Post-anesthesia care unit desaturation in adult deep extubation patients.

OBJECTIVE: Deep extubation refers to endotracheal extubation performed while a patient is deeply anesthetized and without airway reflexes. After deep extubation, patients are sent to the post-anesthesia care unit (PACU) to recover, an area with notably different management and staffing than the operating room (OR). One of the most frequent and concerning complications to occur in the PACU is hypoxemia. As such, this study seeks to evaluate the incidence of desaturation, defined by SpO2 < 90% for longer than 10 s, in the PACU following deep extubation. Additionally, we hope to assess the consequence of desaturation on perioperative workflow by comparing PACU recovery times. RESULTS: Following deep extubation, 4.3% of patients (13/300) experienced desaturation in the PACU. Every episode was notably minor, with patients reverting to normal saturation levels within a minute. Of the 26 case factors assessed, 24 had no significant association desaturation in the PACU, including the amount of time spent in the PACU. History of asthma was the only statistically significant factor found to be positively associated with desaturation. We find that PACU desaturation episodes following deep extubation are rare. Our findings suggest that deep extubation is a viable and safe option for patients without significant respiratory tract pathology.

Incidence of airway complications associated with deep extubation in adults.

BACKGROUND: Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as "deep extubation", in order to provide a "smooth" emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. METHODS: In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients' demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. RESULTS: Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p < 0.05). CONCLUSIONS: The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.

Fenómenos transferenciales en las tomas rituales urbanas de ayahuasca / Transference phenomena in the urban ritual of takes of ayahuasca

Este artículo tiene como finalidad la comprensión de los fenómenos "transferenciales" que se instauran entre el médico indígena yagecero (Médico indígena yagecero hace referencia al líder indígena formado para dirigir una toma ritual de ayahuasca que comparte sus conocimientos ancestrales dentro o fuera de su comunidad. También conocido como Mayor, Curaca, Chamán, o Taita. En este artículo utilizaremos el término yagecero), y los tomadores en las ceremonias de ayahuasca (Nombre del bejuco que se extrae de la selva del piedemonte amazónico; ésta mezclada con otras plantas medicinales es lo que comúnmente se denomina Yagé en la sociedad occidental.) en la ciudad de Cali. La investigación se desarrolló desde una metodología cualitativa (análisis del discurso), con un diseño de tipo descriptivo-exploratorio; se conformaron dos grupos, cada uno constituido por un yagecero, y dos participantes: experto e inexperto, quienes respondieron a entrevistas semiestructuradas; complementadas con observaciones de la conducta no verbal durante el ritual. Los resultados sugieren que los participantes con más experiencia tienden a establecer un tipo de transferencia positiva, en contraste con aquellos menos experimentados quienes establecieron un vínculo ambivalente, y/o negativo con el yagecero, o taita. Se concluye, que los participantes, actualizaron de manera inconsciente conflictos primarios en la figura del yagecero. Las características contextuales, históricas y de la personalidad influyen también en dicha transferencia.

This article aims at the understanding of the phenomenon "transference" that are established between the physician yagecero indigenous (Indian Medical yagecero refers to the indigenous leader formed to conduct a ritual of taking ayahuasca who shares his ancestral knowledge within or outside his community. He is also known as Mayor, Curaca, Shaman, or Taita. This article will use the term yagecero) and the drinkers in the ceremonies of ayahuasca (Name of the rattan extracted from the Amazon jungle foothills that when it is mixed with other medicinal plants is commonly referred to as Yage in Western society.) in the city of Cali. The research was developed from a qualitative methodology (discourse analysis), with a descriptive- exploratory design. Two groups are formed, each one of them consisting of a yagecero, and two participants: skilled and unskilled, who responded to semi-structured interviews, supplemented with observations of nonverbal behavior during the ritual. The results suggest that participants with more experience tend to establish a kind of positive transfer, as opposed to those less experienced who established a bond ambivalent, and / or negative with the yagecero, or Taita. It is concluded that the participants unconsciously updated primary conflicts in the figure of yagecero. The contextual, historical and personality characteristics also influence the transfer.

Glucocorticoid-induced surface expression of annexin 1 blocks beta2-integrin adhesion of human eosinophils to intercellular adhesion molecule 1 surrogate protein.

BACKGROUND: Glucocorticoids attenuate the population of eosinophils and T lymphocytes in asthmatic airways. The decrease in airway eosinophilia is caused both by accelerated cell death and by induction of blockade of integrin adhesion. In this study, we examined the hypothesis that annexin 1 surface expression, which is upregulated by the glucocorticoid receptor, prevents integrin adhesion essential to cell migration by blocking intracellular translocation of cytosolic group IV phospholipase A2 (cPLA2). OBJECTIVE: To examine the relationship of the glucocorticoid on annexin 1 expression and the effect of blockade of annexin 1 activity on adhesion of human eosinophils in vitro. To determine the relationship between annexin 1surface expression and nuclear membrane translocation of cPLA2. METHODS: Eosinophils isolated from human peripheral blood were pretreated with fluticasone propionate (FP), and beta2-integrin adhesion was measured after stimulation with IL-5 or eotaxin. Effects of FP on cPLA2 expression, phosphorylation, and translocation were determined. The role of annexin 1 was examined by using annexin 1 blocking antibody and/or mimetic peptides. RESULTS: Fluticasone propionate decreased stimulated eosinophil adhesion and caused 4-fold increase in annexin 1 expression on the plasma membrane. Inhibition of adhesion by FP was blocked with annexin 1 blocking antibody. Annexin 1 N-terminal mimetic peptide also blocked beta2-integrin adhesion. Translocation of cPLA2 to the nuclear membrane was significantly blocked by incubation with FP. Blockade was reversed with annexin 1 blocking antibody. CONCLUSION: Blockade of beta2-integrin adhesion by glucocorticoid is regulated by annexin 1, which blocks cPLA2 translocation to nuclear membrane.

Autopercepcion y autoconcepto relacionado con el desempeno de los roles familiares en pacientes paraplejicos / Selfperception and selfconcept related with familial role performance in paraplegic patients

Se planteo como problema de investigacion la influencia que tiene la autopercepcion y autoconcepto en el desempeno de los roles, familiares del paciente paraplejico basado en dos de los once patrones funcionales de Marjory Gordon, para determinar la autopercepcion y autoconcepto de los roles familiares del paciente paraplejico para su readaptacion y asi poder establecer actividades educativas y vivenciales que permitan el conocimiento de sus capacidades y limitaciones, al igual que realizar actividades fisicas, psicologicas y de integracion social. Teniendo en cuenta la anterior apreciacion, se hizo una resena historica de la rehabilitacion desde la antiguedad hasta los ultimos abances realizados en este aspecto. De igual manera, se revizaron los diferentes patrones funcionales que de una u otra forma podria tener utilidad en el estudio de estos pacientes, pero la eleccion de estos dos patrones se decidio con base a Marjory Gordon a desarrollado un marco de referencia para organizar la valoracion de enfermeria basandose en funciones, con el fin de organizar las categorias, diagnosticar y estandarizar la recoleccion de datos. Tambien por que los pacientes objeto de estudio lo que mas se les vio afectado fue el patron de autopercepcion y autoconcepto y el patron de relaciones de rol, dichos patrones funcionales fueron motivos de revision y analisis, asi como los diferentes niveles de la lesion medular, traumatica, y discapacidades que estas producen en este tipo de pacientes, y asi poder dar cumplimiento a los objetivos propuestos en dicho estudio. Estos dos ..