Revisiones_bibliográficas TyO

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viernes, 17 de junio de 2016

Hemodinamia en neonatos pretérmino / Hemodynamics in preterm neonates

Junio 17, 2016. No. 2360

Hemodinámica de transición en prematuros recién nacidos: relevancia clínica.

Transitional Hemodynamics in Preterm Neonates: Clinical Relevance.

Wu TW1, Azhibekov T2, Seri I3.

Pediatr Neonatol. 2016 Feb;57(1):7-18. doi: 10.1016/j.pedneo.2015.07.002. Epub 2015 Aug 29.

Abstract

BACKGROUND: Each newborn enters this world facing tremendous respiratory, hemodynamic and neuroendocrine challenges while going through drastic physiological changes during the process of adaption from fetal to postnatal life. Even though the vast majority of term infants transitions moothly without apparent consequences, this task becomes increasingly arduous for the extremely preterm infant. METHODS & RESULTS: This article reviews the physiology and pathophysiology of cardiovascular adaptation of the very preterm neonate. In particular it describes the physiology of fetal circulation, summarizes the hemodynamic changes occurring during preterm births and discusses the impact of the most frequently seen clinical scenarios that place additional burden on the premature infant during immediate transition. Finally an emphasis is placed on discussing common clinical dilemmas and practical aspects of developmental hemodynamics such as neonatal hypotension and patent ductus arteriosus; clinical presentations the neonatologist encounters on a daily basis. CONCLUSION: The review provides a physiology-based view on the hemodynamics of the immediate postnatal transitional period.

KEYWORDS: Preterm neonate; developmental hemodynamics; fetal circulation; neonatal hypotension; persistent ductus arteriosus

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16th World Congress of Anaesthesiologists

28 August - 2 September 2016
Hong Kong Convention and Exhibition Centre

World Federation of Societies of Anaesthesiologists

http://wca2016.com/

Cursos de Anestesiología en Chile, 2016

Facultad de Medicina. Pontificia Universidad Católica de Chile

Información

Anestesiología y Medicina del Dolor

52 664 6848905

vwhizar@anestesia-dolor.org

anestesia-dolor.org

jueves, 16 de junio de 2016

Vía aérea difícil / Difficult airway

Junio 16, 2016. No. 2359

Anestesia regional en vía aérea difícil. Continúa la búsqueda de una solución

Regional anesthesia in difficult airway: The quest for a solution continues.

Khetarpal R1, Chatrath V1, Dhawan A1, Attri JP1.

Anesth Essays Res. 2016 May-Aug;10(2):178-83. doi: 10.4103/0259-1162.167829.

Abstract

Difficult airway, a scenario with potentially life threatening outcome, is routinely encountered by an anesthesiologist leaving him with the dilemma of whether to use regional anesthesia (RA) or general anesthesia. Our study aims to look into this problem. The literature search was performed in the Google, PubMed, and Medscape using key words "regional anesthesia, difficult airway, pregnancy, ventilation, intubation, epidural anesthesia, nerve blocks." More than 38 free full articles and books published from the year 1987 to 2014 were retrieved and studied. At first sight, RA may appear to offer an ideal solution as it helps to avoid the problem of difficult airway. However, the possibility of a total spinal block, failed or incomplete RA, local anesthetic toxicity or unforeseen surgical complication may make it imperative that the airway is secured. The correct decision can only be made by the anesthetist when all the relevant clinical information is taken into account. It is also important to ensure that before considering RA in a patient of difficult airway, an anesthesiologist must have a preformulated strategy for intubation.

KEYWORDS: Difficult airway; epidural anesthesia; intubation; nerve blocks; pregnancy; regional anesthesia; ventilation

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El encuentro con vía aérea difícil inesperada: la relación con la escala de intubación difícil.

Encountering unexpected difficult airway: relationship with the intubation difficulty scale.

Koh W1, Kim H1, Kim K1, Ro YJ1, Yang HS1.

Korean J Anesthesiol. 2016 Jun;69(3):244-9. doi: 10.4097/kjae.2016.69.3.244. Epub 2016 Jun 1.

Abstract

BACKGROUND: An unexpected difficult intubation can be very challenging and if it is not managed properly, it may expose the encountered patient to significant risks. The intubation difficulty scale (IDS) has been used as a validated method to evaluate a global degree of intubation difficulty. The aims of this study were to evaluate the prevalence and characteristics of unexpected difficult intubation using the IDS. METHODS: We retrospectively reviewed 951 patients undergoing elective surgery in a single medical center. Patients expected to have a difficultintubation or who had history of difficult intubation were excluded. Each patient was assessed by the IDS scoring system with seven variables. Total prevalence of difficult intubation and the contributing individual factors were further analyzed. RESULTS: For the 951 patients, the difficult intubation cases presenting IDS > 5 was 5.8% of total cases (n = 55). The prevalence of Cormack-Lehane Grade 3 or 4 was 16.2% (n = 154). Most of the difficult intubation cases were managed by simple additional maneuvers and techniques such as stylet application, additional lifting force and laryngeal pressure. CONCLUSIONS: Unexpected difficult airway was present in 5.8% of patients and most was managed effectively. Among the components of IDS, the Cormack-Lehane grade was most sensitive for predicting difficult intubation.

KEYWORDS: Difficult; Grade; Intubation; Scale; Unexpected

PDF

16th World Congress of Anaesthesiologists

28 August - 2 September 2016
Hong Kong Convention and Exhibition Centre

World Federation of Societies of Anaesthesiologists

http://wca2016.com/

Cursos de Anestesiología en Chile, 2016

Facultad de Medicina. Pontificia Universidad Católica de Chile

Información