lunes, 25 de septiembre de 2017

Neumoperitoneo / Pneumoperitoneum

Septiembre 25, 2017. No. 2822



  


CTCT-20170914_102711 a.m.
Efectos fisiológicos del neumoperitoneo en la obesidad mórbida
The physiologic effects of pneumoperitoneum in the morbidly obese.
Ann Surg. 2005 Feb;241(2):219-26.
Abstract
OBJECTIVE: To review the physiologic effects of carbon dioxide (CO2) pneumoperitoneum in the morbidly obese. SUMMARY BACKGROUND DATA: The number of laparoscopic bariatric operations performed in the United States has increased dramatically over the past several years. Laparoscopic bariatric surgery requires abdominal insufflation with CO2 and an increase in the intraabdominal pressure up to 15 mm Hg. Many studies have demonstrated the adverse consequences of pneumoperitoneum; however, few studies have examined the physiologic effects of pneumoperitoneum in the morbidly obese. METHODS: A MEDLINE search from 1994 to 2003 was performed using the key words morbid obesity, laparoscopy, bariatric surgery, pneumoperitoneum, and gastric bypass. The authors reviewed papers evaluating the physiologic effects of pneumoperitoneum in morbidly obese subjects undergoing laparoscopy. The topics examined included alteration in acid-base balance, hemodynamics, femoral venous flow, and hepatic, renal, and cardiorespiratory function. RESULTS: Physiologically, morbidly obese patients have a higher intraabdominal pressure at 2 to 3 times that of nonobese patients. The adverse consequences of pneumoperitoneum in morbidly obese patients are similar to those observed in nonobese patients. Laparoscopy in the obese can lead to systemic absorption of CO2 and increased requirements for CO2 elimination. The increased intraabdominal pressure enhances venous stasis, reduces intraoperative portal venous blood flow, decreases intraoperative urinary output, lowers respiratory compliance, increases airway pressure, and impairs cardiac function. Intraoperative management to minimize the adverse changes include appropriate ventilatory adjustments to avoid hypercapnia and acidosis, the use of sequential compression devices to minimizes venous stasis, and optimize intravascular volume to minimize the effects of increased intraabdominal pressure on renal and cardiac function. CONCLUSIONS: Morbidly obese patients undergoing laparoscopic bariatric surgery are at risk for intraoperative complications relating to the use of CO2 pneumoperitoneum. Surgeons performing laparoscopic bariatric surgery should understand the physiologic effects of CO2 pneumoperitoneum in the morbidly obese and make appropriate intraoperative adjustments to minimize the adverse changes.
Paro cardiaco asociado con embolismo gaseoso por bióxido de carbono durante cirugía laparoscópica para cáncer colorrectal y metástasis hepáticas. Informe de caso
Cardiac arrest associated with carbon dioxide gas embolism during laparoscopic surgery for colorectal cancer and liver metastasis -A case report-.
Korean J Anesthesiol. 2012 Nov;63(5):469-72. doi: 10.4097/kjae.2012.63.5.469. Epub 2012 Nov 16.
Abstract
Clinically apparent carbon dioxide (CO(2)) gas embolism is uncommon, but it may be a potentially lethal complication if it occurs. We describe a 40-year-old woman who suffered a CO(2) gas embolism with cardiac arrest during laparoscopic surgery for colorectal cancer and liver metastasis. Intra-abdominal pressure was controlled to less than 15 mmHg during CO(2) gas pneumoperitoneum. The right hepatic vein was accidentally disrupted during liver dissection, and an emergent laparotomy was performed. A few minutes later, the end-tidal CO(2) decreased, followed by bradycardia and pulseless electrical activity. External cardiac massage, epinephrine, and atropine were given promptly. Ventilation with 100% oxygen was started and the patient was moved to the Trendelenburg position. Two minutes after resuscitation was begun, a cardiac rhythm reappeared and a pulsatile arterial waveform was displayed. A transesophageal echocardiogram showed airbubbles in the right pulmonary artery. The patient recovered completely, with no cardiopulmonary or neurological sequelae.
KEYWORDS: Carbon dioxide gas embolism; Laparoscopic surgery; Transesophageal echocardiography
La eficacia de la dexmedetomidina intravenosa en la hemodinámica perioperatoria, requerimientos de analgésicos y perfil de efectos secundarios en pacientes sometidos a cirugía laparoscópica bajo anestesia general.
The Effectiveness of Intravenous Dexmedetomidine on Perioperative Hemodynamics, Analgesic Requirement, and Side Effects Profile in Patients Undergoing Laparoscopic Surgery Under General Anesthesia.
Anesth Essays Res. 2017 Jan-Mar;11(1):72-77. doi: 10.4103/0259-1162.200232.
Abstract
BACKGROUND: There is an upward surge in the use of laparoscopic surgeries due to various advantages when compared to open surgeries. Major advantages are, due to small incisions which are cosmetically acceptable and most of them are now daycare procedures. Problem of economic burden and hospital bed occupancy has been overcome with laparoscopic surgeries. All these advantages are not free from disadvantages, as hemodynamic changes such as hypertension; tachycardia and other surgical-related complications are commonly observed intraoperatively. Dexmedetomidine is one of the α2 agonist drugs which acts at both supraspinal and spinal level and modulate the transmission of nociceptive signals in the central nervous system. The basic effect of dexmedetomidine on the cardiovascular system is to decrease the heart rate and systemic vascular resistance with additional feature of opioid sparing effect. This drug has become an ideal adjuvant during general anesthesia, especially when stress is expected. Hence, the drug was studied in laparoscopic surgeries. AIMS AND OBJECTIVES: (a) To study the effect of dexmedetomidine on hemodynamic parameters during perioperative period in patients undergoing laparoscopic surgery. (b) To study the postoperative sedation score and analgesic requirement. (c) To study the side effect profile of dexmedetomidine. SETTINGS AND DESIGN:
Randomized double blind controlled trial. SUBJECTS AND METHODS: After obtaining the Institutional Ethical Clearance, the study was conducted. Forty patients of American Society of Anesthesiologists Class I and II were enrolled in this randomized study. The patients were randomly divided into two groups; group normal saline (NS) and group dexmedetomidine. Patient received either NS or dexmedetomidine in group NS and group dexmedetomidine, respectively, depending upon the allocation. The infusion rate was adjusted according to; loading dose (1 μg/kg) over 10 min and maintenance dose (0.5 μg/kg/h) and perioperative hemodynamics was recorded. Routine general anesthesia was administered in all the patients with conventional technique without deviating from institutional protocols. Postoperatively, Rasmsay sedation score, time taken for request of first analgesic dose, and side effects if any were recorded. STATISTICAL ANALYSIS USED: The categorical factors are represented by the number and frequency (%) of cases. The continuous variables are represented by measures of central frequency and standard deviation. The statistical analysis was done by using unpaired t-test and Chi-square. P < 0.05 was considered statistically significant. RESULTS: Significant hemodynamic changes are observed in NS group during laryngoscopy, intubation, during pneumoperitoneumformation, and during extubation. Hemodynamic stress response in dexmedetomidine group was significantly attenuated. Analgesic requirement during postoperative 24 h were much less in dexmedetomidine group when compared to NS group. No significant side effects were noted except for bradycardia; which was observed in two cases of dexmedetomidine group. CONCLUSION: Dexmedetomidine infusion in the dose of 1 μg/kg body weight as bolus over 10 min and 0.5 μg/kg/h intraoperatively as maintenance dose controlled the hemodynamic stress response in patients undergoing laparoscopic surgery. Use of dexmedetomidine extends the pain free period postoperatively and thereby reducing total analgesic requirement. Thus, dexmedetomidine can be utilized as an ideal anesthetic adjuvant during laparoscopic surgeries.
KEYWORDS: Analgesia; dexmedetomidine; laparoscopic surgery; sedation; α2 agonist

