Revisiones_bibliográficas TyO

viernes, 24 de marzo de 2017

El anciano quirúrgico / Suigical elderly patients

Marzo 21, 2017. No. 2635

Los pacientes geriátricos tienen más posibilidades de complicaciones perioperatorias, incluyendo la muerte. La fragilidad y las fallas orgánicas son factores de riesgo que se deben de conocer y cuantificar detenidamente durante la evaluación preanestésica. Esta semana le enviaremos información sobre este tema.

Geriatric patients are more likely to have perioperative complications, including death. Fragility and organic failure are risk factors that must be known and quantified carefully during the preanesthetic evaluation. This week we will send you information on this subject.

Pacientes geriátricos são mais propensos a complicações perioperatórias, incluindo a morte. Fragilidade e falência de órgãos são factores de risco que devem ser cumpridas e cuidadosamente quantificados durante a avaliação pré-anestésica. Nesta semana, vamos enviar-lhe informações sobre este tópico.

Evaluación preoperatoria del paciente quirúrgico de mayor edad: Sobre los síndromes geriátricos.

Preoperative assessment of the older surgical patient: honing in on geriatric syndromes.

Kim S1, Brooks AK2, Groban L2.

Clin Interv Aging. 2014 Dec 16;10:13-27. doi: 10.2147/CIA.S75285. eCollection 2015Abstract

Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ≥65 years of age) undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused) to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors - including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility - which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation) to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented.

KEYWORDS: frailty; mobility-disability; postoperative delirium; preoperative evaluation; stress response

PDF

Mortalidad prevenible después de cirugía urológica común. ¿Fallar en el rescate?

Preventable mortality after common urological surgery: failing to rescue?

Sammon JD1, Pucheril D, Abdollah F, Varda B, Sood A, Bhojani N, Chang SL, Kim SP, Ruhotina N, Schmid M, Sun M, Kibel AS, Menon M, Semel ME, Trinh QD.

BJU Int. 2015 Apr;115(4):666-74. doi: 10.1111/bju.12833. Epub 2014 Aug 19.

Abstract

OBJECTIVE: To assess in-hospital mortality in patients undergoing many commonly performed urological surgeries in light of decreasing nationwide perioperative mortality over the past decade. This phenomenon has been attributed in part to a decline in 'failure to rescue' (FTR) rates, e.g. death after a complication that was potentially recognisable/preventable. PATIENTS AND METHODS: Discharges of all patients undergoing urological surgery between 1998 and 2010 were extracted from the Nationwide Inpatient Sample and assessed for overall and FTR mortality. Admission trends were assessed with linear regression. Logistic regression models fitted with generalised estimating equations were used to estimate the impact of primary predictors on over-all and FTR mortality and changes in mortality rates. RESULTS: Between 1998 and 2010, an estimated 7,725,736 urological surgeries requiring hospitalisation were performed in the USA; admissions for urological surgery decreased 0.63% per year (P = 0.008). Odds of overall mortality decreased slightly (odds ratio [OR] 0.990, 95% confidence interval [CI] 0.988-0.993), yet the odds of mortality attributable to FTR increased 5% every year (OR 1.050, 95% CI 1.038-1.062). Patient age, race, Charlson Comorbidity Index, public insurance status, as well as urban hospital location were independent predictors of FTR mortality (P < 0.001). CONCLUSION: A shift from inpatient to outpatient surgery for commonly performed urological procedures has coincided with increasing rates of FTR mortality. Older, sicker, minority group patients and those with public insurance were more likely to die after a potentially recognisable/preventable complication. These strata of high-risk individuals represent ideal targets for process improvement initiatives.

KEYWORDS: failure to rescue; preventable mortality; urological surgery

PDF

Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.

Committee for European Education in Anaesthesiology (CEEA)

y el Colegio de Anestesiólogos de León A.C.

