Revisiones_bibliográficas TyO

viernes, 11 de marzo de 2016

Bupivacaina liposomal en cirugía mamaria / Exparel in breast surger

Febrero 26, 2016. No. 2248

El dolor postoperatorio y la estancia se disminuye con Exparel en la reconstrucción mamaria inmediata, con implantes.

Postoperative Pain and Length of Stay Lowered by Use of Exparel in Immediate, Implant-Based Breast Reconstruction.

Butz DR, Shenaq DS, Rundell VL, Kepler B, Liederbach E, Thiel J, Pesce C, Murphy GS, Sisco M, Howard MA.

Plast Reconstr Surg Glob Open. 2015 Jun 5;3(5):e391. doi: 10.1097/GOX.0000000000000355. eCollection 2015.

Abstract

BACKGROUND: Patients undergoing mastectomy and prosthetic breast reconstruction have significant acute postsurgical pain, routinely mandating inpatient hospitalization. Liposomal bupivacaine (LB) (Exparel; Pacira Pharmaceuticals, Inc., Parsippany, N.J.) has been shown to be a safe and effective pain reliever in the immediate postoperative period and may be advantageous for use in mastectomy and breast reconstruction patients.METHODS:Retrospective review of 90 immediate implant-based breast reconstruction patient charts was completed. Patients were separated into 3 groups of 30 consecutively treated patients who received 1 of 3 pain treatment modalities: intravenous/oral narcotic pain control (control),bupivacaine pain pump, or LB injection. Length of hospital stay, patient-reported Visual Analog Scale (VAS) pain scores, postoperative patient-controlled analgesia usage, and nausea-related medication use were abstracted and subjected to analysis of variance and multiple linear-regression analysis, as appropriate. RESULTS: Subjects were well-matched for age (P = 0.24) regardless of pain-control modality. Roughly half (53%) of control and pain pump-treated subjects had bilateral procedures, as opposed to 80% of LB subjects. Mean length of stay for LB subjects was significantly less than control (1.5 days vs 2.00 days; P = 0.016). LB subjects reported significantly lower VAS pain scores at 4, 8, 12, 16, and 24 hours compared with pain pump and control (P < 0.01). There were no adverse events in the LB group. CONCLUSION: Use of LB in this group of immediate breast reconstruction patients was associated with decreased patient VAS pain scores in the immediate postoperative period compared with bupivacaine pain pump and intravenous/oral narcotic pain management and reduced inpatient length of stay.

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Bloqueo del pectoral medial y lateral con bupivacaína liposomal en el manejo del DPO después de aumento mamario submuscular

Medial and lateral pectoral nerve block with liposomal bupivacaine for the management of postsurgical pain after submuscular breast augmentation.

Leiman D, Barlow M, Carpin K, Piña EM, Casso D.

Plast Reconstr Surg Glob Open. 2015 Jan 8;2(12):e282. doi: 10.1097/GOX.0000000000000253. eCollection 2014.

Abstract

SUMMARY: This report describes an ultrasound-guided medial and lateral pectoralis nerve block using liposome bupivacaine, performed before the surgical incision, in a patient undergoing submuscular breast augmentation. The anatomic basis and technique are described. This procedure may be offered to patients undergoing submuscular insertion of a breast implant or tissue expander. Advancements in ultrasound guidance allow for more precise anatomic placement of local anesthetic agents. The injection technique used for this procedure resulted in complete relaxation of the pectoralis major, facilitating the surgical dissection and markedly diminishing postsurgical pain and muscle spasms.

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Anestesiología y Medicina del Dolor

52 664 6848905

vwhizar@anestesia-dolor.org

anestesia-dolor.org

Libros con acceso abierto / Free access books

Marzo 3, 2016. No. 2254-A

Nuevos aspectos de los mecanismos moleculares y celulares de la carcinogénesis humana

New Aspects in Molecular and Cellular Mechanisms of Human Carcinogenesis

Edited by Dmitry Bulgin, ISBN 978-953-51-4382-6, 192 pages, Publisher: InTech, Chapters published March 02, 2016 under CC BY 3.0 license
Edited Volume
Written by an international team of experts in the field of human carcinogenesis, this book discusses recent advances in cancer research, which include the following topics: basic molecular and cellular mechanisms behind cancer growth, new approaches in cancer therapy, and cancer diagnostic. The book serves as a useful source of reference for cancer biologists, medical doctors, and clinical researchers in the fields of cancer diagnosis, prevention, and treatment.

