miércoles, 14 de febrero de 2018

El anestesiólogo y las drogadicciones / Addiction and substance abuse in anesthesiology

Febrero 14, 2018. No. 2994
Abuso a drogas en anestesiólogos. Realidad preocupante
Dr. Gustavo Calabrese
Rev Mex Anestesiol Vol. 33. Supl. 1, Abril-Junio 2010 pp S206-S208
Adicción y anestesiología
Dra. Dania Elena Escamilla-Ríos
Rev Mex Anestesiol Vol. 35. Supl. 1 Abril-Junio 2012 pp S226-S229
Abuso de Fármacos Anestésicos por parte de los Anestesiólogos
Flavia Serebrenic Jungerman, Hamer Nastasy Palhares Alves, Maria José Carvalho Carmona, TSA, Nancy Brisola Conti, André Malbergier
Rev Bras Anestesiol  2012; 62: 3: 375-386
Adicción y abuso de sustancias en anestesiología.
Addiction and substance abuse in anesthesiology.
Anesthesiology. 2008 Nov;109(5):905-17. doi: 10.1097/ALN.0b013e3181895bc1.
Abstract
Despite substantial advances in our understanding of addiction and the technology and therapeutic approaches used to fight this disease, addiction still remains a major issue in the anesthesia workplace, and outcomes have not appreciably changed. Although alcoholism and other forms of impairment, such as addiction to other substances and mental illness, impact anesthesiologists at rates similar to those in other professions, as recently as 2005, the drug of choice for anesthesiologists entering treatment was still an opioid. There exists a considerable association between chemical dependence and other psychopathology, and successful treatment for addiction is less likely when comorbid psychopathology is not treated. Individuals under evaluation or treatment for substance abuse should have an evaluation with subsequent management of comorbid psychiatric conditions. Participation in self-help groups is still considered a vital component in the therapy of the impaired physician, along with regular monitoring if the anesthesiologist wishes to attempt reentry into clinical practice.
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
World Congress on Regional Anesthesia & Pain Medicine
April 19-21, 2018, New York City, USA
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Anestesiología y Medicina del Dolor

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martes, 13 de febrero de 2018

Cannabis

Enero 31, 2018. No. 2980
¿Los cannabinoides confieren neuroprotección contra la epilepsia? Una descripción general.
Do Cannabinoids Confer Neuroprotection Against Epilepsy? An Overview.
Open Neurol J. 2017 Dec 18;11:61-73. doi: 10.2174/1874205X01711010061. eCollection 2017.
Abstract
OBJECTIVE: Cannabinoid-based medications provide not only relief for specific symptoms, but also arrest or delay of disease progression in patients with pain, multiple sclerosis, and other conditions. Although they also seem to hold potential as anticonvulsant agents, evidence of their efficacy in epilepsy is supported by several evidences. METHOD: The data reviewed herein lend support to the notion that the endocannabinoid signalling system plays a key modulation role in the activities subserved by the hippocampus, which is directly or indirectly affected in epilepsy patients. CONCLUSION: The notion is supported by a variety of anatomical, electrophysiological, biochemical and pharmacological findings. These data suggest the need for developing novel treatments using compounds that selectively target individual elements of the endocannabinoid signalling system.
KEYWORDS: Antiepileptic; Cannabinoids; Cannabis sativa; Epilepsy; Neuroprotection
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
World Congress on Regional Anesthesia & Pain Medicine
April 19-21, 2018, New York City, USA
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Anestesiología y Medicina del Dolor

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Opioides postoperatorios en pacientes vírgenes a narcóticos / Postsurgical opioids prescriptions for opioid naive patients


