domingo, 28 de noviembre de 2010

OCLUSION DE VENAS RETINALES

Teaching Topic
Retinal-Vein Occlusion
Clinical Practice
Retinal-Vein Occlusion
T.Y. Wong and I.U. Scott
     


Retinal-vein occlusion is a common cause of vision loss in older persons, and the second most common retinal vascular disease after diabetic retinopathy. In branch retinal-vein occlusion, the occlusion is at an arteriovenous intersection; in central retinal-vein occlusion, the occlusion is at or proximal to the lamina cribosa of the optic nerve, where the central retinal vein exits the eye.
Clinical Pearls
  How does branch retinal-vein occlusion present?
Patients with retinal-vein occlusion typically present with sudden, unilateral, painless loss of vision. The degree of vision loss depends on the extent of retinal involvement and on macular-perfusion status. Some patients with branch retinal-vein occlusion report only a peripheral visual-field defect.
  What are the major risk factors for branch retinal-vein occlusion?
The strongest risk factor for branch retinal-vein occlusion is hypertension, but associations have been reported for diabetes mellitus, dyslipidemia, cigarette smoking, and renal disease.
Figure 1. Branch Retinal-Vein Occlusion in the Superotemporal Quadrant of the Right Eye.
Morning Report Questions
Q. What is the recommended management of a patient with branch retinal-vein occlusion?
A. The authors suggest that first-line treatment of branch retinal-vein occlusion is grid laser photocoagulation, since longer-term data from clinical trials have shown improvement in visual acuity, lower rates of adverse effects, and lower costs with this treatment than with anti-VEGF therapy. Grid, or focal, laser photocoagulation is used for the treatment of macular edema resulting from branch retinal-vein occlusion. Treatment with a dexamethasone implant is another option, but evidence is lacking to demonstrate an improvement in visual acuity beyond 3 months.
Q. What is the recommended management of a patient with a central retinal-vein occlusion?
A. Whereas macular edema resulting from branch retinal-vein occlusion is susceptible to treatment with grid laser photocoagulation, that resulting from central retinal-vein occlusion is not. Ranibizumab and bevacizumab are widely used in the treatment of central retinal-vein occlusion, as well as in the treatment of branch retinal-vein occlusion, and have been demonstrated to improve vision. The study of intravitreal injection of dexamethasone through an implant showed that the intervention improved vision in patients with central retinal-vein occlusion.

Resucitación cardiopulmonar


 

----- Mensaje reenviado ----
De: Victor Whizar-Lugo <vwhizar@anestesia-dolor.org>
Para: maximocuadros@yahoo.es
Enviado: jue,25 noviembre, 2010 12:51
Asunto: Resucitación cardiopulmonar

Anestesia y Medicina del Dolor
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No:327     

Noviembre 24, 2010
 Tradiciones

Estimad@ Maximo Jesus Cuadros Chavez:

 

Aspectos destacados de las guías de la American Heart Association de 2010 para RCP y ACE

Mary Fran Hazinski, RN, MSN
© 2010 American Heart Association


La presente publicación "Aspectos destacados de las guías" resume las principales cuestiones y cambios de las Guías de la American Heart Association (AHA) de 2010 para reanimación cardiopulmonar (RCP) y atención cardiovascular de emergencia (ACE). Se ha desarrollado con el objetivo de que los proveedores de reanimación y los instructores de la AHA se enfoquen en la ciencia y en las recomendaciones que son más importantes, las que fueron más discutidas o las que resultarán en cambios en la aplicación de la reanimación o en el modo de entrenarse para ello. Además, se ofrecen los fundamentos de dichas recomendaciones.


Artículo en PDF

Atentamente
Enf. Rosario Camacho

Anestesiología y Medicina del Dolor


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Sedation of Ventilated Patients and Analgesia....


