VII Foro Internacional de Medicina del Dolor y Paliativa

VII Foro Internacional de Medicina del Dolor y Paliativa Clínica del Dolor del Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" Ciudad de Mexico, Octubre 1,2 y 3, 2015   Dra. Argelia Lara - Solares Jefe del Departamento de Medicina del Dolor y Paliativa Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Tel. Ofna. 5487 0900 Ext. 5011 Sitio web: www.dolorypaliativos.org Programa/Program

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Ultrasonido para bloqueos neuroaxiales/Ultrasound for neuraxial blockade

Ultrasonido para bloqueos neuroaxiales Ultrasound for neuraxial blockade. Srinivasan KK, Lee PJ, Iohom G. Med Ultrason.2014 Dec;16(4):356-63. Abstract Neuraxial blockade is still largely performed as a blind procedure. Despite of developments in the type of needles used and drugs administered, the process of locating the epidural or intra-thecal space is still limited to identification of landmarks by palpation and reliance on tactile feedback of the operator. Ultrasound has provided the long needed "eye" to the procedure and has already shown promise of improving the safety and efficacy or neuraxial blocks. This review focuses on understanding the sonoanatomy of the neuraxial space, performing a systematic pre-procedural ultrasound scan, and reviewing the available evidence.  PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

3 BECAS para CONGRESISTAS XXIII Congreso Internacional SLAOT para HOSPITALES en ALEMANIA

#slaot2015


http://traumayortopediaslaot.blogspot.mx/


3 BECAS para CONGRESISTAS


XXIII Congreso Internacional SLAOT

para HOSPITALES en ALEMANIA


Ver bases en Convocatoria:


www.congresoslaot.org

Zoonosis de la recámara

Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 19 Agosto 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: 

“Zoonosis de la recámara” por los“Dres. Cesar Martínez L. y Pablo Treviño V”, Infectologos pediatras de la Cd de Monterrey N.L.. 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/zoonosis_recamara/

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

Ventilación mecánica protectiva/Protective mechanical ventilation

No. 2056                                                                                  Agosto 16, 2015

Ventilación protectiva intraoperatoria y riesgo de complicaciones respiratorias postoperatorias. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study. Ladha K, Vidal Melo MF, McLean DJ, Wanderer JP, Grabitz SD, Kurth T, Eikermann M. BMJ. 2015 Jul 14;351:h3646. doi: 10.1136/bmj.h3646. PDF Ventilación protectiva vs convencional en cirugía. Protective versus Conventional Ventilation for Surgery: A Systematic Review and Individual Patient Data Meta-analysis Ary Serpa Neto, M.D., M.Sc., Ph.D.; Sabrine N. T. Hemmes, M.D.; Carmen S. V.  et al Anesthesiology. 2015 May 15. [Epub ahead of print] Abstract This individual patient meta-analysis of 2,127 patients ventilated under general anesthesia for surgery from 15 randomized controlled trials shows that intraoperative ventilation with low tidal volume protects against postoperative pulmonary complications, but further trials are necessary to define the role of intraoperative higher positive end-expiratory pressure to prevent postoperative pulmonary complications after major abdominal surgery. PDF  Ventilación pulmonar protectiva en pacientes obesos Perioperative lung protective ventilation in obese patients. Fernandez-Bustamante A, Hashimoto , Serpa Neto A, Moine P, Vidal Melo MF, Repine JE. BMC Anesthesiol. 2015 May 6;15:56. doi: 10.1186/s12871-015-0032-x. Abstract The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8-15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity. PDF  Efecto de la ventilación protectiva sobre las complicaciones pulmonares en pacientes bajo anestesia general Effect of protective ventilation on postoperative pulmonary complications in patients undergoing general anaesthesia: a meta-analysis of randomised controlled trials. Tao T, Bo L, Chen F, Xie Q, Zou Y, Hu B, Li J, Deng X. BMJ Open. 2014 Jun 24;4(6):e005208. doi: 10.1136/bmjopen-2014-005208.   CONCLUSIONS: Intraoperative use of protective ventilation strategies has the potential to reduce the incidence of postoperative pulmonary complications in patients undergoing general anaesthesia. Prospective, well-designed clinical trials are warranted to confirm the beneficial effects of protective ventilation strategies in surgical patients. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Dexmedetomidina en CAM/Dexmedetomidine in monitored anesthesia care