Abril 7-9, 2017, León Guanajuato, México

Informes (477) 716 06 16, kikinhedz@gmail.com

Congreso Latinoamericano de Anestesia Regional

Asociación Latinoamericana de Anestesia Regional, Capítulo México

Ciudad de México, Mayo 24-27, 2017

Informes http://r.enviosgrupolahe.com/2e7l0th0feu87f.html

Vacante para Anestesiología Pediátrica

Hospital de Especialidades Pediátrico de León, Guanajuato México

Informes con la Dra Angélica García Álvarez

angy.coachanestped@gmail.com o al teléfono 477 101 8700 Ext 1028

Anestesiología y Medicina del Dolor

52 664 6848905

vwhizar@anestesia-dolor.org

anestesia-dolor.org

jueves, 23 de marzo de 2017

TÉCNICA QUIRÚRGICA Y RESULTADOS CLÍNICOS DE LA TRANSFERENCIA OSTEOCONDRAL RETRÓGRADA DE AUTOINJERTO PARA LESIONES OSTEOCONDRALES DE LA MESETA TIBIAL

http://www.perezartro.com.mx/academia/tecnica-quirurgica-y-resultados-clinicos-de-la-transferencia-osteocondral-retrograda-de-autoinjerto-para-lesiones-osteocondrales-de-la-meseta-tibial/

Surgical Technique and Clinical Outcomes of Retrograde Osteochondral Autograft Transfer for Osteochondral Lesions of the Tibial Plateau

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28325693

http://www.arthroscopyjournal.org/article/S0749-8063(17)30100-7/abstract

De:

Yabumoto H1,Nakagawa Y2,Mukai S2,Saji T2,Nakamura T2.

Arthroscopy.

2017 Mar 18. pii: S0749-8063(17)30100-7. doi: 10.1016/j.arthro.2017.01.026. [Epub ahead of print]

Abstract

PURPOSE:

To present the surgical technique, clinical outcomes, and poor prognostic factors of arthroscopic retrograde osteochondral autograft transfer of the tibial plateau.

CONCLUSIONS:

Most clinical scores improved significantly postoperatively. The results indicate that arthroscopic retrograde osteochondral autograft transfer is an effective procedure to achieve sufficient cartilage congruity for osteochondral lesions of the tibial plateau <400 mm² in size.

Resumen

PROPÓSITO:

Presentar la técnica quirúrgica, los resultados clínicos y los malos factores pronósticos de la transferencia artroscópica retrógrada osteocondral del autoinjerto de la meseta tibial.

CONCLUSIONES:

La mayoría de las puntuaciones clínicas mejoraron significativamente en el postoperatorio. Los resultados indican que la transferencia artroscópica retrógrada osteocondral de autoinjerto es un procedimiento eficaz para lograr una congruencia suficiente del cartílago para las lesiones osteocondrales de la meseta tibial <400 mm2 de tamaño.

PMID: 28325693 DOI:

10.1016/j.arthro.2017.01.026

#Técnica quirúrgica #RESULTADOS CLÍNICOS #TRANSFERENCIA OSTEOCONDRAL RETRÓGRADA #lesiones osteocondrales #meseta tibial

Urología en el anciano / Geriatric urology

Marzo 22, 2017. No. 2636

Raquianestesia con Baja Dosis de la Combinación de Bupivacaina y Fentanilo: Una Buena Alternativa para la Cirugía de Resección Transuretral de Próstata en Pacientes Ancianos en Régimen Ambulatorial Akcaboy ZN, Akcaboy EY, Mutlu NM, Serger N, Aksu C, Gogus

Revista Brasileira de Anestesiologia Vol. 62, No 6, Noviembre-Diciembre, 2012

Resumen:

Justificativa y objetivos: Evaluar la eficacia, la duración del bloqueo, la permanencia en la sala de recuperación postanestésica y los efectos adversos del uso por vía intratecal de dosis bajas de bupivacaina en combinación con el Fentanilo, y compararlos con la dosis convencional de prilocaína y Fentanilo en cirugía de resección transuretral de próstata en pacientes ancianos en régimen ambulatorial. Materiales y métodos: Fueron designados aleatoriamente 60 pacientes para dos grupos: el Grupo B que recibió 4 mg de bupivacaina al 0,5% + 25 µg de Fentanilo y el Grupo P que recibió 50 mg de prilocaína al 2% + 25 µg de Fentanilo intratecal. Se compararon la calidad y la duración de los bloqueos, el tiempo de permanencia en la sala de recuperación postanestésica y los efectos adversos. Resultados: La duración del bloqueo y el tiempo de permanencia en la sala de recuperación postanestesia fueron menores en el Grupo B que en el Grupo P (p < 0,001 para ambos). La hipotensión y la bradicardia no se observaron en el Grupo B, que fue significativamente diferente del Grupo P (p = 0,024, p = 0,011, respectivamente). Conclusiones: La administración intratecal de 4 mg de bupivacaina + 25 µg de Fentanilo produjo una raquianestesia adecuada con menos tiempo de duración del bloqueo y permanencia en la sala de recuperación postanestésica, con el perfil hemodinámico estable que la administración intratecal de 50 mg de prilocaína + 25 µg de Fentanilo para la cirugía de resección transuretral de próstata en pacientes ancianos en régimen ambulatorial. Descriptores: ANESTESIA, Regional, raquianestesia; ANESTÉSICOS, Local, bupivacaina, prilocaína; CIRUGÍA, Urología

PDF

Masas renales pequeñas en los ancianos: enfoques de tratamiento contemporáneos y resultados oncológicos comparativos de estrategias quirúrgicas y no quirúrgicas.

Small renal masses in the elderly: Contemporary treatment approaches and comparative oncological outcomes of nonsurgical and surgical strategies.

Vetterlein MW1, Jindal T2, Becker A1, Regier M3, Kluth LA1, Tilki D4, Chun FK5.

Investig Clin Urol. 2016 Jul;57(4):231-9. doi: 10.4111/icu.2016.57.4.231. Epub 2016 Jul 5.

Abstract

Over the last decades, there has been a significant stage migration in renal cell carcinoma and especially older patients are getting diagnosed more frequently with low stage disease, such as small renal masses ≤4 cm of size. Considering the particular risk profile of an older population, often presenting with a nonnegligible comorbidity profile and progressive renal dysfunction, treatment approaches beyond aggressive radical surgical procedures have come to the fore. We sought to give a contemporary overview of the available different treatment strategies for incidental small renal masses in an elderly population with the focus on comparative oncological outcomes of nonsurgical and surgical modalities.

KEYWORDS: Ablation techniques; Aged; Kidney neoplasms; Nephrectomy; Watchful waitin

PDF

Cirugía urológica en mayores de 80 años. Estudio clínico retrospectivo de 30 años

Urological surgery in patients aged 80 years and older: a 30-year retrospective clinical study.

Takao T1, Tsujimura A, Kiuchi H, Komori K, Fujita K, Miyagawa Y, Takada S, Nonomura N, Okuyama A.

Int J Urol. 2008 Sep;15(9):789-93. doi: 10.1111/j.1442-2042.2008.02110.x. Epub 2008 Jul 10.

Abstract

OBJECTIVES:To investigate changes in the management of cases over time, we undertook a retrospective analysis of urological surgeries carried out in patients aged 80 years and older in a single institution over the last 30 years. METHODS: Between 1975 and 2004, 402 patients aged 80 years and older underwent 412 surgeries in our department. We reviewed the clinical records and analyzed changes in clinical data over time. We evaluated the observed comorbidities and postoperative complications in selected patients for whom complete clinical records were available. We then identified risk factors for postoperative complications by means of multiple logistic regression analysis. RESULTS: The number of surgeries carried out in patients aged 80 years and older increased every 5 years. Over time, the number of endourological and laparoscopic surgeries increased. Of 255 patients, 225 (88.3%) had at least one comorbidity, and 51 patients had postoperative complications. The number of observed comorbidities, such as cardiovascular disorder, central nervous system disorder, and diabetes mellitus, increased over the most recent 10-year period. However, there were no differences in postoperative complications over time. Male sex and open surgery were found to be independent risk factors for postoperative complications. CONCLUSIONS: Although elderly patients had various comorbidities, the postoperative morbidity rate was acceptable in our selected cases. This study may provide useful detailed information for patients 80 years and older who will undergo urological surgery.

PDF