Libro / Book

Cánceres ginecológicos. Ciencias básicas, clínica y perspectivas terapéuticas

Gynecologic Cancers - Basic Sciences, Clinical and Therapeutic Perspectives

Edited by Samir A. Farghaly, ISBN 978-953-51-4278-2, 338 pages, Publisher: InTech, Chapters published March 02, 2016 under CC BY 3.0 license
Edited Volume
Gynecologic cancers include malignancies of the female genital tract involving the vulva, vagina, cervix, uterus, fallopian tubes or ovaries. In the USA, 98,280 women had gynecological cancers in 2015, and 30,440 died of these cancers. World wide, the number of women who had cancers of the female genital tract was 1,085,900, in 2012 and the number of deaths was 417,600. Cancers of the uterus, cervix and ovary are most common. Widespread screening with the Pap test has allowed physicians to find per-cancerous changes in the cervix and vagina. This has assisted in identifying some invasive cancers early. Multidisciplinary team of experts includes specialists in medical oncology, gynecologic oncology, radiology, urology, radiotherapy, and surgery who work together to determine the best treatment approach for the patient. Recent progress in the development of new surgical techniques has transformed the treatment of gynecologic cancers, resulting in greater surgical precision and fewer complications. In addition targeted adjuvant therapy has become useful in improving the oncologic outcome of patients with these cancers.

Libro / Book

Avances en cirugía oftalmológica

Advances in Eye Surgery

Edited by Patricio A. Pacheco, ISBN 978-953-51-2249-4, 302 pages, Publisher: InTech, Chapters published February 24, 2016 under CC BY 3.0 license
DOI: 10.5772/59216
Edited Volume
This is a comprehensive, practical guidebook that provides a clear overview and update of current modern techniques of ocular surgery. The chapters will be of interest to a wide audience. The chapters are written by experts with special interest and extensive clinical experience in the topics.

Libro / Book

Anestesiología y Medicina del Dolor

52 664 6848905

vwhizar@anestesia-dolor.org

anestesia-dolor.org

Neumonía / Pneumonia

Marzo 7, 2016. No. 2258

Manejo de la neumonía por Pseudomona aeuruginosa asociada al ventilador

Pseudomonas aeruginosa ventilator-associated pneumonia management.

Ramírez-Estrada S, Borgatta B, Rello J.

Infect Drug Resist. 2016 Jan 20;9:7-18. doi: 10.2147/IDR.S50669. eCollection 2016.

Abstract

Ventilator-associated pneumonia is the most common infection in intensive care unit patients associated with high morbidity rates and elevated economic costs; Pseudomonas aeruginosa is one of the most frequent bacteria linked with this entity, with a high attributable mortality despite adequate treatment that is increased in the presence of multiresistant strains, a situation that is becoming more common in intensive care units. In this manuscript, we review the current management of ventilator-associated pneumonia due to P. aeruginosa, the most recent antipseudomonal agents, and new adjunctive therapies that are shifting the way we treat these infections. We support early initiation of broad-spectrum antipseudomonal antibiotics in present, followed by culture-guided monotherapy de-escalation when susceptibilities are available. Future management should be directed at blocking virulence; the role of alternative strategies such as new antibiotics, nebulized treatments, and vaccines is promising.

KEYWORDS: ICU; adjunctive-therapies; care-bundles; multidrug-resistant; new-antibiotics

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Valor pronóstico de procalcitonina en neumonía. Revisión sistemática y meta-análisis

Prognostic value of procalcitonin in pneumonia: A systematic review and meta-analysis.

Liu D, Su LX, Guan W, Xiao K, Xie LX.

Respirology. 2016 Feb;21(2):280-8. doi: 10.1111/resp.12704. Epub 2015 Dec 10.

For critically ill patients, an elevated PCT level was associated with an increased risk of mortality (RR 4.18, 95% CI: 3.19-5.48). The prognostic performance was nearly equal between patients with ventilator-associated pneumonia (VAP) and patients with CAP.

KEYWORDS: meta-analysis; mortality; pneumonia; procalcitonin; prognosis

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