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Hace 8 años
lunes, 9 de noviembre de 2009
ROTANTES DE ANESTESIA MES DE NOVIEMBRE 2009
Durante el mes de noviembre del 2009 nos acompañan los residentes:
1.-Dra Fanny Alarcon Muñoz R3 Hospital Maria Auxiliadora rotaciòn anestesia pediatrica
correo:flam_02@hotmail.com
2.-Dr R2 Hospital regional de Ica rotacion en anestesia obstetrica
correo marck186@hotmail.com
martes, 6 de octubre de 2009
ROTANTES DE ANESTESIA MES DE OCTUBRE 2009
Durante el mes de setiembre del 2009 nos acompañan los residentes1.-DR FREDY ZAPANA ARIAS R2 Hospital regional de Ica rot en anestesia obstetrica
correo fredyz_medic@hotmail.com telefono: 956058509
2.-DRA DELIA ROSA SALAZAR APAZA R2 Hospital Maria Auxiliadora rot en anest pediatrica
correo delyrosy11@hotmail.com telefono : 995904310
3.-Interno de Odontologia MIJAIL SILVA DE LASCASAS UNIV WIENER
correo zerocool1182446@hotmail.com telefono 985368670
Efficacy of a low-dose spinal morphine with bupivacaine for postoperative analgesia in children undergoing hypospadias repair
Pediatric Anesthesia Volume 19 Issue 11, Pages 1078 - 1083
Published Online: 25 Aug 2009
ABSTRACT
Background: Children undergoing hypospadias repair need to be protected from highly unpleasant sensory and emotional experiences during and after surgery. We designed a double-blinded, randomized, and placebo-controlled study to compare the efficacy of a low-dose (2 μg·kg−1) of intrathecal morphine with placebo for postoperative pain control of children undergoing repair of hypospadias surgery with spinal anesthesia.
Methods: Fifty-four children were randomly assigned to one of two spinal anesthesia groups. Group M (n = 27) received hyperbaric bupivacaine plus 2 μg·kg−1 of preservative-free morphine and group P (n = 27) received hyperbaric bupivacaine plus 0.9% NaCl (placebo) under inhalation anesthesia. General anesthetics were discontinued subsequent to the block. The primary outcome was the presence of pain-requiring analgesics during the first 12 h after the spinal block. Side effects were also recorded. The analgesic effects were evaluated by using the Children's Hospital of Eastern Ontario Pain Scale.
Results: Forty-nine patients completed the trial. Fifteen patients (60%) in group P received supplementary analgesics within the first 12 h compared to only four patients (16.7%) in group M (P = 0.005). Mean duration of analgesia was 480 ± 209 and 720 ± 190 min in group P and group M respectively (P = 0.009). The groups were similar in postoperative side effects.
Conclusion: Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 μg·kg−1 intrathecal morphine provides better postoperative pain control when compared to placebo in these children.
Published Online: 25 Aug 2009
ABSTRACT
Background: Children undergoing hypospadias repair need to be protected from highly unpleasant sensory and emotional experiences during and after surgery. We designed a double-blinded, randomized, and placebo-controlled study to compare the efficacy of a low-dose (2 μg·kg−1) of intrathecal morphine with placebo for postoperative pain control of children undergoing repair of hypospadias surgery with spinal anesthesia.
Methods: Fifty-four children were randomly assigned to one of two spinal anesthesia groups. Group M (n = 27) received hyperbaric bupivacaine plus 2 μg·kg−1 of preservative-free morphine and group P (n = 27) received hyperbaric bupivacaine plus 0.9% NaCl (placebo) under inhalation anesthesia. General anesthetics were discontinued subsequent to the block. The primary outcome was the presence of pain-requiring analgesics during the first 12 h after the spinal block. Side effects were also recorded. The analgesic effects were evaluated by using the Children's Hospital of Eastern Ontario Pain Scale.
Results: Forty-nine patients completed the trial. Fifteen patients (60%) in group P received supplementary analgesics within the first 12 h compared to only four patients (16.7%) in group M (P = 0.005). Mean duration of analgesia was 480 ± 209 and 720 ± 190 min in group P and group M respectively (P = 0.009). The groups were similar in postoperative side effects.