Prescripciones posquirúrgicas para pacientes vírgenes a los opioides y asociación 
con sobredosis y uso indebido: estudio de cohorte retrospectivo.
Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: 
retrospective cohort study.
BMJ. 2018 Jan 17;360:j5790. doi: 10.1136/bmj.j5790.
Uso persistente de opiáceos después del parto por cesárea: patrones y predictores entre mujeres que no habían recibido opiáceos.
Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women.
Am J Obstet Gynecol. 2016 Sep;215(3):353.e1-353.e18. doi: 10.1016/j.ajog.2016.03.016. Epub 2016 Mar 17.
Abstract
BACKGROUND: The incidence of opioid-related death in women has increased 5-fold over the past decade. For many women, their initial opioid exposure will occur in the setting of routine medical care. Approximately 1 in 3 deliveries in the United States is by cesarean, and opioids are commonly prescribed for postsurgical pain management. OBJECTIVE: The objective of this study was to determine the risk that opioid-naïve women prescribed opioids after cesarean delivery will subsequently become consistent prescription opioid users in the year following delivery and to identify predictors for this behavior. STUDY DESIGN: We identified women in a database of commercial insurance beneficiaries who underwent cesarean delivery and who were opioid naïve in the year prior to delivery. To identify persistent users of opioids, we used trajectory models, which group together patients with similar patterns of medication filling during follow-up, based on patterns of opioid dispensing in the year following cesarean delivery. We then constructed a multivariable logistic regression model to identify independent risk factors for membership in the persistent user group. RESULTS: A total of 285 of 80,127 (0.36%, 95% confidence interval, 0.32-0.40), opioid-naïve women became persistent opioid users (identified using trajectory models based on monthly patterns of opioid dispensing) following cesarean delivery. Demographics and baseline comorbidity predicted such use with moderate discrimination (c statistic = 0.73). Significant predictors included a history of cocaine abuse (risk, 7.41%; adjusted odds ratio, 6.11, 95% confidence interval, 1.03-36.31) and other illicit substance abuse (2.36%; adjusted odds ratio, 2.78, 95% confidence interval, 1.12-6.91), tobacco use (1.45%; adjusted odds ratio, 3.04, 95% confidence interval, 2.03-4.55), back pain (0.69%; adjusted odds ratio, 1.74, 95% confidence interval, 1.33-2.29), migraines (0.91%; adjusted odds ratio, 2.14, 95% confidence interval, 1.58-2.90), antidepressant use (1.34%; adjusted odds ratio, 3.19, 95% confidence interval, 2.41-4.23), and benzodiazepine use (1.99%; adjusted odds ratio, 3.72, 95% confidence interval, 2.64-5.26) in the year prior to the cesarean delivery. CONCLUSION: A very small proportion of opioid-naïve women (approximately 1 in 300) become persistent prescription opioid users following cesarean delivery. Preexisting psychiatric comorbidity, certain pain conditions, and substance use/abuse conditions identifiable at the time of initial opioid prescribing were predictors of persistent use.
KEYWORDS: cesarean delivery; cohort; opioids; pain; pregnancy studies
Incidencia y factores de riesgo para el uso crónico de opiáceos en pacientes vírgenes a opioides en el período postoperatorio.
Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period.
JAMA Intern Med. 2016 Sep 1;176(9):1286-93. doi: 10.1001/jamainternmed.2016.3298.
Abstract
IMPORTANCE: Chronic opioid use imposes a substantial burden in terms of morbidity and economic costs. Whether opioid-naive patients undergoing surgery are at increased risk for chronic opioid use is unknown, as are the potential risk factors for chronic opioid use following surgery. .....
CONCLUSIONS AND RELEVANCE: In opioid-naive patients, many surgical procedures are associated with an increased risk of chronic opioid use in the postoperative period. A certain subset of patients (eg, men, elderly patients) may be particularly vulnerable.
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
World Congress on Regional Anesthesia & Pain Medicine
April 19-21, 2018, New York City, USA
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Anestesiología y Medicina del Dolor

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Peyote y otros alucinógenos / Peyote and other hallucinogens