Maximo Cuadros Chavez posted in cibermedicos.
Sedation of Ventilated Patients and Analgesia.  Sandiumenge, Alberto MD, PhD One of every 3 patients admitted in an  intensive care unit undergoes mechanical  ventilation. Sedation and  analgesia are required to facilitate patient  tolerance to such an  aggressive procedure, diminishing stress response,  relieving pain and  anxiety, ensuring patient comfort, and facilitating nursing  care.  However, misuse of sedatives and analgesics may impact negatively on   critically ill patients. The recognition of the potential for enduring  effects  derived from sedative and analgesic misuse, the availability of  new agents, and  the growing emphasis on cost containment have led to  important changes in the  way that sedation and analgesia practices are  implemented. The aim of the  present review is to discuss the agents,  indications, complications, and most  important strategies to optimize  the sedation and analgesic practices in the  intensive care unit.  Clin Pulm Med 2010;17: 290–299 PDF (461 K) http://www.facebook.com/l/2b97azD73sIpFIAiod9tXCO69aQ;pt.wkhealth.com/pt/re/merck/pdfhandler.00045413-201011000-00006.pdf;jsessionid=MyJVCkcGDpK2bVR2MgTFHJPtx0T1hqG5fl4W1B7psyGb51GpGsym!1173397540!181195629!8091!-1  Atte. Dr.Máximo Cuadros Chávez Celular 99199698 – Movistar - rpm #800515  http://www.facebook.com/l/2b97avSIOYqlN8HF8or5Z3ojjKw;es.groups.yahoo.com/group/interno_residente_medico_PERU/ http://es-la.facebook.com/people/Maximo-Cuadros-Chavez/100001101314342 http://www.facebook.com/l/2b97aYBg96px6dDuOMoo9Juzsuw;medicalia.ning.com/ http://www.facebook.com/l/2b97aKWkCqFmXBdJtT7YPZFy5Pg;www.medsocial.org/ http://www.facebook.com/l/2b97arWz_PsRntUj8w9rxf1xfDg;medbook.ning.com/ UNYK: 245 HRP
Maximo Cuadros Chavez 8:46am Nov 28
Sedation of Ventilated Patients and Analgesia.
Sandiumenge, Alberto MD, PhD
One of every 3 patients admitted in an intensive care unit undergoes mechanical
ventilation. Sedation and analgesia are required to facilitate patient
tolerance to such an aggressive procedure, diminishing stress response,
relieving pain and anxiety, ensuring patient comfort, and facilitating nursing
care. However, misuse of sedatives and analgesics may impact negatively on
critically ill patients. The recognition of the potential for enduring effects
derived from sedative and analgesic misuse, the availability of new agents, and
the growing emphasis on cost containment have led to important changes in the
way that sedation and analgesia practices are implemented. The aim of the
present review is to discuss the agents, indications, complications, and most
important strategies to optimize the sedation and analgesic practices in the
intensive care unit.

Clin Pulm Med 2010;17: 290–299
PDF (461 K)
http://www.facebook.com/l/2b97azD73sIpFIAiod9tXCO69aQ;pt.wkhealth.com/pt/re/merck/pdfhandler.00045413-201011000-00006.pdf;jsessionid=MyJVCkcGDpK2bVR2MgTFHJPtx0T1hqG5fl4W1B7psyGb51GpGsym!1173397540!181195629!8091!-1

Atte.
Dr.Máximo Cuadros Chávez
Celular 99199698 – Movistar - rpm #800515

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UNYK: 245 HRP

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sábado, 27 de noviembre de 2010

Cannabis y dolor


 

----- Mensaje reenviado ----
De: Victor Whizar-Lugo <vwhizar@anestesia-dolor.org>
Para: maximocuadros@yahoo.es
Enviado: jue,25 noviembre, 2010 13:06
Asunto: Cannabis y dolor

Anestesia y Medicina del Dolor
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No:328     

Noviembre 25, 2010
 Tradiciones

Estimad@ Maximo Jesus Cuadros Chavez:

 

Cannabis fumada para el dolor neuropático crónico: un ensayo controlado aleatorizado

Smoked cannabis for chronic neuropathic pain: a randomized controlled trial.
Ware MA, Wang T, Shapiro S, Robinson A, Ducruet T, Huynh T, Gamsa A, Bennett GJ, Collet JP.
Department of Anesthesia, McGill University, Montréal, Que.

