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miércoles, 29 de marzo de 2017

Delirio postoperatorio en geriatría / Postoperative delirium in geriatrics

Marzo 29, 2017. No. 2643

Delirio postoperatorio en geriatría

Postoperative Delirium in the Geriatric Patient.

Schenning KJ1, Deiner SG2.

Anesthesiol Clin. 2015 Sep;33(3):505-16. doi: 10.1016/j.anclin.2015.05.007. Epub 2015 Jul 7.

Abstract

Postoperative delirium, a common complication in older surgical patients, is independently associated with increased morbidity and mortality. Patients older than 65 years receive greater than one-third of the more than 40 million anesthetics delivered yearly in the United States. This number is expected to increase with the aging of the population. Thus, it is increasingly important that perioperative clinicians who care for geriatric patients have an understanding of the complex syndrome of postoperative delirium.

KEYWORDS: Geriatric; Management; Postoperative delirium; Risk factors; Screening

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Demencia y delirio, resultados en pacientes con fracturas de cadera de edad avanzada.

Dementia and delirium, the outcomes in elderly hip fracture patients.

Mosk CA1, Mus M1, Vroemen JP1, van der Ploeg T2, Vos DI1, Elmans LH3, van der Laan L1.

Clin Interv Aging. 2017 Mar 10;12:421-430. doi: 10.2147/CIA.S115945. eCollection 2017.

Abstract

BACKGROUND: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. METHODS: This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. RESULTS: Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (P<0.001), institutionalization (P<0.001), and 6-month mortality (P<0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%, P<0.001) but a shorter hospital stay (P<0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%). CONCLUSION: Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes.

KEYWORDS: adverse outcomes; complications; delirium; dementia; elderly; hip fracture

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Intralipid en el tratamiento del delirio postoperatorio

Intralipid Treatment for Post Operative Delirium

Eldor J

Anesth Crit Care Open Access 2017, 7(5): 00273

Abstract

Postoperative delirium (POD) is a common and serious adverse event in the elderly patient and is associated with significant morbidity and mortality. A new treatment for POD by intravenous Intralipid injection in the recovery room is first suggested in the medical literature. Keywords:

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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

martes, 28 de marzo de 2017

Etapa IV Enfermedad de Kienböck: Carpectomía de hilera proximal y aplicación de implante RCPI(Resurfacing Capitate Pyrocarbon Implant Prosthesis)

http://www.clinicademano.com.mx/academia/etapa-iv-enfermedad-de-kienbock-carpectomia-de-hilera-proximal-y-aplicacion-de-implante-rcpiresurfacing-capitate-pyrocarbon-implant-prosthesis/

Stage IV Kienböck’s disease: Proximal row carpectomy and application of RCPI implant

De:

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28325423

http://www.sciencedirect.com/science/article/pii/S2468122917300312

De:

Marcuzzi A1,Colantonio F2,Petrella G3,Ozben H4,Russomando A1.

Hand Surg Rehabil.

2017 Apr;36(2):102-108. doi: 10.1016/j.hansur.2016.12.005. Epub 2017 Feb 24.

Abstract

Kienböck disease is an aseptic osteonecrosis of the lunate, which gradually leads to total carpal collapse. Lichtman’s classification relates radiographic evidence of wrist damage to four different stages and supports surgical decision-making. This study pertains to six patients (2 males and 4 females) affected by stage IV Kienböck’s disease who underwent proximal row carpectomy and received an RCPI implant. The clinical outcomes consisted of wrist range of motion (ROM), pain on a VAS scale (0-10), the DASH score and the patient’s level of satisfaction. The mean follow-up was 27.6 months (16-36). Pain relief and improvements in wrist flexion – extension ROM, radial – ulnar deviation and strength were achieved in every patient. There were no cases of implant failure or dislocation. Considering the good results obtained, we believe that proximal row carpectomy associated with the use of a pyrocarbon RCPI implant is a valid surgical technique for the treatment of stage IV Kienböck’s disease. It is a good alternative to carpal fusion, which leads to wrist immobility, and to total wrist joint replacement, which has a high incidence of dislocation and fracture.

KEYWORDS:

Kienböck’s disease; Maladie de Kienböck; Prothèse RCPI; Proximal row carpectomy; Pyrocarbon; Pyrocarbone; RCPI implant; Résection de la rangée proximale du carpe

Resumen

La enfermedad de Kienböck es una osteonecrosis aséptica del lunado, que gradualmente conduce al colapso total del carpo. La clasificación de Lichtman relaciona la evidencia radiográfica del daño de la muñeca en cuatro etapas diferentes y apoya la toma de decisiones quirúrgicas. Este estudio se relaciona con seis pacientes (2 varones y 4 mujeres) afectados por la enfermedad de Kienböck en estadio IV que se sometieron a una carpectomía en hilera proximal y recibieron un implante de RCPI. Los resultados clínicos consistieron en el rango de movimiento de la muñeca (ROM), el dolor en una escala VAS (0-10), la puntuación DASH y el nivel de satisfacción del paciente. El seguimiento medio fue de 27,6 meses (16-36). Se obtuvieron alivio del dolor y mejoras en la flexión de la muñeca – ROM de extensión, desviación radial – ulnar y fuerza en cada paciente. No hubo casos de fracaso o dislocación de implantes. Teniendo en cuenta los buenos resultados obtenidos, creemos que la carpectomía de hilera proximal asociada con el uso de un implante de RCPI (Resurfacing Capitate Pyrocarbon Implant Prosthesis) es una técnica quirúrgica válida para el tratamiento de la enfermedad de Kienböck en estadio IV. Es una buena alternativa a la fusión del carpo, que conduce a la inmovilidad de la muñeca, y al reemplazo total de la articulación de la muñeca, que tiene una alta incidencia de dislocación y fractura.

