miércoles, 11 de abril de 2018

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.
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.
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.
Cochrane Database Syst Rev. 2017 Apr 11;4:CD011190. doi: 10.1002/14651858.CD011190.pub2.


Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905

martes, 10 de abril de 2018

Guías pediátricas / Pediatric guidelines

Marzo 31, 2018. No. 3039

Guías para la cirugía pediátrica diurna de las Sociedades Italianas de Cirugía Pediátrica (SICP) y Anestesiología Pediátrica (SARNePI).
Guidelines on pediatric day surgery of the Italian Societies of Pediatric Surgery (SICP) and Pediatric Anesthesiology (SARNePI).
Ital J Pediatr. 2018 Mar 12;44(1):35. doi: 10.1186/s13052-018-0473-1.Abstract
The Italian Society of Pediatric Surgery (SICP) together with The Italian Society of Pediatric Anesthesia (SARNePI) through a systematic analysis of the scientific literature, followed by a consensus conference held in Perugia on 2015, have produced some evidence based guidelines on the feasibility of day surgery in relation to different pediatric surgical procedures. The main aspects of the pre-operative assessment, appropriacy of operations and discharge are reported.
KEYWORDS: Ambulatory surgery; Day case surgery; Day surgery; Guidelines; Outpatient
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905

Pancreatitis aguda / Acute pancreatitis

Abril 2, 2018. No. 3041
Guía del American Gastroenterological Association Institute sobre el manejo inicial de la pancreatitis aguda.
American Gastroenterological Association Institute Guideline on Initial Management of AcutePancreatitis.
Gastroenterology. 2018 Mar;154(4):1096-1101. doi: 10.1053/j.gastro.2018.01.032. Epub 2018 Feb 3.
Pancreatitis aguda: perspectivas actuales sobre diagnóstico y tratamiento.
Acute pancreatitis: current perspectives on diagnosis and management.
J Inflamm Res. 2018 Mar 9;11:77-85. doi: 10.2147/JIR.S135751. eCollection 2018.
Abstract
The last two decades have seen the emergence of significant evidence that has altered certain aspects of the management of acute pancreatitis. While most cases of acute pancreatitis are mild, the challenge remains in managing the severe cases and the complications associated with acute pancreatitis. Gallstones are still the most common cause with epidemiological trends indicating a rising incidence. The surgical management of acute gallstone pancreatitis has evolved. In this article, we revisit and review the methods in diagnosing acute pancreatitis. We present the evidence for the supportive management of the condition, and then discuss the management of acute gallstone pancreatitis. Based on the evidence, our local institutional pathways, and clinical experience, we have produced an outline to guide clinicians in the management of acute gallstone pancreatitis.
KEYWORDS: acute pancreatitis; diagnostic imaging; management of gallstone pancreatitis; severity scoring
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905

Más de pancreatitis / More on pancreatitis

Abril 3, 2018. No. 3042

Evolución de pacientes ancianos después de pancreatitis biliar aguda.
Outcome of elderly patients after acute biliary pancreatitis.
Biosci Trends. 2018;12(1):54-59. doi: 10.5582/bst.2017.01303.
Abstract
The specific management and outcome of acute biliary pancreatitis in elderly patients is not well established. The aim of this study was to assess the outcome of elderly compared to younger patients after acute biliary pancreatitis. Retrospective analysis of consecutive patients admitted with acute biliary pancreatitis between January 2006 and December 2012. Elderly patients (≥ 70 years) were compared to younger patients (< 70 years) in a case-control study. Comorbidities were assessed according to the Charlson score. Clinical (Atlanta score) and radiological (Balthazar and computed tomography severity index scores) severity were analyzed, as well as clinical outcome. Among 212 patients admitted with acute biliary pancreatitis, 76 were > 70 years (35.8%). Elderly patients had a higher Charlson comorbidity index score at admission (p < 0.001). No difference was observed in terms of clinical and radiological severity of acute pancreatitis. The median hospital stay was longer in elderly (11 days, interquartile range 7-15) than in younger patients (7 days, interquartile range 5-11) (p < 0.001). No difference was observed regarding in-hospital 90-day mortality (3 vs. 1 patients, p = 0.133). Elderly patients had similar clinical and radiological severity of acute biliary pancreatitis compared to younger patients.
KEYWORDS: Pancreatitis; aged; gallstones
Nuevo predictor de pancreatitis necrosante aguda: distribución de la amplitud de distribución eritrocitaria.
New predictor of acute necrotizing pancreatitis: Red cell distribution width.
Adv Clin Exp Med. 2018 Feb;27(2):225-228. doi: 10.17219/acem/67590.
Abstract
BACKGROUND: Acute pancreatitis (AP) is inflammation of the pancreas of various severity ranging from mild abdominal pain to mortality. AP may be classified as acute interstitial edematous pancreatitis (AEP) or acute necrotizing pancreatitis (ANP), according to the revised Atlanta criteria. Most of the patients with AP are AEP (75-85% of patients), while 15-25% of patients have ANP. The mortality rate is 3% in AEP and 15% in ANP. Thus, it is important to predict the severity of AP to decrease the morbidity and mortality. OBJECTIVES: The aim of the study was to evaluate the relationship between red cell distribution width (RDW) and the severity of AP on admission to hospital. MATERIAL AND METHODS: Patients admitted to Adana Numune Research and Educational Hospital with a diagnosis of AP through the time frame of January 2014-May 2016 were included in our study. Diagnosis of AP was made according to the revised Atlanta classification. Patients' age, sex, etiology of AP, and RDW values were recorded on admission to the hospital. RESULTS: A total of 180 patients were included in the study. Eighty patients (44%) were male and 100 patients were female. Mean age was 56.25 ±18.3 years (52.66 ±14.4 in males; 59.84 ±20.2 in females). There was no statistically significant difference between patients' age. The most frequently observed etiologic factor was gallstone disease followed by alcohol intake and the use of pharmaceuticals. Drug-related AP was associated with azathioprine, furosemide, and thiazide diuretics. One hundred forty-four (80%) patients had AEP and 36 (20%) patients had ANP. RDW values showed a statistically significant difference between patients with AEP and ANP (p = 0.011). The cut-off value of RDW was 16.4 and the area under curve (AUC) value was 0.591 (p = 0.0227) with a sensitivity of 29.2% and specificity of 89.83%. CONCLUSIONS: Red cell distribution width could be used to evaluate the prognosis of acute pancreatitis.
KEYWORDS: acute necrotizing pancreatitis; acute pancreatitis; red cell distribution width
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905