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Anestesia en el espacio / Anesthesia in space

Abril 17, 2018. No. 3054

Anestesia en ambientes austeros: revisión de literatura y consideraciones para futuras misiones de exploración espacial. Anaesthesia in austere environments: literature review and considerations for future space exploration missions. Komorowski M1,2,3, Fleming S4, Mawkin M1, Hinkelbein J5. Author information NPJ Microgravity. 2018 Feb 23;4:5. doi: 10.1038/s41526-018-0039-y. eCollection 2018. Abstract Future space exploration missions will take humans far beyond low Earth orbit and require complete crew autonomy. The ability to provide anaesthesia will be important given the expected risk of severe medical events requiring surgery. Knowledge and experience of such procedures during space missions is currently extremely limited. Austere and isolated environments (such as polar bases or submarines) have been used extensively as test beds for spaceflight to probe hazards, train crews, develop clinical protocols and countermeasures for prospective space missions. We have conducted a literature review on anaesthesia in austere environments relevant to distant space missions. In each setting, we assessed how the problems related to the provision of anaesthesia (e.g., medical kit and skills) are dealt with or prepared for. We analysed how these factors could be applied to the unique environment of a space exploration mission. The delivery of anaesthesia will be complicated by many factors including space-induced physiological changes and limitations in skills and equipment. The basic principles of a safe anaesthesia in an austere environment (appropriate training, presence of minimal safety and monitoring equipment, etc.) can be extended to the context of a space exploration mission. Skills redundancy is an important safety factor, and basic competency in anaesthesia should be part of the skillset of several crewmembers. The literature suggests that safe and effective anaesthesia could be achieved by a physician during future space exploration missions. In a life-or-limb situation, non-physicians may be able to conduct anaesthetic procedures, including simplified general anaesthesia. PDF Intubación después de la inducción de secuencia rápida realizada por personal no médico durante las misiones de exploración espacial: un estudio piloto de simulación en un entorno analógico de Marte. Intubation after rapid sequence induction performed by non-medical personnel during space exploration missions: a simulation pilot study in a Mars analogue environment. Komorowski M1, Fleming S2. Author information Extrem Physiol Med. 2015 Nov 1;4:19. doi: 10.1186/s13728-015-0038-5. eCollection 2015. Abstract BACKGROUND: The question of the safety of anaesthetic procedures performed by non anaesthetists or even by non physicians has long been debated. We explore here this question in the hypothetical context of an exploration mission to Mars. During future interplanetary spacemissions, the risk of medical conditions requiring surgery and anaesthetic techniques will be significant. On Earth, anaesthesia is generally performed by well accustomed personnel. During exploration missions, onboard medical expertise might be lacking, or the crew doctor could become ill or injured. Telemedical assistance will not be available. In these conditions and as a last resort, personnel with limited medical training may have to perform lifesaving procedures, which could include anaesthesia and surgery. The objective of this pilot study was to test the ability for unassisted personnel with no medical training to perform oro-tracheal intubation after a rapid sequence induction on a simulated deconditioned astronaut in a Mars analogue environment. The experiment made use of a hybrid simulation model, in which the injured astronaut was represented by a torso manikin, whose vital signs and hemodynamic status were emulated using a patient simulator software. Only assisted by an interactive computer tool (PowerPoint(®) presentation), five participants with no previous medical training completed a simplified induction of general anaesthesia with intubation. RESULTS: No major complication occurred during the simulated trials, namely no cardiac arrest, no hypoxia, no cardiovascular collapse and no failure to intubate. The study design was able to reproduce many of the constraints of a space exploration mission. CONCLUSIONS: Unassisted personnel with minimal medical training and familiarization with the equipment may be able to perform advanced medical care in a safe and efficient manner. Further studies integrating this protocol into a complete anaesthetic and surgical scenario will provide valuable input in designing health support systems for space exploration missions. KEYWORDS: Anaesthesia; Medical training; Simulation; Space exploration; Space medicine PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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

