Revisiones_bibliográficas TyO

Local Reg Anesth. 2017 Aug 9;10:83-90. doi: 10.2147/LRA.S111459. eCollection 2017.

Abstract

BACKGROUND:

Intraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids. METHODS: Given the high and even increasing rate of cesarean sections and the sparse information on the etiology, incidence and severity of nausea and vomiting and the impact of prophylactic measures on the incidence of PONV/IONV, this article aims to review the available information and provide pragmatic suggestions on how to prevent nausea and vomiting in this patient cohort. Current literature and guidelines were identified by electronic database searching (MEDLINE via PubMed and Cochrane database of systematic reviews) up to present, searching through reference lists of included literature and personal contact with experts. DISCUSSION AND CONCLUSION: Taking into account the current guidelines and literature as well as everyday clinical experience, the first step for decreasing the incidence of IONV and PONV is a comprehensive management of circulatory parameters. This management includes liberal perioperative fluid administration and the application of vasopressors as the circumstances require. By using low-dose local anesthetics, an additional application of intrathecal or spinal opioids or hyperbaric solutions for a sufficient controllability of neuraxial distribution, maternal hypotension might be reduced. Performing a combined spinal-epidural anesthesia or epidural anesthesia may be considered as an alternative to spinal anesthesia. Antiemetic drugs may be administered restrainedly due to off-label use in pregnant women for IONV or PONV prophylaxis and may be reserved for treatment.

KEYWORDS: PONV; antiemetics; hypotension; neuraxial anesthesia; obstetrics

Comparación de fenilefrina y efedrina en el manejo de la hipotensión inducida por raquia en embarazo de alto riesgo. Revisión narrativa

Comparison of Phenylephrine and Ephedrine in Treatment of Spinal-Induced Hypotension in High-Risk Pregnancies: A Narrative Review.

Dusitkasem S1, Herndon BH2, Somjit M3, Stahl DL2, Bitticker E4, Coffman JC2.

Front Med (Lausanne). 2017 Jan 20;4:2. doi: 10.3389/fmed.2017.00002. eCollection 2017.

Abstract

PURPOSE: To compare maternal and fetal effects of intravenous phenylephrine and ephedrine administration during spinal anesthesia for cesarean delivery in high-risk pregnancies. SOURCE: An extensive literature search was conducted using the US National Library of Medicine, MEDLINE search engine, Cochrane review, and Google Scholar using search terms "ephedrine and phenylephrine," "preterm and term and spinal hypotension," "preeclampsia and healthy parturients," or "multiple and singleton gestation and vasopressor." PRINCIPLE FINDINGS: Both phenylephrine and ephedrine can be safely used to counteract hypotension after spinal anesthesia in patients with uteroplacental insufficiency, pregnancy-induced hypertension, and in non-elective cesarean deliveries. Vasopressor requirements before delivery in high-risk cesarean sections are reduced compared to healthy parturients. Among the articles reviewed, there were no statistically significant differences in umbilical arterial pH, umbilical venous pH, incidence of fetal acidosis, Apgar scores, or maternal hypotension when comparing maternal phenylephrine and ephedrine use. CONCLUSION: From the limited existing data, phenylephrine and ephedrine are both appropriate selections for treating or preventing hypotension induced by neuraxial blockade in high-risk pregnancies. There is no clear evidence that either medication is more effective at maintaining maternal blood pressure or has a superior safety profile in this setting. Further investigations are required to determine the efficacy, ideal dosing regimens, and overall safety of phenylephrine and ephedrine administration in high-risk obstetric patients, especially in the presence uteroplacental insufficiency.

KEYWORDS: ephedrine; fetal compromise; hypotension; phenylephrine; preeclampsia; uteroplacental insufficiency

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

International Anesthesia Research Society Annuals Meetings

USA

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

Congreso IberoLatinoamericano de Cirugía de Mano, del 12 al 14 de abril del 2018 Hotel Barceló Maya Caribe

http://www.clinicademano.com.mx/academia/congreso-iberolatinoamericano-de-cirugia-de-mano/

martes, 19 de diciembre de 2017

Una masa muscular tonificada preserva la función articular en rodillas y caderas con artrosis

http://www.cirugiarticular.com.mx/academia/una-masa-muscular-tonificada-preserva-la-funcion-articular-en-rodillas-y-caderas-con-artrosis/

Body composition and clinical symptoms in patients with hip or knee osteoarthritis: Results from the KHOALA cohort.

