Pai In The Breast Bone

Review the blogosphere in February 2011

Blogs

In the blog " On the road (air) and other things " which took time unpublished, this month have posted a series of review articles, which are interesting. Take a look. I found

Ignacio, an anesthesiologist who writes - very well indeed - in the blog "Diary of an anesthesiologist ." It defines itself as a pure agonist (Do you sound familiar?)

Sonsomar speaks of Perioperative Medicine Course de La Princesa in this post : an annual course to be taken into account. The website of the Anesthesiology Service has posted Princess sessions last year and this year, in case you've missed or want of remembering them or just browse.

Julia's story chuckle. And I'm sure the unpronounceable name anestesioblasto (schlappen00) will be a good anesthesiologist when I finish residency.

MiAnestesista spoke in this post the nuances of pain. And it makes us think. As always. Anesthesia

publishes first volume of Rear with ILCOR recommendations. The second volume will soon, but we can get you started. And today, just in time to enter this summary, please post on the use of intraoperative neurophysiology , very interesting. The Anestesia2

of this podcast published, which is also echoed the blog of San Juan de Dios, on critical incidents in anesthesia. A topical issue, as always, very well treated.

Magazines

Anesthesia & Analgesia In make a review of air embolism ( Emergency Treatment of Air Embolism . Morris J. Nicholson, MD and Joseph P. Crehan, MLD), which has come to me now that I'm rotating hair in Neuro. Explicadito good for you like. And the focus review focuses on the difficult path of intubation in obstetrics ( The Unanticipated Difficult Intubation in Obstetrics Mhyre Jill M., MD, and David Healy, MD).
discussed in JAMA IDSA guidelines that came out last January 5 on MRSA infection in adults and children. If you want to check out these guides competition can be downloaded here .
The American Journal of Therapeutics speak of dabigatran as an alternative to oral warfarin-type anticoagulants in the treatment of atrial fibrillation ( Newer anticoagulant as an Alternate to Warfarin in Atrial Fibrillation : A Changing Paradigm Dhara Chaudhari, MBBS, Rohit Bhuriya, MD, and Rohit Arora, MD). Recommended.
The Pediatric Critical Care Medicine says the study results Resolve corticosteroid use in childhood sepsis. ( Adjunctive corticosteroid therapy in Pediatric Severe Sepsis: Observations from the RESOLVE study Jerry J. Zimmerman, PhD, MD, FCCM; Mark D. Williams, MD). The
Anesthesiology, apart from giving us his review - which is essential - it brings a review of etomidate and its effects toxic adrenal ( Clinical & molecular pharmacology of etomidate . Forman SA).
The Anesthesiology Clinics reviews the sugammadex (Sugammadex: cyclodextrins, selective binding agents, pharmacology, Clinical Development & future directions. Akha AS +). The "future directions" are interesting to see where the shots go.
And finally, could not miss my prized Current Opinion in Critical Care , which devotes nearly half the number of acute and chronic liver failure. As
provided, any article of these do not meet, you can ask me to mail the blog.

# FF
Starting this month, I take care of Anesthesia twitter, so to follow him away!

you enjoy the month of March begins now!

Mario Salieri Pctures

anesthetic Anesthesia in Duchenne muscular dystrophy

Muscular dystrophies are genetically determined diseases characterized by progressive deterioration of skeletal muscle function without affecting peripheral nerves or the system CNS. Duchenne muscular dystrophy, in particular, is an autosomal recessive myopathy linked to chromosome X, whose pathophysiological basis is the absence of dystrophin in the sarcolemma. Dystrophin is responsible for maintaining the integrity of the muscle membrane. The lack of this protein or its dysfunction leads to instability of the membrane, a progressive leakage of intracellular components and an elevated CPK. This happens not only in skeletal muscle and smooth, but in the heart muscle and brain. In the end, the cell units with impaired dystrophin are captured by macrophages and destroyed cells are replaced destruidas.Las by fibrofatty infiltration leading to proximal muscle weakness and pseudohypertrophy in joints and muscles affected to a lesser extent, muscle cardíaco.En it, the replacement of myocardium by fatty tissue results in dilated cardiomyopathy. The demonstrations in the electrocardiogram is sinus tachycardia, tall R waves in right precordial leads, prominent Q waves in left precordial leads and inverted T waves due to scarring of the left ventricle. With progression of the picture, may be ventricular arrhythmias and CHF. ACE inhibitors are preferred in the early stages and can use beta blockers. From the point of Respiratory view, these patients developed progressive fatigue and exhaustion of respiratory muscles, which does not help a restrictive pattern, with difficulty in expelling secretions, conditioned by deformities of the rib cage.

Well, those patients whose life expectancy is 15-25 years extend to the operating room and their anesthesiologists, we need to know a set of guidelines to avoid complications.

preanesthesia:

- CXR: for deformities of the chest and possible tracheobronchial compression.

- Arterial blood gas can be hypercapnic hypoventilation.

- Lung function tests: there is a decrease in the CV and the CPT.

- ECG: with the changes outlined above.

- echocardiography ejection fraction: To assess the degree of myopathy and the presence of valvular heart disease (10-20% of patients have a mitral valve).

- If necessary: \u200b\u200bHolter.

- Assess swallowing disorders also malnourished or gastrostomy.

- Possible sleep apnea may contribute to pulmonary hypertension. Intraoperative

: Dantrolene Check stock in the hospital

- There may be a decrease in laryngeal reflexes and increased gastric emptying time, increasing the risk of aspiration

- Difficult airway by deformities and muscle contractures as well as the difficulty of placement.

- Contraindicated succinylcholine and halogenated due to the possibility of severe hyperkalemia and rhabdomyolysis due to the instability of the sarcolemma.

- Increased sensitivity to nondepolarizing muscle relaxants .

- can be used opiates, but we recommend short-acting and small increments doses.

- Increased risk of arrhythmias . Postoperative

:

- Increased risk of respiratory failure and respiratory infections, with difficulty for the withdrawal of mechanical ventilation for respiratory depression secondary to anesthetic drugs and prolonged paralysis.

- Chest physiotherapy

-

early nutritional support - Poor wound healing, thus, higher incidence of suture dehiscence.

If you want to know more about the issue, the journal Chest in its December issue in 2007 he published an article of consensus on the anesthetic management of patients with Duchenne ( American College of Chest Physicians Consensus Statement on the Respiratory and Related Management of Patients With Duchenne Muscular Dystrophy Undergoing Anesthesia or Sedation ).

Catering Permit California

Johns Hopkins Manual of Anesthesiology Review

Today I bought this book through the recommendation Jose Mateos, in the library Averroes (a site strongly recommended that I encourage you to browse.) The protocols of anesthesia at Johns Hopkins hospital long tradition of teaching. In other words, a chuletario, but well done.

And last week, I bought the Miller.

Now only I have to find time to read.