Agosto 15, 2015. No. 2055

Comparación de dexmedetomidina en cuidado anestésico monitorizado vs anestesia espinal encirugía de várices The comparison of monitored anesthesia care with dexmedetomidine and spinal anesthesia during varicose vein surgery. Moon EJ, Kang KW, Chung JY, Kang JM, Park JH, Joh JH, Park HC, Yi JW. Ann Surg Treat Res. 2014 Nov;87(5):245-52. Abstract PURPOSE: The purpose of this study was to investigate the effectiveness and safety of monitored anesthesia care (MAC) using dexmedetomidine for its sedative and analgesic effect during varicose vein surgery. METHODS: Forty-two patients, who underwent varicose vein surgery, were divided into the MAC group (n = 20) or the spinal anesthesia group (n = 22) for randomized clinical trial. In the MAC group, dexmedetomidine was administered by a loading dose of 1 µg/kg for 10 minutes, followed by a maintenance infusion of 0.2-1.0 µg/kg/hr. Ketamine was used for intermittent injection. In the spinal anesthesia group, midazolam was used for sedation. Intraoperative vital signs, the number of adverse events, and the satisfaction of patients and surgeons concerning the anesthetic condition were compared between the two groups. RESULTS: Systolic blood pressure was intraoperatively significantly different over time between the two groups. The groups had statistical differences in the change in heart rate with regard to time. In the postanesthetic care unit, patients and surgeons in the MAC group had a lower satisfaction score, compared to patients and surgeons in the spinal anesthesia group. However, in the recovery period, patients had a positive perception concerning MAC anesthesia. In addition, without significant adverse events, the MAC group had a shorter time to possible ambulation, which indicated an early recovery. CONCLUSION: We believe that MAC using dexmedetomidine in combination with ketamine may be an alternative anesthetic technique for varicose vein surgery with regard to a patient's preference and medical condition. KEYWORDS: Dexmedetomidine; Monitored anesthesia care; Sedation; Spinal anesthesia PDF  La dexmedetomidina aminora el cuidado anestésico monitorizado Dexmedetomidine ameliorates monitored anaesthesia care. Gupta P, Joshi S, Jethava D, Kumar A. Indian J Anaesth. 2014 Mar;58(2):154-9. doi: 10.4103/0019-5049.130816. Abstract BACKGROUND AND AIMS: Monitored anaesthesia care (MAC) is meant for procedures under local anaesthesia. Various drugs have been used for this purpose. The recently introduced alpha2 agonist, dexmedetomidine provides "conscious sedation" with adequate analgesia and minimal respiratory depression. Hence, the safety and efficacy of two doses of dexmedetomidine for sedation and analgesia were evaluated. METHODS: A total of 90 patients were distributed in three groups of 30 each: Dexmedetomidine 0.5 μg/kg (DL), dexmedetomidine 1.0 μg/kg (DH) and normal saline (C). The initial loading dose was followed by maintenance infusion of 0.2-0.7 μg/kg/h of dexmedetomidine or equivalent volume of saline. Study drug was started at least 15 min before placement of local anaesthesia. Drugs were titrated to a target level of sedation (=3 on Ramsay sedation scale [RSS]). Midazolam 0.02 mg/kg for RSS < 3 and fentanyl 0.5 μg/kg were supplemented as required. The statistical analysis was performed using Chi-square test and mean and anova analysis. RESULTS: In groups DL and DH fewer patients required supplemental midazolam, 56.7% (17/30) and 40% (12/30), compared with control, where 86.7% (26/30)needed midazolam supplements. P = 0.000. Both groups DL and DH required significantly less fentanyl (84.8 and 83.9 μg) versus control (144.2 μg). There was significantly increased ease of achieving and maintaining targeted sedation and analgesia in both dexmedetomidine groups when compared with placebo (P = 0.001). Adverse events observed with dexmedetomidine were bradycardia and hypotension. CONCLUSIONS: Dexmedetomidine in the doses studied was considered safe and effective sedative and analgesic for patients undergoing procedures under MAC. KEYWORDS: Conscious sedation; dexmedetomidine; monitored anaesthesia care; respiratory depression PDF   Estudio prospectivo, aleatorizado, doble ciego comparando dexmedetomidina vs. midazolam-fentanilo para timpanoplastía en cuidado anestésico monitorizado A prospective randomized double-blind study comparing dexmedetomidine vs. combination of midazolam-fentanyl for tympanoplasty surgery under monitored anesthesia care. Parikh DA, Kolli SN, Karnik HS, Lele SS, Tendolkar BA. J Anaesthesiol Clin Pharmacol. 2013 Apr;29(2):173-8. doi: 10.4103/0970-9185.111671. Abstract BACKGROUND: Analgesia and sedation are usually required for the comfort of the patient and surgeon during tympanoplasty surgery done under local anesthesia. In this study, satisfaction scores and effectiveness of sedation and analgesia with dexmedetomidine were compared with a combination of midazolam-fentanyl. MATERIALS AND METHODS: Ninety patients undergoing tympanoplasty under local anesthesia randomly received either IV dexmedetomidine 1 μg kg(-1) over 10 min followed by 0.2 μg kg(-1)h(-1) infusion (Group D) or IV midazolam 0.06 mg kg(-1) plus IV fentanyl 1 μg kg(-1) over 10 min (Group MF) followed by normal saline infusion at 0.2 ml kg(-1)h(-1). Sedation was titrated to Ramsay sedation score (RSS) of three. Vital parameters, rescue analgesics (fentanyl 1 μg kg(-1)) and sedatives (midazolam 0.01 mg kg(-1)), patient and surgeon satisfaction scores were recorded. RESULTS: Patient and surgeon satisfaction score was better in Group D than Group MF (median interquartile range (IQR) 9 (8-10) vs. 8 (6.5-9.5) and 9 (8.5-9.5) vs. 8 (6.75-9.25), P = 0.0001 for both). Intraoperative heart rate and mean arterial pressure in Group D were lower than the baseline values and the corresponding values in Group MF (P < 0.05). Percentage of patients requiring rescue fentanyl was higher in Group MF than Group D (40% vs. 11.1%, P = 0.01). One patient in Group D while four in Group MF (8.8%) required rescue sedation with midazolam (P > 0.17). Seven patients in Group D had dry mouth vs. none in Group MF (P = 0.006). One patient in Group D had bradycardia with hypotension which was effectively treated. CONCLUSION: Dexmedetomidine is comparable to midazolam-fentanyl for sedation and analgesia in tympanoplasty with better surgeon and patient satisfaction. Hemodynamics need to be closely monitored. KEYWORDS: Dexmedetomidine; midazolam fentanyl sedation; monitored anesthesia care; otological; satisfaction scores; sedation; surgery PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015