ABSTRACT
No disponible
Subject(s)
Humans , Critical Care/trends , Intensive Care Units/trends , Patient Care Team , Anesthesia/trends , SpainABSTRACT
La infección relacionada con los catéteres venosos centrales supone un aumento sustancial de morbimortalidad en los pacientes que los portan. En el momento actual, el incremento de bacterias multirresistentes, la reciente aparición de nuevos antibióticos y el desarrollo de nuevas guías de tratamiento hacen necesario su constante estudio. El objetivo de esta revisión es definir de forma breve conceptos epidemiológicos y patogénicos, para profundizar en las medidas preventivas y terapéuticas de dicho tipo de infección. Se aportan aspectos prácticos ante distintos escenarios clínicos como el sellado antibiótico del catéter venoso central y la retirada o mantenimiento del catéter(AU)
Central venous catheter-related infections can lead to a substantial increase in morbidity and mortality in patients. Nowadays, with the increase in multi-resistant bacteria, the recent appearance of new antibiotics, and the development of new treatment guidelines, means that this has to be constantly reviewed. The objective of this review is to briefly define the epidemiological and pathogenic concepts and to look in detail at the preventive and therapeutic measures of this type of infection. Practical aspects are presented of different clinical situations such as, antibiotic-lock of the central venous catheter, and the withdrawal or maintenance of the catheter(AU)
Subject(s)
Humans , Male , Female , Catheter-Related Infections/complications , Catheter-Related Infections/diagnosis , Catheter-Related Infections/mortality , Bacteremia/complications , Bacteremia/diagnosis , Gram-Positive Bacteria/isolation & purification , Gram-Positive Bacteria/pathogenicity , Critical Care/methods , Critical Care , Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Indicators of Morbidity and Mortality , Cross Infection/epidemiology , Cross Infection/prevention & control , Gram-Negative Aerobic Bacteria/isolation & purification , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/complications , Gram-Negative Bacterial Infections/diagnosisABSTRACT
Central venous catheter-related infections can lead to a substantial increase in morbidity and mortality in patients. Nowadays, with the increase in multi-resistant bacteria, the recent appearance of new antibiotics, and the development of new treatment guidelines, means that this has to be constantly reviewed. The objective of this review is to briefly define the epidemiological and pathogenic concepts and to look in detail at the preventive and therapeutic measures of this type of infection. Practical aspects are presented of different clinical situations such as, antibiotic-lock of the central venous catheter, and the withdrawal or maintenance of the catheter.
Subject(s)
Catheter-Related Infections , Anti-Bacterial Agents/therapeutic use , Catheter-Related Infections/diagnosis , Catheter-Related Infections/therapy , HumansABSTRACT
El flurbiprofeno es un analgésico antiinflamatorio no esteroideo del grupo de los aril-propiónicos. Posee una actividad antiagregante plaquetaria importante que ejerce de forma reversible y cuyo efecto desaparece en 24 h. Esta cualidad es uno de los motivos de su resurgimiento actual en el arsenal terapéutico. En anestesia se está indicando para la sustitución de la profilaxis secundaria de clopidogrel o ticlopidina, con un nivel de evidencia II. Sólo son necesarias dosis de 50 a 100 mg/día para ejercer este efecto de forma similar al AAS, ya que es muy potente y raramente a esta dosis prolonga el tiempo de hemorragia. Se revisan distintos aspectos farmacocinéticos, su perfil clínico de seguridad, estudios sobre su eficacia antiagregante y sus potenciales efectos adversos
Flurbiprofen is a non steroidal anti-inflammatory drug of the aryl-propionic acid class. It possesses an important platelet antiaggregant activity, that is reversible, and its effects disappear in 24 h. This characteristic is one of the causes for its renewed importance in the therapeutic arsenal. Now, in neuraxial anesthesia, flurbiprofen is indicated for the substitution of secondary prophylaxis when the patients are treated with clopidogrel or ticlopidine, with a II level of evidence. Only 50-100 mg/day are necessary to get the same effect as aspirin, because flurbiprofen is very powerful and rarely prolongs the hemorrhagic time. We review several pharmacokinetic aspects, clinical safety profile, antiaggregant efficacy studies and its potencial adverse effects
Subject(s)
Humans , Flurbiprofen/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/pharmacokinetics , Platelet Aggregation Inhibitors/adverse effects , Platelet Aggregation Inhibitors/pharmacokinetics , Flurbiprofen/pharmacokinetics , Flurbiprofen/adverse effectsABSTRACT
El abdomen agudo en la embarazada constituye uno de los problemas diagnósticos más difíciles para los obstetras y cirujanos, debido a los cambios anatómicos y fisiológicos que se producen durante la gestación. La presentación de múltiples patologías no tienen la misma intensidad en los síntomas con que se presentan normalmente y la presencia de náuseas y vómitos, común en la mayoría de ellas, pueden aparecer en una gestante sin abdomen agudo aumentando la confusión. Por ello es necesario conocer los cambios fisiológicos de la embarazada y tener en cuenta que cualquier patología que se pueda presentar en una mujer de edad fértil también la puede presentar una embarazada, siendo importante un diagnóstico y tratamiento precoz para evitar un aumento de la morbimortalidad materno-fetal