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29224976
http://www.semarthritisrheumatism.com/article/S0049-0172(17)30138-5/fulltext

De:

Jeanmaire C1, Mazières B2, Verrouil E2, Bernard L3, Guillemin F4, Rat AC5.
Semin Arthritis Rheum. 2017 Oct 18. pii: S0049-0172(17)30138-5. doi: 10.1016/j.semarthrit.2017.10.012. [Epub ahead of print]

Todos los derechos reservados para:

Copyright © 2017 Elsevier Inc. All rights reserved.

Abstract

OBJECTIVE:

To analyze the associations between body composition, notably low lean mass, and clinicalsymptoms [pain, physical function, quality of life (QoL)] in patients with symptomatic hip and/or knee OA.
METHODS:

Cross-sectional study using data from the 3-year follow-up visit of the Knee and HipOsteoArthritis Long-term assessment (KHOALA) cohort. Skeletal muscle and fat mass were measured by dual X-ray absorptiometry (DXA). Fat mass index (FMI) was defined as total fat mass/height2. Appendicular lean mass was adjusted on body mass index (ALM/BMI), and low lean mass was defined according to the definition of FNIH Sarcopenia Project recommendations. Pain and function were measured by the WOMAC index and QoL by the SF-36.
RESULTS:

In total, 358 patients underwent DXA (67% women, mean [SD] age 63.4 [8.4] years, mean BMI 29.5 [5.6]kg/m2). The visual analog scale (0-100) pain score was 38.0 [24.7] and 25.4% had hipand 74.6% knee OA. Low lean mass and ALM/BMI were associated with impaired QoL and WOMAC scores on bivariate analysis (all p ≤ 0.001) but not on multivariate analysis after adjustment for FMI. For patients with normal BMI, mean [SD] WOMAC scores were higher (greater impairment) with low lean mass than normal body composition (WOMAC function 33.4 [23.3] and 24.0 [17.4], p = 0.02), and mean SF-36 physical component score was lower (greater impairment) 40.3 [10.2] and (44.3 [8.4], p = 0.04). Among patients with obesity, low lean mass had no additional effect.
CONCLUSION:

For patients with OA and normal BMI, QoL and function were more impaired for those with than without low lean mass. Conserving muscle mass in people with OA could have functional and antalgic benefits especially for those with normal BMI.

Copyright © 2017 Elsevier Inc. All rights reserved.

KEYWORDS:

Body composition; Dual X-ray absorptiometry; Knee osteoarthritis; Low lean mass

Resumen

OBJETIVO:

Analizar las asociaciones entre la composición corporal, notablemente la baja masa magra y los síntomas clínicos [dolor, función física, calidad de vida (CdV)] en pacientes con OA de cadera y / o rodilla sintomática.

MÉTODOS:

Estudio transversal con datos de la visita de seguimiento de 3 años de la cohorte de evaluación de la rodilla y la osteoartritis de la cadera a largo plazo (KHOALA). El músculo esquelético y la masa de grasa se midieron mediante absorciometría doble de rayos X (DXA). El índice de masa grasa (FMI) se definió como la masa grasa total / altura2. La masa magra apendicular se ajustó en el índice de masa corporal (ALM / IMC), y la baja masa magra se definió de acuerdo con la definición de las recomendaciones del Proyecto de Sarcopenia FNIH. El dolor y la función se midieron mediante el índice WOMAC y la CdV por el SF-36.

RESULTADOS:

En total, 358 pacientes se sometieron a DXA (67% mujeres, media [DE] edad 63,4 [8,4] años, IMC medio 29,5 [5,6] kg / m2). La escala de la escala analógica visual (0-100) fue de 38.0 [24.7] y el 25.4% tenía cadera y el 74.6% de rodilla OA. La baja masa magra y la ALM / IMC se asociaron con puntuaciones de QoL y WOMAC dañadas en el análisis bivariado (todos p ≤ 0.001) pero no en el análisis multivariado después del ajuste para FMI. Para pacientes con IMC normal, las puntuaciones medias [SD] WOMAC fueron más altas (mayor deterioro) con baja masa magra que la composición corporal normal (función WOMAC 33.4 [23.3] y 24.0 [17.4], p = 0.02) y media SF-36 física el puntaje del componente fue menor (mayor deterioro) 40.3 [10.2] y (44.3 [8.4], p = 0.04). Entre los pacientes con obesidad, la baja masa magra no tuvo ningún efecto adicional.

CONCLUSIÓN:

Para los pacientes con OA y el IMC normal, la CdV y la función fueron más perjudicadas para los que tenían una masa magra baja. La conservación de la masa muscular en personas con OA podría tener beneficios funcionales y antálgicos especialmente para aquellos con un IMC normal.