XIV Congreso Virtual Mexicano de Anestesiología 2017
Octubre 1-Diciembre 31, 2017
Información / Information
XXVII Congreso Peruano de Anestesiología
Lima, Noviembre 2-4, 2017
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Anestesiología y Medicina del Dolor

52 664 6848905

domingo, 24 de septiembre de 2017

Libros sobre desastres naturales / Books on natural disasters

Septiembre 24, 2017. No. 2821





Los huracanes Katia, Irma y José han sido devastadores en los países del Caribe, y su fuerza destructiva ha llegado al continente americano afectando a México y Estados Unidos de Norteamérica. María es otro de los 27 huracanes que se esperan en México para este 2017.
Nuestro país está ubicado en una zona de riesgo sísmico al estar sobre cuatro placas tectónicas: Caribe, Norteamérica, Nazca y Cocos por lo cual cada día se registran más de 15 temblores de magnitud superior a 2. La combinación de los desastres por los ciclones y los sismos frecuentes nos ha puesto a prueba, prueba que vamos superando gracias a nuestra forma de ser, al cariño entre mexicanos que nos brindamos apoyo total aun sin conocernos y desde luego, al gran apoyo internacional que México ha recibido.
Con este envío agradecemos las muestras de empatía y los apoyos que los mexicanos hemos recibido durante esta crisis nacional. ¡Dios les bendiga!