CMAJ. 2010 Oct 5;182(14):E694-701. Epub 2010 Aug 30.


Abstract
BACKGROUND: Chronic neuropathic pain affects 1%-2% of the adult population and is often refractory to standard pharmacologic treatment. Patients with chronic pain have reported using smoked cannabis to relieve pain, improve sleep and improve mood. METHODS: Adults with post-traumatic or postsurgical neuropathic pain were randomly assigned to receive cannabis at four potencies (0%, 2.5%, 6% and 9.4% tetrahydrocannabinol) over four 14-day periods in a crossover trial. Participants inhaled a single 25-mg dose through a pipe three times daily for the first five days in each cycle, followed by a nine-day washout period. Daily average pain intensity was measured using an 11-point numeric rating scale. We recorded effects on mood, sleep and quality of life, as well as adverse events. RESULTS: We recruited 23 participants (mean age 45.4 [standard deviation 12.3] years, 12 women [52%]), of whom 21 completed the trial. The average daily pain intensity, measured on the 11-point numeric rating scale, was lower on the prespecified primary contrast of 9.4% v. 0% tetrahydrocannabinol (5.4 v. 6.1, respectively; difference = 0.7, 95% confidence interval [CI] 0.02-1.4). Preparations with intermediate potency yielded intermediate but nonsignificant degrees of relief. Participants receiving 9.4% tetrahydrocannabinol reported improved ability to fall asleep (easier, p = 0.001; faster, p < 0.001; more drowsy, p = 0.003) and improved quality of sleep (less wakefulness, p = 0.01) relative to 0% tetrahydrocannabinol. We found no differences in mood or quality of life. The most common drug-related adverse events during the period when participants received 9.4% tetrahydrocannabinol were headache, dry eyes, burning sensation in areas of neuropathic pain, dizziness, numbness and cough. CONCLUSION: A single inhalation of 25 mg of 9.4% tetrahydrocannabinol herbal cannabis three times daily for five days reduced the intensity of pain, improved sleep and was well tolerated. Further long-term safety and efficacy studies are indicated. (International Standard Randomised Controlled Trial Register no. ISRCTN68314063).

 

Lea el artículo completo en el siguiente enlace:


http://www.cmaj.ca/cgi/reprint/182/14/E694

 

El sistema endocannabinoide y el dolor

The endocannabinoid system and pain.
Guindon J, Hohmann AG.
Neuroscience and Behavior Program, Department of Psychology, University of Georgia, Athens, GA 30602-3013, USA.
CNS Neurol Disord Drug Targets. 2009 Dec;8(6):403-21.


Abstract
The therapeutic potential of cannabinoids has been the topic of extensive investigation following the discovery of cannabinoid receptors and their endogenous ligands. Cannabinoid receptors and their endogenous ligands are present at supraspinal, spinal and peripheral levels. Cannabinoids suppress behavioral responses to noxious stimulation and suppress nociceptive processing through activation of cannabinoid CB(1) and CB(2) receptor subtypes. Endocannabinoids, the brain's own cannabis-like substances, share the same molecular target as Delta(9)-tetrahydrocannabinol, the main psychoactive component in cannabis. Endocannabinoids serve as synaptic circuit breakers and regulate multiple physiological and pathological conditions, e.g. regulation of food intake, immunomodulation, inflammation, analgesia, cancer, addictive behavior, epilepsy and others. This review will focus on uncovering the roles of anandamide and 2-arachidonoylglycerol, the two best characterized endocannabinoids identified to date, in controlling nociceptive responding. The roles of anandamide and 2-arachidonoylglycerol, released under physiological conditions, in modulating nociceptive responding at different levels of the neuraxis will be emphasized in this review. Effects of modulation of endocannabinoid levels through inhibition of endocannabinoid hydrolysis and uptake is also compared with effects of exogenous administration of synthetic endocannabinoids in acute, inflammatory and neuropathic pain models. Finally, the therapeutic potential of the endocannabinoid signaling system is discussed in the context of identifying novel pharmacotherapies for the treatment of pain.