Copyright © 2017 Elsevier Inc. Todos los derechos reservados.

PALABRAS CLAVE:

Composición corporal; Absorciometría dual de rayos X, Osteoartritis de rodilla; Baja masa magra
PMID: 29224976 DOI: 10.1016/j.semarthrit.2017.10.012

Cuidado respiratorio perioperatorio del obeso / Perioperative respiratory care of obesity

Diciembre 18, 2017. No. 2936

Manejo respiratorio perioperatorio de los pacientes obesos

Respiratory Management of Perioperative Obese Patients.

Imber DA1,2, Pirrone M1,3, Zhang C1,4, Fisher DF5, Kacmarek RM6, Berra L7,8.

Respir Care. 2016 Dec;61(12):1681-1692. Epub 2016 Sep 13.

Abstract

With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia.

KEYWORDS: PEEP; atelectasis; mechanical ventilation; noninvasive ventilation; obesity; recruitment maneuver

International Anesthesia Research Society Annuals Meetings

USA

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

Disectomia endoscopica por hernia de disco L5/S1 y discoplastia L4/L5

http://www.clinicadeartroscopia.com.mx/academia/disectomia-endoscopica-por-hernia-de-disco-l5-s1-y-discoplastia-l4-l5/

Disectomia endoscopica por hernia de disco L5/S1 y discoplastia L4/L5 Equipo de cirugía de Columna Findmed Spine Experts

www.findmed.com.mx

www.clinicadeartroscopia.com.mx

www.drhinojosa-artroscopia.com

¿Cuál es la política óptima para reducir la incidencia del alcohol en la siniestralidad vial?

http://www.traumaysiniestros.com.mx/siniestros/cual-es-la-politica-optima-para-reducir-la-incidencia-del-alcohol-en-la-siniestralidad-vial/

An assessment of the effects of alcohol consumption and prevention policies on traffic fatality rates in the enlarged EU. Time for zero alcohol tolerance?

Este artículo es originalmente publicado en:

Record URL:http://dx.doi.org/10.1016/j.trf.2017.06.017
Record URL:http://www.sciencedirect.com/science/article/pii/S1369847816301838
Availability:
Find a library where document is available. Order URL: http://worldcat.org/issn/13698478

DE:

José I.Castillo-Manzanoa MercedesCastro-Nuñoa XavierFagedab LourdesLópez-Valpuestaa

a: Applied Economics & Management Research Group, University of Seville, Spain

b: Dept. of Economic Policy, University of Barcelona, Spain

https://doi.org/10.1016/j.trf.2017.06.017

Transportation Research Part F: Traffic Psychology and Behaviour

Volume 50, October 2017, Pages 38-49

© 2017 Elsevier Ltd. All rights reserved.

Supplemental Notes:

Abstract reprinted with permission of Elsevier.

Este estudio mantiene que una reducción de la tasa de alcoholemia por sí sola no disminuiría la siniestralidad. Los resultados obtenidos permiten destacar el papel relevante que para la seguridad vial desempeñan la tolerancia social y los hábitos de consumo en torno al alcohol que caracterizan a los 28 estados miembros de la Unión Europea.

Keywords

Alcohol consumption,

Drink driving,

Control policies,

Zero tolerance, approach

Traffic fatalities,

European Union

Palabras clave
Consumo de alcohol, Beber mientras se maneja, políticas de control, tolerancia cero, enfoque fatalidades de tráfico

Analgesia obstétrica / Obstetric analgesia

Diciembre 19, 2017. No. 2937

Anestesia neuroaxial moderna para trabajo de parto y parto.

Modern Neuraxial Anesthesia for Labor and Delivery.

Meng ML1, Smiley R1.

F1000Res. 2017 Jul 25;6:1211. doi: 10.12688/f1000research.11130.1. eCollection 2017.

Abstract

The availability of safe, effective analgesia during labor has become an expectation for women in most of the developed world over the past two or three decades. More than 60% of women in the United States now receive some kind of neuraxial procedure during labor. This article is a brief review of the advantages and techniques of neuraxial labor analgesia along with the recent advances and controversies in the field of labor analgesia. For the most part, we have aimed the discussion at the non-anesthesiologist to give other practitioners a sense of the state of the art and science of labor analgesia in the second decade of the 21st century.

KEYWORDS: analgesia; epidural; neuraxial

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

International Anesthesia Research Society Annuals Meetings

USA