Hurricanes Katia, Irma and Jose have been devastating in the Caribbean countries, and their destructive force has reached the American continent affecting Mexico and the United States of America. María is another of the 27 hurricanes expected in Mexico for this 2017. Our country is in an area of seismic risk because it is on four tectonic plates: Caribbean, North America, Nazca and Cocos, whereby every day more than 15 tremors of magnitude higher than 2 are registered. The combination of cyclone disasters and frequent earthquakes has tested us, proves that we are surpassing thanks to our way of being, to the affection among Mexicans that we give ourselves full support even without knowing ourselves and of course, the great international support that Mexico has received.
With this e-mail we are grateful for the signs of empathy and support that Mexicans have received during this national crisis. God bless you!

Os furacões Katia, Irma e José foram devastadores nos países do Caribe e sua força destrutiva atingiu o continente americano afetando o México e os Estados Unidos da América. María é outro dos 27 furacões esperados no México para este ano de 2017. Nosso país está localizado em uma zona de risco sísmico porque está em quatro placas tectônicas: Caribe, América do Norte, Nazca e Cocos, onde todos os dias são registados mais de 15 tremores de magnitude superiores a 2.
A combinação de catástrofes e terremotos freqüentes nos testou, prova que estamos superando graças ao nosso modo de ser, ao afeto entre os mexicanos que nos damos todo o suporte, mesmo sem nos conhecer e, claro, o grande apoio internacional que O México recebeu.
Com este envio, agradecemos os sinais de empatia e apoio que os mexicanos receberam durante esta crise nacional. Deus os abençoe!

Els huracans Katia, Irma i José han estat devastadors en els països del Carib, i la seva força destructiva ha arribat al continent americà afectant Mèxic i Estats Units d'Amèrica del Nord. Maria és un altre dels 27 huracans que s'esperen a Mèxic per a aquest 2017. El nostre país està ubicat en una zona de risc sísmic a l'estar sobre quatre plaques tectòniques: Carib, Amèrica del Nord, Nazca i Cocos per la qual cosa cada dia es registren més de 15 tremolors de magnitud superior a 2.
La combinació dels desastres pels ciclons i els sismes freqüents ens ha posat a prova, prova que anem superant gràcies a la nostra manera de ser, a l'afecte entre mexicans que ens brindem suport total i tot sense conèixer-nos i per descomptat, al gran suport internacional que Mèxic ha rebut.
Amb aquesta tramesa agraïm les mostres d'empatia i els suports que els mexicans hem rebut durant aquesta crisi nacional. Déu els beneeixi!
Enlaces para donar / Links to donate
Investigación y Análisis de Sismos - Estudios Estadísticos, Observaciones y Planificación
Earthquake Research and Analysis - Statistical Studies, Observations and Planning
Edited by Sebastiano D'Amico, ISBN 978-953-51-0134-5, 470 pages, Publisher: InTech, Chapters published March 02, 2012 under CC BY 3.0 license
DOI: 10.5772/2461
Edited Volume
The study of earthquakes plays a key role in order to minimize human and material losses when they inevitably occur. 
Chapters in this book will be devoted to various aspects of earthquake research and analysis. The different sections present in the book span from statistical seismology studies, the latest techniques and advances on earthquake precursors and forecasting, as well as, new methods for early detection, data acquisition and interpretation. The topics are tackled from theoretical advances to practical applications.
Investigación y Análisis de terremotos - Sismología, Sismotectonica y Geología de terremotos
Earthquake Research and Analysis - Seismology, Seismotectonic and Earthquake Geology
Edited by Sebastiano D'Amico, ISBN 978-953-307-991-2, 416 pages, Publisher: InTech, Chapters published February 08, 2012 under CC BY 3.0 license
DOI: 10.5772/1117
Edited Volume
This book is devoted to different aspects of earthquake research. 
Depending on their magnitude and the placement of the hypocenter, earthquakes have the potential to be very destructive. Given that they can cause significant losses and deaths, it is really important to understand the process and the physics of this phenomenon. This book does not focus on a unique problem in earthquake processes, but spans studies on historical earthquakes and seismology in different tectonic environments, to more applied studies on earthquake geology.
Avances en la Investigación de Huracanes - Modelado, Meteorología, Preparación e Impactos
Advances in Hurricane Research - Modelling, Meteorology, Preparedness and Impacts
Edited by Kieran Hickey, ISBN 978-953-51-0867-2, 206 pages, Publisher: InTech, Chapters published December 05, 2012 under CC BY 3.0 license
DOI: 10.5772/3399
Edited Volume
This book provides a wealth of new information, ideas and analysis on some of the key unknowns in hurricane research. 
Topics covered include the numerical prediction systems for tropical cyclone development, the use of remote sensing methods for tropical cyclone development, a parametric surface wind model for tropical cyclones, a micrometeorological analysis of the wind as a hurricane passes over Houston, USA, the meteorological passage of numerous tropical cyclones as they pass over the South China Sea, simulation modelling of evacuations by motorised vehicles in Alabama, the influence of high stream-flow events on nutrient flows in the post hurricane period, a reviews of the medical needs, both physical and psychological of children in a post hurricane scenario and finally the impact of two hurricanes on Ireland. Hurricanes discussed in the various chapters include Katrina, Ike, Isidore, Humberto, Debbie and Charley and many others in the North Atlantic as well as numerous tropical cyclones in the South China Sea.
Desastres naturales
Natural Disasters
Edited by Sorin Cheval, ISBN 978-953-51-0188-8, 166 pages, Publisher: InTech, Chapters published March 02, 2012 under CC BY 3.0 license
DOI: 10.5772/1373
Edited Volume
The crossroads between a more and more populated human communities and their changing environment pose different challenges than ever before. 
Therefore, any attempt to identify and deliver possible solutions is more than welcome. The book Natural Disasters addresses the needs of various users, interested in a better understanding of hazards and their more efficient management. It is a scientific enterprise tackling a variety of natural hazards potentially deriving into disasters, i.e. tropical storms, avalanches, coastal floods. The case studies presented cover different geographical areas, and they comprise mechanisms for being transferred to other spots and circumstances. Hopefully, the book will be beneficial to those who invest their efforts in building communities resilient to natural disasters.
Trastornos de estrés postraumático en un contexto global
Post Traumatic Stress Disorders in a Global Context
Edited by Emilio Ovuga, ISBN 978-953-307-825-0, 298 pages, Publisher: InTech, Chapters published January 20, 2012 under CC BY 3.0 license
DOI: 10.5772/1281
Edited Volume
If, as a health care or social service provider, one was called upon to help someone who has experienced terror in the hands of a hostage taker, an irate and chronically abusive spouse or parent, or a has survived a motor vehicle accident, landslide, earthquake, hurricane or even a massive flood, what would be one's priority response? 
What would be considered as the most pressing need of the individual requiring care? Whatever the answer to each of these questions, people who have experienced terror, suffer considerable psychological injury. Post-Traumatic Stress Disorder in a Global Context offers some answers to meet the needs of health care and socials service providers in all settings, whether in a hospital emergency room, at the war front, or natural disaster site. The take home message is, after providing emergency care, there is always a pressing need to provide mental health care to all victims of traumatic stress.
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Resultados radiológicos y clínicos a largo plazo de la osificación heterotópica después del reemplazo total del disco lumbar