 

Artí­culo en PDF 

Novedades sobre las potencialidades terapéuticas del Cannabis y el sistema cannabinoide 

Marta Duran, Joan-Ramon Laporte y Dolors Capellà
Fundació Institut Català de Farmacologia. Hospitals Vall d'Hebron.
Universitat Autònoma de Barcelona. Barcelona. España.
Med Clin (Barc) 2004;122(10):390-8


Durante la última década una rica investigación básica ha permitido caracterizar el sistema cannabinoide. Comienzan a acumularse pruebas de que los cannabinoides podrían ser eficaces en el tratamiento de las náuseas y vómitos por quimioterápicos antineoplásicos, el dolor, la espasticidad y otros síntomas de la esclerosis múltiple y algunas alteraciones del movimiento. Hay que esperar la publicación de los resultados de los ensayos clínicos en curso con extractos de Cannabis por vía oral y sublingual para definir de manera precisa su lugar en terapéutica en estas y otras indicaciones. Actualmente se están desarrollando nuevas vías de administración como la rectal, sublingual o transdérmica para evitar los efectos perjudiciales del humo del
Cannabis fumado. Aunque el futuro inmediato parece basarse en medicamentos derivados directamente del Cannabis, la investigación actual tiende a desarrollar por un lado nuevos fármacos que actúen potenciando o inhibiendo los efectos de los cannabinoides endógenos y
por otro, fármacos sintéticos agonistas y antagonistas de los receptores cannabinoides.
Palabras clave: Sistema cannabinoide. Cannabis. Cannabinoides. Dolor. Espasticidad. Náuseas y vómitos. Eficacia. Efectos indeseados.

 

Artículo en PDF

Anestesiología y Medicina del Dolor


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Guias de tratamiento de la fibrilación auricular


 

----- Mensaje reenviado ----
De: Victor Whizar-Lugo <vwhizar@anestesia-dolor.org>
Para: maximocuadros@yahoo.es
Enviado: sáb,27 noviembre, 2010 09:46
Asunto: Guis de tratamiento de la fibrilación auricular

Anestesia y Medicina del Dolor
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No:330     

Noviembre 27, 2010
 Tradiciones

Estimad@ Maximo Jesus Cuadros Chavez:

 

Guías para el manejo de la fibrilación auricular 

Guidelines for the management of atrial fibrillation.
The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)
Developed with the special contribution of the European Heart Rhythm Association (EHRA)
Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS)
Authors/Task Force Members: A. John Camm (Chairperson) (UK)*, Paulus Kirchhof (Germany), Gregory Y.H. Lip (UK), Ulrich Schotten (The Netherlands),Irene Savelieva (UK), Sabine Ernst (UK), Isabelle C. Van Gelder (The Netherlands), Nawwar Al-Attar (France), Gerhard Hindricks (Germany), Bernard Prendergast
(UK), Hein Heidbuchel (Belgium), Ottavio Alfieri (Italy), Annalisa Angelini (Italy),Dan Atar (Norway), Paolo Colonna (Italy), Raffaele De Caterina (Italy), Johan De Sutter (Belgium), Andreas Goette (Germany), Bulent Gorenek (Turkey), Magnus Heldal (Norway), Stefan H. Hohloser (Germany), Philippe Kolh (Belgium),Jean-Yves Le Heuzey (France), Piotr Ponikowski (Poland), Frans H. Rutten (The Netherlands).
European Heart Journal (2010) 31, 2369-2429. doi:10.1093/eurheartj/ehq278


Preamble
Guidelines summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering
from a given condition, taking into account the impact on outcome, as well as the risk-benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously. A large number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice,quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. 
Guidelines summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering
from a given condition, taking into account the impact on outcome, as well as the risk-benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously. A large number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice,quality criteria for development of guidelines have been established in order to make all decisions transparent to the user.
The recommendations for formulating and issuing ESC Guidelines can be found on the ESC Web Site (http://www.escardio.org/knowledge/guidelines/rules).