Conclusion: Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 μg·kg−1 intrathecal morphine provides better postoperative pain control when compared to placebo in these children.
lunes, 5 de octubre de 2009
The effect of flexion on the level of termination of the dural sac in paediatric patients
ARTICULO DE REVISTA ANESTHESIA OCT 2009
ABSTRACT
Although the anatomy of the spinal cord and its associated structures have been well defined, the effects of body position relevant to neuraxial blockade have not been elucidated. This study was designed to determine the effect of body position on the end of the dural sac in children. After induction of anaesthesia, ultrasound examination was performed to evaluate the location of the dural sac end in the lateral position with a straight back and knee, and in the lateral position with the knees, legs, and neck flexed. The level of the end of the dural sac was determined in relation to the vertebrae. Our data demonstrate that the dural sac shifts significantly cephalad in the lateral flexed position used for neuraxial blockade (p < 0.001). These results suggest that the safety margin to avoid dural puncture during hiatal or S2-3 approach for caudal block can be increased in younger children.
ABSTRACT
Although the anatomy of the spinal cord and its associated structures have been well defined, the effects of body position relevant to neuraxial blockade have not been elucidated. This study was designed to determine the effect of body position on the end of the dural sac in children. After induction of anaesthesia, ultrasound examination was performed to evaluate the location of the dural sac end in the lateral position with a straight back and knee, and in the lateral position with the knees, legs, and neck flexed. The level of the end of the dural sac was determined in relation to the vertebrae. Our data demonstrate that the dural sac shifts significantly cephalad in the lateral flexed position used for neuraxial blockade (p < 0.001). These results suggest that the safety margin to avoid dural puncture during hiatal or S2-3 approach for caudal block can be increased in younger children.
miércoles, 9 de septiembre de 2009
jueves, 3 de septiembre de 2009
ROTANTES DE ANESTESIA MES DE SETIEMBRE 2009
Durante el mes de setiembre del 2009 nos acompañan los residentesDr John Laurencio R2 H. Maria Auxiliadora rot en anestesia pediatrica
Dr vicente R2 INEN rot en anestesia obstetrica chr78vt@hotmail.com 998785008
martes, 1 de septiembre de 2009
REUNION ACADEMICA MARTES 01 SETIEMBRE 2009
CONTINUANDO CON LAS ACTIVIDADES ACADEMICAS DE BIOSEGURIDAD EN CENTROQUIRURGICO, HIY SE PRESENTARON LOS VIDEOS GRABADOS DE LAS CLASES DE SEGURIDAD EN EQUIPOS BIOMEDICOS QUE DICTO EL INGENIERO PIÑEYRO DURANTE LOS MESES DE MAYO JUNIO DEL 2009.viernes, 28 de agosto de 2009
ACTUALIZACION DE NORMAS TECNICAS DE ANESTESIOLOGIA
El dia viernes 28 de agosto 2009 se realizo en el ministerio de salud la 3 reunion de revision y actualizacion de las normas tecnicas de anestesiologia , con la presencia de jefes de departamento y servicio de los hospitales deL seguro social, d el minsa, y fuerzas armadas asi como representantes de la sociedad de anestesiologia donde se siguio discutiendo sobre el peep de 0-20 u otros valores , los requerimientos minimos de equipos de sop niveles I , II , III 1- III-2 , tambien recalcar los sistemas de evacuacion de gases anestesicos y de ventilacion, y la necesidad de contar con bombas y jeringas perfusoras para realizar TIVA.
ROTANTES DE ANESTESIA MES DE AGOSTO 2009
Durante el mes de agosto del 2009 nos acompañan los residentesDra Machuca R3 H. Maria Auxiliadora rot en anestesia pediatrica
Dra Diaz R3H de Policia rot en anestesia obstetrica
Dr vicente R2 INEN rot en anestesia obstetrica chr78vt@hotmail.com 998785008
REUNION ACADEMICA MARTES 25 AGISTO 2009
En la reunion de este martes se difundio el video sobre verificacion de equipos en sala de operaciones dada por el Dr cruz en el curso de anestesia y cirugia segura agosto 2009asimismo se presentaron videos de cirigias donde se cumple parcialmente la lista de chequeo, se sigirio por parte de enfermeria mayor enfasis en hacer cumplir a los cirujanos(ginecologos )estos pasos del
la lista de chequeo.