Radiological and clinical long-term results of heterotopic ossification following lumbar total disc replacement

Fuente
Este artículo es originalmente publicado en:
De:
2017 Sep 19. pii: S1529-9430(17)30985-3. doi: 10.1016/j.spinee.2017.09.003. [Epub ahead of print]
Todos los derechos reservados para:
Copyright © 2017 Elsevier Inc. All rights reserved
Abstract
BACKGROUND:
The long-term results of heterotopic ossification (HO) following lumbar total disc replacement (TDR) and the corresponding clinical and radiological outcomes are unclear.
PURPOSE:
To report the long-term results of HO following lumbar TDR and to analyze the clinical and radiological outcomes.
CONCLUSION:
We found that the incidence of HO is the highest within 12 months after lumbar TDR, and the incidence might increase 5 years after surgery. Furthermore, HO progressed over time. Segmental ROM (range of motion ) was decreased in HO groups; however, the limitation in motion might have little clinical influence.
KEYWORDS:
Degenerative disc disease; Heterotopic ossification; Lumbar disc; Total disc Replacement

Resumen
ANTECEDENTES:
Los resultados a largo plazo de la osificación heterotópica (HO) después de la sustitución del disco lumbar total (TDR) y los correspondientes resultados clínicos y radiológicos no están claros.
PROPÓSITO:
Informar los resultados a largo plazo de la HO tras el TDR lumbar y analizar los resultados clínicos y radiológicos.
CONCLUSIÓN:
Se encontró que la incidencia de HO es la más alta dentro de los 12 meses después del TDR lumbar, y la incidencia podría aumentar 5 años después de la cirugía. Además, HO progresó con el tiempo. El  segmento de ROM  (rango de movimiento) disminuyó en los grupos HO; sin embargo, la limitación en movimiento podría tener poca influencia clínica.
PALABRAS CLAVE:
Enfermedad degenerativa del disco; Osificación osteotópica; Disco lumbar; Reemplazo total del disco
Copyright © 2017 Elsevier Inc. All rights reserved.
PMID: 28939171   DOI:   10.1016/j.spinee.2017.09.00