Febrero 13, 2018. No. 2993
El Peyote y otros cactos alucinógenos de México
Batis A, Rojas M.
Biodiversitas 2002
EN LA AMÉRICAINDÍGENA, el empleo de plantas alucinógenas se presenta como una costumbre de profundo arraigo y antigüedad milenaria. El continente americano es el espacio geográfico donde se ha registrado la mayor diversidad de plantas que contienen principios psicoactivos (más de 100 especies). Estas plantas contienen sustancias químicas -alcaloides- capaces de promover estados anormales de conciencia que ocasionan alteraciones visuales, auditivas, táctiles, olfativas e incluso gustativas. Por esta razón son vistas por algunas culturas como portadoras de inteligencia y son consideradas instru
El "Viaje interminable" entre los usuarios de nuevas sustancias psicoactivas: psicopatología y psicofarmacología en el trastorno de percepción persistente del alucinógeno. Una revisión sistemática.
The "Endless Trip" among the NPS Users: Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review.
Front Psychiatry. 2017 Nov 20;8:240. doi: 10.3389/fpsyt.2017.00240. eCollection 2017.
Abstract
Hallucinogen-persisting perception disorder (HPPD) is a syndrome characterized by prolonged or reoccurring perceptual symptoms, reminiscent of acute hallucinogen effects. HPPD was associated with a broader range of LSD (lysergic acid diethylamide)-like substances, cannabis, methylenedioxymethamphetamine (MDMA), psilocybin, mescaline, and psychostimulants. The recent emergence of novel psychoactive substances (NPS) posed a critical concern regarding the new onset of psychiatric symptoms/syndromes, including cases of HPPD. Symptomatology mainly comprises visual disorders (i.e., geometric pseudo-hallucinations, haloes, flashes of colors/lights, motion-perception deficits, afterimages, micropsia, more acute awareness of floaters, etc.), even though depressive symptoms and thought disorders may be comorbidly present. Although HPPD was first described in 1954, it was just established as a fully syndrome in 2000, with the revised fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). HPPD neural substrates, risk factors, and aetiopathogenesys still largely remain unknown and under investigation, and many questions about its pharmacological targets remain unanswered too. A critical mini review on psychopathological bases, etiological hypothesis, and psychopharmacological approaches toward HPPD, including the association with some novel substances, are provided here, by means of a literature search on PubMed/Medline, Google Scholar, and Scopus databases without time restrictions, by using a specific set of keywords. Pharmacological and clinical issues are considered, and practical psychopharmacological recommendations and clinical guidelines are suggested.
KEYWORDS: flashbacks; hallucinations; hallucinogen-persisting perception disorder; hallucinogens; novel psychoactive substances; palinopsia
La etnobotánica del uso de plantas psicoactivas: una perspectiva filogenética.
The ethnobotany of psychoactive plant use: a phylogenetic perspective.
PeerJ. 2016 Oct 5;4:e2546. doi: 10.7717/peerj.2546. eCollection 2016.
Abstract
Psychoactive plants contain chemicals that presumably evolved as allelochemicals but target certain neuronal receptors when consumed by humans, altering perception, emotion and cognition. These plants have been used since ancient times as medicines and in the context of religious rituals for their various psychoactive effects (e.g., as hallucinogens, stimulants, sedatives). The ubiquity of psychoactive plants in various cultures motivates investigation of the commonalities among these plants, in which a phylogenetic framework may be insightful. A phylogeny of culturally diverse psychoactive plant taxa was constructed with their psychotropic effects and affected neurotransmitter systems mapped on the phylogeny. The phylogenetic distribution shows multiple evolutionary origins of psychoactive families. The plant families Myristicaceae (e.g., nutmeg), Papaveraceae (opium poppy), Cactaceae (peyote), Convolvulaceae (morning glory), Solanaceae (tobacco), Lamiaceae (mints), Apocynaceae (dogbane) have a disproportionate number of psychoactive genera with various indigenous groups using geographically disparate members of these plant families for the same psychoactive effect, an example of cultural convergence. Pharmacological traits related to hallucinogenic and sedative potential are phylogenetically conserved within families. Unrelated families that exert similar psychoactive effects also modulate similar neurotransmitter systems (i.e., mechanistic convergence). However, pharmacological mechanisms for stimulant effects were varied even within families suggesting that stimulant chemicals may be more evolutionarily labile than those associated with hallucinogenic and sedative effects. Chemically similar psychoactive chemicals may also exist in phylogenetically unrelated lineages, suggesting convergent evolution or differential gene regulation of a common metabolic pathway. Our study has shown that phylogenetic analysis of traditionally used psychoactive plants suggests multiple ethnobotanical origins and widespread human dependence on these plants, motivating pharmacological investigation into their potential as modern therapeutics for various neurological disorders.
KEYWORDS: Drug discovery; Ethnopharmacology; Evolutionary ethnobotany; Neuropsychopharmacology; Psychotropic; Traditional medicine
Avances recientes en la neuropsicofarmacología de los alucinógenos serotoninérgicos.
Recent advances in the neuropsychopharmacology of serotonergic hallucinogens.
Behav Brain Res. 2015 Jan 15;277:99-120. doi: 10.1016/j.bbr.2014.07.016. Epub 2014 Jul 15.
Abstract
Serotonergic hallucinogens, such as (+)-lysergic acid diethylamide, psilocybin, and mescaline, are somewhat enigmatic substances. Although these drugs are derived from multiple chemical families, they all produce remarkably similar effects in animals and humans, and they show cross-tolerance. This article reviews the evidence demonstrating the serotonin 5-HT2A receptor is the primary site of hallucinogen action. The 5-HT2A receptor is responsible for mediating the effects of hallucinogens in human subjects, as well as in animal behavioral paradigms such as drug discrimination, head twitch response, prepulse inhibition of startle, exploratory behavior, and interval timing. Many recent clinical trials have yielded important new findings regarding the psychopharmacology of these substances. Furthermore, the use of modern imaging and electrophysiological techniques is beginning to help unravel how hallucinogens work in the brain. Evidence is also emerging that hallucinogens may possess therapeutic efficacy.
KEYWORDS: 5-HT2A receptor; Head twitch; Prefrontal cortex; Psychedelic; Visual effects
Charcot, Mitchell y Lees: pensadores libres de neurología y sus experiencias con drogas psicoactivas.
Charcot, Mitchell and Lees: neurology free thinkers and their experiences of psychoactive drugs.
Arq Neuropsiquiatr. 2016 Dec;74(12):1035-1038. doi: 10.1590/0004-282X20160160.
Abstract
Three world-famous neurologists, Charcot and Mitchell, in the 19th century, and Lees, in this century, all of whom had great scientific curiosity, experimented with the psychoactive drugs hashish, mescal and yagé, respectively, in an attempt to increase their knowledge of neurological diseases and how the brain works.
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
World Congress on Regional Anesthesia & Pain Medicine
April 19-21, 2018, New York City, USA
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Anestesiología y Medicina del Dolor

52 664 6848905