jueves, 23 de abril de 2009
The specific gravity of bupivacaine with fentanyl influences bispectral index value during spinal anesthesia combined with fentanyl in patients underg
Source: Jap J Anesthesiol Posted 1 week ago
The specific gravity of bupivacaine with fentanyl influences bispectral index value during spinal anesthesia combined with fentanyl in patients undergoing cesarean section; Nakamoto M, Murao K, Kimoto M, Nakao S, Shingu K; Japanese Journal of Anesthesiology (Masui) 58 (4), 460-2 (Apr 2009)
BACKGROUND: Spinal anesthesia combined with fentanyl sometimes induces sedation. We previously reported that the bispectral index (BIS) value during spinal anesthesia with isobaric bupivacaine is reduced with intrathecal fentanyl but not with intravenous or epidural fentanyl. The current study investigated whether the specific gravity of bupivacaine combined with intrathecal fentanyl in spinal anesthesia for cesarean section effected the BIS values. METHODS: Thirty-one partrients scheduled for cesarean section were allocated into two groups: 0.5% isobaric bupivacaine 2 ml plus fentanyl 20 microg (I group, n = 14) or 0.5% hyperbaric bupivacaine 2 ml plus fentanyl 20 microg (H group, n = 17). BIS values were recorded throughout the anesthesia. RESULTS: The lowest BIS values in the I group and in the H group were 77 +/- 13 and 87 +/- 6, respectively. The cumulative time for BIS values of or below 80 in the I group was longer than that in the H group. The number of BIS decreased cases, defined as the cases in which the BIS values continuously fell down to or below 80 for more than 10 minutes, in the I group was higher than in the H group. CONCLUSIONS: The BIS values in patients who received intrathecal isobaric bupivacaine with fentanyl were lower than those with intrathecal hyperbaric bupivacaine and fentanyl.
lunes, 6 de abril de 2009
jueves, 26 de marzo de 2009
martes, 24 de marzo de 2009
MONITOREO GRÁFICO VENTILATORIO
El DR Robert Agreda Soriano , medico residente de 3 año del Hospital militar expuso el tema monitoreo gráfico ventilatorio , tema importante y de aplicabilidad ya que contamos con un sistema de anestesia datex ohmeda. con gráfica de bucles presión -volumen
domingo, 22 de marzo de 2009
I CURSO TALLER INTERNACIONAL-SEGURIDAD DEL PACIENTE-1
La seguridad del paciente
es el principio fundamental
de la atención sanitaria y
un componente crítico de
la gestión de la calidad. Se
sabe que las intervenciones
en el proceso de atención
de la salud deteriorada se
realizan para beneficiar a
los pacientes, sin embargo,
un importante porcentaje
de estas, pueden causar
daño, justamente por la
complejidad en que se desarrollan
estas acciones.
A nivel mundial existen crecientes
reportes epidemiológicos
en los que se muestran
el incremento de la
magnitud del problema.
En este contexto, el Colegio
Médico del Perú realizo
este evento con
la finalidad de promover
una cultura de seguridad y
calidad de atención en las
organizaciones públicas y
privadas prestadoras de salud
en nuestro pais.
miércoles, 11 de febrero de 2009
ANESTESIA CAUDAL- DRA CRUZ R3 H. POLICIA
residentes rotantes en formacion , realizando la tecnica de anestesia caudal , utilizada en sop h. san bartolome
miércoles, 14 de enero de 2009
rocuronio y dolor de brazo
debido al pK que tiene el rocuronio es qu enecesita de un pH ácido (pH cercano a 3) para ser efectivo.
Pedro Klinger
Rocuronio:
la parálisis respiratoria se inicia en el mejor de los casos un minuto después de la inducción, en cambio la retirada del brazo (si no hay plano anestésico adecuado, claro) es inmediata al iniciar la inyección.
Esto se comprueba en aquellos casos en que se hace inducción de secuencia rápida (RSI) con rocuronio y por las razones que fuere (hipotensión?) se ha administrado una dosis escasa de inductor.
por supuesto que un plano adecuado de anestesia lo evita, pero con sólo ver el pK del producto se entiende que es un irritante venoso.
Pedro Klinger
Rocuronio:
la parálisis respiratoria se inicia en el mejor de los casos un minuto después de la inducción, en cambio la retirada del brazo (si no hay plano anestésico adecuado, claro) es inmediata al iniciar la inyección.
Esto se comprueba en aquellos casos en que se hace inducción de secuencia rápida (RSI) con rocuronio y por las razones que fuere (hipotensión?) se ha administrado una dosis escasa de inductor.
por supuesto que un plano adecuado de anestesia lo evita, pero con sólo ver el pK del producto se entiende que es un irritante venoso.
martes, 13 de enero de 2009
domingo, 11 de enero de 2009
sábado, 10 de enero de 2009
lunes, 5 de enero de 2009
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