Delirio postoperatorio / Postoperative delirium

Noviembre 22, 2017. No. 2910

Salino hipertónico en la prevención del delirio en ancianos operados de la cadera Hypertonic saline for prevention of delirium in geriatric patients who underwent hip surgery. Xin X1, Xin F2, Chen X1, Zhang Q1, Li Y1, Huo S1, Chang C1, Wang Q3. Author information J Neuroinflammation. 2017 Nov 14;14(1):221. doi: 10.1186/s12974-017-0999-y. Abstract BACKGROUND: Postoperative delirium (POD) is a common disorder in the elderly patients, and neuroinflammation is the possible underlying mechanism. This study is designed to determine whether or not hypertonic saline (HS) pre-injection can alleviate POD in aged patients. CONCLUSION: HS can alleviate POD in geriatric patients and may inhibit the secretion of inflammatory factors by monocytes. KEYWORDS: Cytokines; Elderly; Hypertonic saline; Monocytes; Neuroinflammation; Postoperative delirium PDF Nivel preoperatorio alto de IL-6 es un factor de riesgo de inicio de delirio postoperatorio en viejos Pre-Operative, High-IL-6 Blood Level is a Risk Factor of Post-Operative Delirium Onset in Old Patients. Capri M1, Yani SL2, Chattat R3, Fortuna D4, Bucci L5, Lanzarini C5, Morsiani C6, Catena F7, Ansaloni L8, Adversi M9, Melotti MR10, Di Nino G10, Franceschi C1. Front Endocrinol (Lausanne). 2014 Oct 17;5:173. doi: 10.3389/fendo.2014.00173. eCollection 2014. Author information Abstract BACKGROUND: Post-operative delirium (POD) is a common complication in elderly patients undergoing surgery, but the underpinning causes are not clear. We hypothesized that inflammaging, the subclinical low and chronic grade inflammation characteristic of old people, can contribute to POD onset. Accordingly, we investigated the association of pre-operative and circulating cytokines in elderly patients, admitted for elective and emergency surgery. CONCLUSION: Pre-operative, high-plasma level of IL-6 was significantly associated with POD onset. We propose IL-6 as an additional risk factor of POD onset together with the previously identified factors. Discovery of all risk factors contributing to POD onset will permit to improve hospitalized patient management and the decrease of healthcare cost. KEYWORDS: IL-6; aging; inflammaging; inflammatory cytokines; post-operative delirium PDF DELIRIUM POST OPERATORIO EN PACIENTES ANCIANOS: UNA REVISIÓN DEL TEMA Nicolás García S. y Ricardo Fuentes H Rev Chil Anest, 2013; 42: 162-166 INTRODUCCIÓN Y CONTEXTO Los cambios demográficos a nivel nacional, dados principalmente por la disminución de la fecundidad y el aumento de la esperanza de vida, han producido un aumento dramático de la población quirúrgica mayor de 65 años. Datos del Instituto Nacional de Estadística (INE) muestran que entre 1907 y 1952 el ritmo de crecimiento medio anual de la población del país entre los distintos grupos de edad era prácticamente el mismo, situación que cambió entre 1952 y el 2002, en que el ritmo de crecimiento de los adultos mayores casi triplicó al de los menores de 15 años. Así, entre los años 2001 y 2011 en el Hospital Clínico de la Pontificia Universidad Católica de Chile se realizaron un total de 110.820 cirugías, de las cuales 28.055 fueron pacientes mayores de 65 años, correspondiente al 25,3% del total, con un promedio de edad de 77 años. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Enfermedades graves y embarazo

Revisión clínica. Poblaciones especiales. Enfermedades graves y embarazo. Clinical review: Special populations--critical illness and pregnancy. Neligan PJ1, Laffey JG. Author information Crit Care. 2011 Aug 12;15(4):227. doi: 10.1186/cc10256. Abstract Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia. Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients. PDF Atención crítica materna: ¿qué podemos aprender de la experiencia del paciente? Un estudio cualitativo Maternal critical care: what can we learn from patient experience? A qualitative study Lisa Hinton, Louise Locock, Marian Knight BMJ Open. 2015; 5(4): e006676. Published online 2015 Apr 27. doi: 10.1136/bmjopen-2014-006676 Objective For every maternal death, nine women develop severe maternal morbidity. Many of those women will need care in an intensive care unit (ICU) or high dependency unit (HDU). Critical care in the context of pregnancy poses distinct issues for staff and patients, for example, with breastfeeding support and separation from the newborn. This study aimed to understand the experiences of women who experience a maternal near miss and require critical care after childbirth. Setting: Women and some partners from across the UK were interviewed as part of a study of experiences of near-miss maternal morbidity. Design: A qualitative study, using semistructured interviews. Participants; A maximum variation sample was recruited of 35 women and 11 partners of women who had experienced a severe maternal illness, which without urgent medical attention would have led to her death. 18 of the women were admitted to ICU or HDU. Results; The findings are presented in three themes: being in critical care; being a new mother in critical care; transfer and follow-up after critical care. The study highlights the shock of requiring critical care for new mothers and the gulf between their expectations of birth and what actually happened; the devastation of being separated from their baby, how valuable access to their newborn was, if possible, and the importance of breast feeding; the difficulties of transfer and the need for more support; the value of follow-up and outreach to this population of critical care patients. Conclusions: While uncommon, critical illness in pregnancy can be devastating for new mothers and presents a challenge for critical care and maternity staff. This study provides insights into these challenges and recommendations for overcoming them drawn from patient experiences. Keywords: QUALITATIVE RESEARCH PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Síndrome de burnout / Burnout syndorme