PALABRAS CLAVE:
Enfermedad de Kienböck; Maladie de Kienböck; Prothèse RCPI; Carpectomía de fila proximal; Pirocarbono; Pirocarbona; Implante RCPI; Résection de la rangée proximale du carpe

PMID: 28325423 DOI:

10.1016/j.hansur.2016.12.005

#Enfermedad de Kienböck #kienböck #Carpectomía #Pirocarbono #RCPI

La Necesidad Urgente de Evidencia en la Cirugía Meniscal Artroscópica

http://www.clinicadeartroscopia.com.mx/academia/la-necesidad-urgente-de-evidencia-en-la-cirugia-meniscal-artroscopica/

The Urgent Need for Evidence in Arthroscopic Meniscal Surgery

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/27432053

http://journals.sagepub.com/doi/abs/10.1177/0363546516650180?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

De:

Monk P1,Garfjeld Roberts P1,Palmer AJ1,Bayliss L1,Mafi R1,Beard D1,

Hopewell S1,Price A1.

Am J Sports Med.

2017 Mar;45(4):965-973. doi: 10.1177/0363546516650180. Epub 2016 Jul 21.

Abstract

BACKGROUND:

Arthroscopic surgery of the knee is one of the most frequently performed orthopaedic procedures. One-third of these procedures are performed for meniscal injuries. It is essential that this commonly performed surgery be supported by robust evidence.

PURPOSE:

To compare the effectiveness of arthroscopic surgery for meniscal injuries in all populations.

STUDY DESIGN:

Systematic review.

CONCLUSION:

Further evidence is required to determine which patient groups have good outcomes from each intervention. Given the current widespread use of arthroscopic meniscal surgeries, more research is urgently needed to support evidence-based practice in meniscal surgery in order to reduce the numbers of ineffective interventions and support potentially beneficial surgery.

KEYWORDS:

arthroscopy; knee; meniscal tear; meniscus; systematic review

Resumen
ANTECEDENTES:
La cirugía artroscópica de la rodilla es uno de los procedimientos ortopédicos más frecuentes. Un tercio de estos procedimientos se realizan para lesiones meniscales.Es esencial que esta cirugía comúnmente realizada sea apoyada por pruebas sólidas.
PROPÓSITO:
Comparar la efectividad de la cirugía artroscópica para lesiones meniscales en todas las poblaciones.

CONCLUSIÓN:
Se requiere más evidencia para determinar qué grupos de pacientes tienen buenos resultados de cada intervención. Dado el uso generalizado de las cirugías meniscales artroscópicas, se necesita más investigación para apoyar la práctica basada en la evidencia en la cirugía meniscal con el fin de reducir el número de intervenciones ineficaces y apoyar la cirugía potencialmente beneficiosa.
PALABRAS CLAVE:
Artroscopia; rodilla; desgarre meniscal; menisco; revisión sistemática

PMID: 27432053 DOI:

10.1177/0363546516650180

#artroscopia #rodilla #desgarre meniscal #menisco

Examen clínico del tobillo

http://www.mishuesosyarticulaciones.com.mx/academia/examen-clinico-del-tobillo/

Clinical Examination of Ankle

Fuente
Este artículo es originalmente publicado en:

https://youtu.be/yURalgCDQW8

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Dr. Ebraheim’s educational animated video describing fractures of the ankle, Clinical examination, Educational video describing fractures of the ankle X-rays.
It describes ankle fracture classification, ankle fracture dislocation.
It also describes ankle fracture treatment and ankle fracture surgery and ankle fracture recovery.
You look for the circulation, diabetes, peripheral neuropathy.
Make sure that the patient doesn’t have Charcot- fracture or Charcot- joint, as this is very important.
Look also for the soft tissue condition; you may want to delay the surgery until soft tissue condition improves.
You want to do elevation.
Try to identify if there is any open fracture.
Try to reduce the dislocation, try to improve the position of the fractures and splint the patient.
There are 2 points related to clinical exam that is worth mentioning:
1- Clinical exam is unreliable in predicting the medial injury; so if you have swelling, tenderness, or ecchymosis, it’s not reliable in predicting medial injury, you probably need to get stress views, to see if the deltoid ligament is injured or not.
2- If the patient has tenderness over the medial malleolus and unable to bear weight, and the patient is older, get an x-ray, this is not an ankle sprain, this may be a fracture.

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