: Spinal anesthesia was performed in 40 parturients scheduled for elective caesarean section. Patients in the ketamine group received a 0.5 mg/kg ketamine bolus intravenously followed by 0.25 mg/kg/h continuous infusion during the operation. The control group received the same volume of normal saline. Immediately after surgery, the patients were connected to a PCA device set to deliver 25-µg fentanyl as an intravenousbolus with a 15-min lockout interval and no continuous dose. Postoperative pain was assessed using the cumulative dose of fentanyl and visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively. RESULTS: Significantly less fentanyl was used in the ketamine group 2 h after surgery (P = 0.033), but the difference was not significant at 6, 12, and 24 h postoperatively. No significant differences were observed between the VAS scores of the two groups at 2, 6, 12, and 24 h postoperatively. CONCLUSIONS: Intraoperative low-dose ketamine did not have a preemptive analgesic effect and was not effective as an adjuvant to decrease opioid requirement or postoperative pain score in parturients receiving intravenous PCA with fentanyl after caesarean section. KEYWORDS: caesarean delivery; ketamine; patient-controlled analgesia; preemptive analgesia; spinal anesthesia PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Medwave abril 2015

A continuación le informamos los artículos recientemente publicados en Medwave.


RESUMEN EPISTEMONIKOS

¿Es beneficiosa la profilaxis antibiótica en la pancreatitis aguda?: primera actualización
Gabriel Rada, José Peña (Chile)

Medwave 2015 Abr;15(3):e6125
http://dx.doi.org/10.5867/medwave.2015.03.6125


EDITORIAL
La evidencia y la región - ¿conversan o colisionan?
Vivienne C. Bachelet

Medwave 2015 Abr;15(3):e6127
http://dx.doi.org/10.5867/medwave.2015.03.6127


ESTUDIO PRIMARIO

Estudio transversal sobre tabaquismo y su relación con valores espirométricos en estudiantes de tercer año de medicina
Victor Hugo Fernández, Mariela Edith Beligoy, Yessica Vanesa Lima, Pablo Federico Barissi (Argentina)

Medwave 2015 Abr;15(3):e6124
http://dx.doi.org/10.5867/medwave.2015.03.6124


RESUMEN EPISTEMONIKOS

¿Debe indicarse acetilcisteína para prevenir la nefropatía por contraste?
Ariel Izcovich, Gabriel Rada (Argentina, Chile)

Medwave 2015 Abr;15(3):e6122
http://dx.doi.org/10.5867/medwave.2015.03.6122


ARTÍCULO DE REVISIÓN

Plantas latinoamericanas como fuente de nuevos antineoplásicos, situación actual y nuevas oportunidades contra el cáncer
Eduardo Freddy Orrego Escobar (Chile)

Medwave 2015 Abr;15(3):e6121
http://dx.doi.org/10.5867/medwave.2015.03.6121


PORTADA MEDWAVE
www.medwave.cl