lunes, 26 de septiembre de 2016

Oxitocina / Oxytocin

Septiembre 25, 2016. No. 2459







Oxitocina en operación cesarean. ¿Que hay de nuevo?
Oxytocin in cesarean-sections. What's new?
Braz J Anesthesiol. 2016 Jul-Aug;66(4):402-7. doi: 10.1016/j.bjane.2014.11.015. Epub 2016 Apr 30.
Abstract
Oxytocin is the uterotonic agent of choice in the prevention and treatment of postpartum uterine atony. Nevertheless, there is no consensus on the optimal dose and rate for use in cesarean sections. The use of high bolus doses (e.g., 10IU of oxytocin) can determine deleterious cardiovascular changes for the patient, especially in situations of hypovolemia or low cardiac reserve. Furthermore, high doses of oxytocin for prolonged periods may lead to desensitization of oxytocin receptors in myometrium, resulting in clinical inefficiency.
KEYWORDS: Cesarean section; Cesariana; Desensitization; Dessensibilização; Dose; Ocitocina; Oxytocin
 PDF
CEEA Veracruz

XIII Congreso Virtual Mexicano de Anestesiología
Octubre a Diciembre 2016

Información / Information
17h World Congress of Anaesthesiologists, WFSA
Sep 6-11, 2020
Prague, Czech Republic
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Fibromialgia / Fibromyalgia

Septiembre 26, 2016. No. 2460







Fibromialgia y síndromes de dolor crónico: Un papel en blanco detallando los retos actuales en este campo
Fibromyalgia and Chronic Pain Syndromes: A White Paper Detailing Current Challenges in the Field.
Clin J Pain. 2016 Sep;32(9):737-46. doi: 10.1097/AJP.0000000000000354.
Abstract
This manuscript, developed by a group of chronic pain researchers and clinicians from around the world, aims to address the state of knowledge about fibromyalgia (FM) and identify ongoing challenges in the field of FM and other chronic pain syndromes that may be characterized by pain centralization/amplification/hypersensitivity. There have been many exciting developments in research studies of the pathophysiology and treatment of FM and related syndromes that have the potential to improve the recognition and management of patients with FM and other conditions with FM-like pain. However, much of the new information has not reached all clinicians, especially primary care clinicians, who have the greatest potential to use this new knowledge to positively impact their patients' lives. Furthermore, there are persistent misconceptions about FM and a lack of consensus regarding the diagnosis and treatment of FM. This paper presents a framework for future global efforts to improve the understanding and treatment of FM and other associated chronic pain syndromes, disseminate research findings, identify ways to enhance advocacy for these patients, and improve global efforts to collaborate and reach consensus about key issues related to FM and chronic pain in generalPDF
Fibromialgia. Estrategias de manejo para los médicos de atención primaria
Fibromyalgia: management strategies for primary care providers.
Int J Clin Pract. 2016 Feb;70(2):99-112. doi: 10.1111/ijcp.12757.
Abstract
AIMS: Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management. METHODS: We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements. RESULTS: The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes. DISCUSSION: The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronicdiseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training. CONCLUSION: Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting.
Libro  Nuevos conocimientos sobre fibromialgia
Book on New Insights into Fibromyalgia
Edited by William S. Wilke, ISBN 978-953-307-407-8, 232 pages, Publisher: InTech, Chapters published January 05, 2012 under CC BY 3.0 license
DOI: 10.5772/1468
Edited Volume
Given the potential problems that can obscure any scientific enterprise, inconsistent results across studies are bound to occur. How are we to decide what is true? Let's turn to philosophy for a reasonable answer. The mathematician-philosopher Bertrand Russell approached a similar problem in his monograph The Problems of Philosophy (Russell B, 1912). He addressed the following question: How do we know that anything is "real"? Is the only reality subjective and simply in our minds, as Bishop Berkley challenged, or can we mostly believe the objective reality? His pragmatic answer: All possibilities may be true, but when the preponderance of evidence indicates that objective reality and knowledge are the most probable case, go with it. If the preponderance of all evidence about the clinical description of fibromyalgia and it's pathogenic mechanisms and treatment strategies indicate a highly probable interrelated hypothesis, go with it. The direction of the literature on the whole trumps the less likely tangents. At the same time, remember Bertrand Russell and his pragmatic answer, and keep an open mind.
CEEA Veracruz

XIII Congreso Virtual Mexicano de Anestesiología
Octubre a Diciembre 2016

Información / Information
17h World Congress of Anaesthesiologists, WFSA
Sep 6-11, 2020
Prague, Czech Republic
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Anestesiología y Medicina del Dolor

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lunes, 19 de septiembre de 2016

Tubos endotraqueales / Endotracheal tubes

Septiembre 19, 2016. No. 2453




Tubos endotraqueales: nuevos y viejos
Endotracheal tubes: old and new.
Respir Care. 2014 Jun;59(6):933-52; discussion 952-5. doi: 10.4187/respcare.02868.
Abstract
The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngeal nerve damage during surgery, preventing airway fires during laser surgery, and administering medications. In critical care management, ventilator-associated pneumonia (VAP) is a major concern, as it is associated with increased morbidity, mortality, and cost. It is increasingly appreciated that the ETT itself is a primary causative risk for developing VAP. Unfortunately, contaminated oral and gastric secretions leak down past the inflated ETT cuff into the lung. Bacteria can also grow within the ETT in biofilm and re-enter the lung. Modifications to the ETT that attempt to prevent bacteria from entering around the ETT include maintaining an adequate cuff pressure against the tracheal wall, changing the material and shape of the cuff, and aspirating the secretions that sit above the cuff. Attempts to reduce bacterial entry through the tube include antimicrobial coating of the ETT and mechanically scraping the biofilm from within the ETT. Studies evaluating the effectiveness of these modifications and techniques demonstrate mixed results, and clear recommendations for which modification should be implemented are weak.
KEYWORDS: Hunsaker Mon-Jet tube; Parker Flex-Tip; RAE tube; biofilm; bronchial blocker; cuff pressure; double-lumen tube; endotracheal tube; laser-resistant tube; microaspiration; polyurethane; silver-coated endotracheal tube; subglottic secretion drainage; tapered cuff; ventilator-associated pneumonia
CEEA Veracruz

XIII Congreso Virtual Mexicano de Anestesiología
Octubre a Diciembre 2016

Información / Information
2017 Winter Anesthesia Conference in Maui
California Society of Anesthesiologists
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Anestesiología y Medicina del Dolor

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