Dolor persistente postcirugía / Persistent postsurgical pain

Marzo 27, 2018. No. 3035

Dolor persistente y anomalías sensoriales después de la abdominoplastia. Persistent Pain and Sensory Abnormalities after Abdominoplasty. Presman B1, Finnerup K1, Andresen SR1, Nikolajsen L1, Finnerup NB1. Author information Plast Reconstr Surg Glob Open. 2015 Dec 9;3(11):e561. doi: 10.1097/GOX.0000000000000542. eCollection 2015 Nov. Abstract BACKGROUND: Persistent postsurgical pain is a well-recognized problem after a number of common surgical procedures, such as amputation, thoracotomy, and inguinal hernia repair. Less is known about persistent pain after cosmetic surgical procedures. We, therefore, decided to study the incidence and characteristics of persistent pain after abdominoplasty, which is one of the most frequent cosmetic surgical procedures. METHODS: In September 2014, a link to a web-based questionnaire was mailed to 217 patients who had undergone abdominoplastybetween 2006 and 2014 at the Department of Plastic Surgery, Aalborg University Hospital, Denmark. The questionnaire included questions about pain and sensory abnormalities located to the abdominal skin, and physical and psychological function; patient satisfaction with surgery was rated on a 4-point scale. RESULTS: One hundred seventy patients answered the questionnaire. Fourteen patients (8.2%) reported pain within the past 7 days related to the abdominoplasty. Abnormal abdominal skin sensation was common and reported by 138 patients (81%). Sensory hypersensitivity was associated with the presence of persistent pain. Satisfaction with the procedure was reported by 149 (88%) patients. The majority of patients reported improvement on all physical and psychological factors. Patients with pain were more often disappointed with the surgery and unwilling to recommend the surgery. CONCLUSIONS: Overall, patients were satisfied with the procedure, although abnormal abdominal skin sensation was common. However, there is a risk of developing persistent neuropathic pain after abdominoplasty, and patients should be informed about this before surgery. PDF Dolor postquirúrgico persistente en niños y jóvenes: predicción, prevención y manejo. Persistent postsurgical pain in children and young people: prediction, prevention, and management. Williams G1, Howard RF1, Liossi C2,3. Author information Pain Rep. 2017 Aug 21;2(5):e616. doi: 10.1097/PR9.0000000000000616. eCollection 2017 Sep. Abstract Ensuring optimum preoperative and postoperative pain management should always be a priority in children. KEYWORDS: Pediatrics; Postsurgical pain; Surgery PDF La asociación entre la esperanza, el estado civil, la depresión y el dolor persistente en hombres y mujeres después de una cirugía cardíaca. The association between hope, marital status, depression and persistent pain in men and women following cardiac surgery. Bjørnnes AK1,2, Parry M3, Lie I4, Falk R5, Leegaard M6, Rustøen T7,8. Author information BMC Womens Health. 2018 Jan 2;18(1):2. doi: 10.1186/s12905-017-0501-0. Abstract BACKGROUND: Cardiac surgery is a major life event, and outcomes after surgery are associated with men's and women's ability to self-manage and cope with their cardiac condition in everyday life. Hope is suggested to impact cardiac health by having a positive effect on how adults cope with and adapt to illness and recommended lifestyle changes. ....  CONCLUSION: Addressing pain and depression, and promoting hope, particularly for women living alone may be important targets for interventions to improve outcomes following cardiac surgery. KEYWORDS: Cardiac surgery; Depression; Hope; Marital status; Persistent pain PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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

Oxigenación en prematuros / Oxygen in premature neonates

Abril 11, 2018. No. 3050

Una revisión de la fisiología del oxígeno y el manejo apropiado de los niveles de oxígeno en neonatos prematuros. A Review of Oxygen Physiology and Appropriate Management of Oxygen Levels in PrematureNeonates. Kayton A1, Timoney P, Vargo L, Perez JA. Author information Adv Neonatal Care. 2018 Apr;18(2):98-104. doi: 10.1097/ANC.0000000000000434. Abstract BACKGROUND: Although oxygen is the most widely used therapeutic agent in neonatal care, optimal oxygen management remains uncertain. PURPOSE: We reviewed oxygen physiology and balance, key studies evaluating oxygen saturation targets, and strategies for oxygen use in the neonatal intensive care unit. RESULTS: Oxygen is a potent vasodilator involved in the transition at birth to breathing. Supplemental oxygen is administered to reverse/prevent hypoxia; however, excessive oxygen can be toxic owing to the formation of reactive oxygen species. Current neonatal resuscitation guidelines recommend using room air for term infants in need of support, with titration to achieve oxygen saturation levelssimilar to uncompromised term infants. In premature infants, targeting a higher oxygen saturation range (eg, 91%-95%) may be safer than targeting a lower range (eg, 85%-89%), but more evidence is needed. In combined analyses, lower oxygen saturation levels increased mortality, suggesting that the higher target may be safer, but higher targets are associated with an increased risk of developing disorders of oxidative stress. IMPLICATIONS FOR PRACTICE: Need for supplemental oxygen should be assessed according to the American Heart Association guidelines. If appropriate, oxygen should be administered using room air, with the goal of preventing hypoxia and avoiding hyperoxia. Use of oximeter alarms may help achieve this goal. Pulmonary vasodilators may improve oxygenation and reduce supplemental oxygen requirements. IMPLICATIONS FOR RESEARCH: Implementation of wider target ranges for oxygen saturation may be more practical and lead to improved outcomes; however, controlled trials are necessary to determine the impact on mortality and disability. PDF Efectos de las saturaciones de oxígeno arterial más bajas versus más altas en la muerte o la discapacidad en los recién nacidos prematuros. Effects of targeting lower versus higher arterial oxygen saturations on death or disability in preterm infants. Askie LM1, Darlow BA2, Davis PG3, Finer N4, Stenson B5, Vento M6, Whyte R7. Author information Cochrane Database Syst Rev. 2017 Apr 11;4:CD011190. doi: 10.1002/14651858.CD011190.pub2. PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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