 

 

Artículo en PDF

Atentamente
Anestesiología y Medicina del Dolor


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viernes, 26 de noviembre de 2010

ABUSO DE DROGAS en deficit de atencion


 

El abuso de drogas en el marco de los trastornos del comportamiento perturbador
pulse sobre visualizar documento

Diagnóstico del trastorno por déficit de atención e hiperactividad (TDAH) en pacientes adultos con dependencia de cocaína: utilidad de los nuevos síntomas de funcionamiento ejecutivo de Barkley
pulse sobre visualizar documento

Trastorno por déficit de atención e hiperactividad (TDAH) y consumo de sustancias: datos preliminares de seguimiento en una población de sujetos jóvenes
pulse sobre visualizar documento

 


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lunes, 22 de noviembre de 2010

Critical Care Medicine Dec 2010 - Vol 38 - Issue 12




Critical Care Medicine Dec 2010 - Vol 38 - Issue 12

ccm.jpg 
Critical Care Medicine Dec 2010 - Vol 38 - Issue 12
Content
http://journals.lww.com/ccmjournal/pages/currenttoc.aspx

Link


Murillo Santucci Cesar de Assunção
Unidade de Terapia Intensiva adulto
Disciplina de Anestesiologia, Dor e Terapia Intensiva
Escola Paulista de Medicina
Rua Napoleão de Barros,715
Vila Clementino - São Paulo - CEP: 04024-002
Tel/Fax: +55-11-55757768
Tel/Fax: +55-11- 55764069










Murillo Santucci Cesar de Assunção
Unidade de Terapia Intensiva adulto
Disciplina de Anestesiologia, Dor e Terapia Intensiva
Escola Paulista de Medicina
Rua Napoleão de Barros,715
Vila Clementino - São Paulo - CEP: 04024-002
Tel/Fax: +55-11-55757768
Tel/Fax: +55-11- 55764069










jueves, 11 de noviembre de 2010

Ketamina en urgencias



 

----- Mensaje reenviado ----
De: Victor Whizar-Lugo <vwhizar@anestesia-dolor.org>
Para: maximocuadros@yahoo.es
Enviado: jue,11 noviembre, 2010 17:12
Asunto: Ketamina en urgencias

XLIV Congreso Mexicano de Anestesiologia

Anestesia y Medicina del Dolor
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No:242     

Noviembre 11, 2010
 Tradiciones

Estimad@ Maximo Jesus Cuadros Chavez:

 

 

Auditoría de la seguridad y la eficacia de la ketamina para la sedación de procedimientos en el servicio de urgencias

Audit of the safety and effectiveness of ketamine for procedural sedation in the emergency department
J M Vardy, N Dignon, N Mukherjee, D M Sami, G Balachandran, S Taylor.
Emerg Med J 2008;25:579-582   doi:10.1136/emj.2007.056200

 

Abstract
Aim: To examine the effectiveness and safety of the sedative agents used in the emergency department following the introduction of ketamine as an agent for procedural sedation. Methods: A 2-year prospective audit of sedation practice was undertaken. This specifically examined the rationale behind a doctor's choice of sedative agent, the depth of sedation achieved, adverse events and the time taken to regain full orientation. Results: 210 patients were included of whom 85 (40%) were given ketamine, 107 (51%) midazolam and 18 (9%) propofol. The median time to full orientation was 25 min for ketamine, 30 min for midazolam and 10 min for propofol. Complications occurred in 15.9% of sedations overall (14.6% of those given ketamine, 15.8% given midazolam and 22.2% given propofol). Apnoea and hypoxia most often occurred with midazolam and propofol, while hypertension and hypertonicity were encountered more frequently with ketamine. In addition, 19.5% of patients given ketamine suffered the re-emergence phenomenon. The association between deep sedation with no response to pain and adverse events encountered with midazolam does not occur with ketamine.  Conclusions: Ketamine is both safe and effective and compares favourably with midazolam as an agent for procedural sedation in the emergency department. Although the re-emergence phenomenon occurred, no psychological sequelae were encountered after return to full orientation. Ketamine may be particularly useful in groups of patients at high risk of adverse effects with midazolam

 

Artí­culo en PDF

Atentamente
Anestesiología y Medicina del Dolor


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