Noviembre 21, 2017. No. 2909

Síndrome de burnout en medicina de urgencias Burnout syndrome in emergency medicine Dubravka Ivanic1, Visnja Nesek Adam1,2,3,  Ivana Srzic1, Anika Stepic1 and Hrvoje Pintaric4,5 Hong Kong Journal of Emergency Medicine 2017:24(6) Abstract Background: Occupational burnout syndrome generally develops in individuals of helping professions and is considered to result from long-standing stress. Burnout syndrome is characterized by loss of interest, fatigue, or frustration, the negative consequences of which affect the individual's performance, thus being a major factor that influences the quality of work. Objectives: The aim of the study was to assess the existence of burnout syndrome in medical staff working at hospital emergency department. Methods: The study included 120 subjects working at emergency departments. The following two questionnaires were used: Copenhagen Burnout Inventory and Copenhagen Psychosocial Questionnaire. Likert scale was employed on scoring the answers offered in the questionnaires. Statistical analysis was performed using the exploratory factor analysis, analysis of variance, Bonferroni test, and Pearson correlation coefficient. The level of statistical significance was set at p < 0.05. Results: Study results revealed that the subjects suffer mostly from the symptoms of fatigue due to occupational burnout and exhaustion at the end of the day. The prevalence of burnout syndrome was highest among subjects with 11-15 years work in emergency department, while lower risk was recorded in those nurses and physicians who reported a higher level of social support, sense of community, and feedback information. Conclusion: Results of the study confirmed the existence of burnout syndrome in medical staff working at hospital emergency department, with the highest prevalence recorded in those working at this department for more than 11 years. The main burnout symptoms reported by study subjects were fatigue, exhaustion at the end of the day, and feeling that they were giving more than they were receiving in return. Burnout syndrome was found to be less common among those nurses and physicians who reported a higher level of social support, sense of community, and feedback information. Keywords Burnout syndrome, medical staff, emergency department PDF Síndrome de burn out durante la residencia Burnout Syndrome During Residency. Turgut N1, Karacalar S1, Polat C1, Kıran Ö1, Gültop F1, Kalyon ST1, Sinoğlu B1, Zincirci M1, Kaya E2. Author information Turk J Anaesthesiol Reanim. 2016 Oct;44(5):258-264. Epub 2016 Oct 1. Abstract OBJECTIVE: The aim of this study is identified the degree of Burnout Syndrome (BOS) and find out its correlation with years of recidency and sociodemograpfic chareacteristics, training, sleeping habits, such as smoking and alcohol consumption. METHODS: After approval from the Hospital Ethics Committee and obtaining informed consent, First, second, third, fourth and fifth year of recidency staff (n=127) working in our hospital were involved in this study. The standardized Maslach Burnout Inventory (MBI) was used in this study. RESULTS: Fifty six male (44.1%) and seventy one female (55.9%) residents were enroled in this study (Coranbach Alfa(α)=0.873). 57% of the first year residents smokes cigaret and 54% of them use alcohol. 2% of them gets one day off after hospital night shift, 61% of them suffers from disturbed sleep. 60% of them had been stated that they willingly selected their profession. 61% of them prefers talking to friends and 32% of them prefers shopping to overcome stress. There were statistical difference acording to years of recidency in MBI, Emotional Burnout (EB) and desensitisation scale (DS) points. EB scale points of the second year of residency group was statisticaly higher than fourth year of residency group. DS points of second year of residency group was also statisticaly higher than the third and fourth year of residency group. There was no statistical difference between any groups in Personal Success. CONCLUSION: BOS is a frequent problem during residency in anaesthesia. Appropriate definition and awareness are the first important steps to prevent this syndrome. Further administrative approaches should be evaluated with regard to their effects. KEYWORDS: Burnout syndrome; Maslach Burnout Inventory; resident PDF Anestesistas y síndrome de burnout: ¿qué estrategias pueden prevenir esta peligrosa combinación? Anesthetists and burnout syndrome: what strategies can prevent this dangerous combination? Caruselli M1, Michel F2,3. Minerva Anestesiol. 2017 Feb;83(2):136-137. doi: 10.23736/S0375-9393.16.11771-7. Epub 2016 Nov 8. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org