Acute abdomen in pregnant women constitutes one of the most difficult diagnoses, as much for obstetricians as for surgeons, due to the anatomical and physiological changes that take place during gestation. The presentation of multiple pathologies does not have the same symptom intensity as it usually does, and the presence of nausea and vomiting, common in most pregnancies, can appear without acute abdomen, which tends to increase the confusion. This is why it is necessary to know the physiological changes of the pregnant woman and to keep in mind that any pathology that can present in a woman of fertile age can also present in a pregnant one. Diagnosis and early treatment are important in order to avoid an increase of morbidity and maternal-fetal mortality
Subject(s)
Female , Adult , Humans , Abdomen, Acute/complications , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Pregnancy Complications/etiology , Pregnancy Complications/pathology , Appendicitis/pathology , Appendicitis/surgery , Fetal Hypoxia/etiology , Fetal Hypoxia/physiopathology , Abdomen, Acute/surgery , Pregnancy Complications/surgery , Laparoscopy , Laparoscopy/methods , Fetal Hypoxia/surgeryABSTRACT
La hemorragia intracraneal durante el embarazo es una complicación poco frecuente pero con una alta morbilidad y mortalidad. Aunque las causas de hemorragia son similares a las de la población general, la embarazada presenta unos cambios fisiológicos así como una patología propia que pueden predisponer a las mismas. La causa más frecuente identificada es la hipertensión arterial. La preeclampsia es específica de las gestantes, siendo la hemorragia cerebral la primera causa de muerte materna en la hipertensión inducida por el embarazo. La hemorragia secundaria a una rotura de aneurisma o una malformación arteriovenosa es una complicación grave pero afortunadamente rara. Cambios fisiológicos asociados al embarazo predisponen a la formación, crecimiento y rotura del aneurisma. Los hematomas secundarios a anestesia subaracnoidea o tras una punción accidental del saco dural durante una anestesia epidural no es muy frecuente pero pueden provocar graves alteraciones con déficit neurológicos significativos. La cefalea prolongada representa un signo de alarma de hematoma subdural. En este trabajo, revisamos distintos aspectos relacionados con la etiología, fisiopatología, diagnóstico y las medidas terapéuticas de la hemorragia intracraneal en la mujer embarazada
Intracranial hemorrhage during pregnancy is a rare complication, but with high morbidity and mortality. Although the causes are similar to those in the general population, pregnancy presents some physiological changes as well as its own pathology predisposes it to hemorrhage. The most frequently identified cause is arterial hypertension. Pre-eclampsia is specific to pregnancy, cerebral hemorrhage being the first cause of maternal death in the hypertension induced by pregnancy. Secondary hemorrhage to a ruptured aneurysm or arteriovenous malformation is a very serious, although fortunately rare, complication. Physiological changes in pregnancy may predispose to the formation, growth and rupture of an aneurysm On the other hand, secondary hematomas from spinal subdural anesthesia or accidental puncture of the dural sack during an epidural anesthesia is not very frequent, but can potentially cause very serious alterations with significant neurological deficits. Prolonged headache should be regarded as a warming sign of subdural hematoma. This update reviews different aspects related to the etiology, physiopathology, diagnosis and therapeutic measures of cerebral hemorrhage in the pregnant patient
Subject(s)
Female , Pregnancy , Humans , Pregnancy Complications, Hematologic , Cerebral Hemorrhage , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/physiopathology , Cerebral Hemorrhage/therapy , Pregnancy Complications, Hematologic/diagnosis , Pregnancy Complications, Hematologic/etiology , Pregnancy Complications, Hematologic/physiopathology , Pregnancy Complications, Hematologic/therapy , Intracranial Arteriovenous Malformations/complications , Intracranial Aneurysm/complications , Hypertension/complicationsSubject(s)
Carotid Artery Diseases/therapy , Embolization, Therapeutic/methods , Intracranial Aneurysm/therapy , Adult , Anesthesia, General , Carotid Artery Diseases/complications , Conscious Sedation , Electroencephalography , Humans , Hypopituitarism/complications , Incidental Findings , Intracranial Aneurysm/complications , Male , Monitoring, Physiologic , PremedicationSubject(s)
Electric Countershock , Protein C , Recombinant Proteins , Aged , Humans , Male , Protein C/therapeutic use , Recombinant Proteins/therapeutic useABSTRACT
No disponible
Subject(s)
Middle Aged , Female , Humans , Spinal Fusion , Pulmonary Embolism , Bone CementsSubject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Cesarean Section , Pregnancy Complications, Cardiovascular/surgery , Adult , Anesthesia, General , Anesthesia, Obstetrical , Aorta , Atropine/pharmacology , Blood Vessel Prosthesis Implantation , Emergencies , Extracorporeal Circulation , Female , Fentanyl/pharmacology , Fetus/drug effects , Hemodynamics/drug effects , Humans , Infant, Newborn , Laparotomy , Piperidines/pharmacology , Pregnancy , Remifentanil , Succinylcholine/pharmacologyABSTRACT
No disponible
Subject(s)
Pregnancy , Adult , Infant, Newborn , Female , Humans , Cesarean Section , Succinylcholine , Piperidines , Pregnancy Complications, Cardiovascular , Blood Vessel Prosthesis Implantation , Aortic Aneurysm , Atropine , Aorta , Anesthesia, Obstetrical , Aortic Dissection , Anesthesia, General , Laparotomy , Emergencies , Extracorporeal Circulation , Fentanyl , Hemodynamics , FetusSubject(s)
Bone Cements/adverse effects , Pulmonary Embolism/etiology , Spinal Fusion , Female , Humans , Middle AgedABSTRACT
No disponible
No disponible
