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Mechanical ventilation in SARS-CoV-2 patients: state of art 严重急性呼吸系统综合征冠状病毒2型患者的机械通气:最新进展
Q3 Medicine Pub Date : 2021-03-10 DOI: 10.5554/22562087.E971
Diana Ávila Reyes, Bayron David García P., Guillermo Salazar Gutierrez, J. G. Gómez González, David Ricardo Echeverry Piedrahita, J. C. Galvis, Mateo Aguirre-Flórez
COVID-19-associated infection leads to a pathology of yet unknown clinical behavior, confronting the clinician with various challenges. An extensive search was conducted based on review articles on SARS-CoV-2 infection and studies including mechanical ventilation management strategies in order to complete this narrative review. Evidenced-based treatment for SARS-CoV2 infection is still in the works. We have some tools from our knowledge from past experiences indicating that a step-wise management approach should be used, without neglecting other joint therapeutic measures for improved clinical outcomes of a condition with a high mortality. The current recommendations indicate that patients with severe acute respiratory failure due to SARS-CoV-2 should be managed with protective mechanical ventilation measures. No strong evidence is yet available on the individualization of mechanical ventilation therapy according to phenotypes.
新冠肺炎相关感染导致临床行为病理未知,给临床医生带来各种挑战。为了完成这一叙述性综述,我们根据关于SARS-CoV-2感染的综述文章和包括机械通气管理策略在内的研究进行了广泛的检索。基于证据的SARS-CoV2感染治疗仍在研究中。我们有一些工具,从我们的知识,从过去的经验表明,一个循序渐进的管理方法应该使用,不忽视其他联合治疗措施,以改善临床结果的条件下,高死亡率。目前的建议表明,对SARS-CoV-2所致严重急性呼吸衰竭患者应采取保护性机械通气措施。目前还没有强有力的证据表明机械通气治疗是根据表型进行个体化的。
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引用次数: 1
Successful systemic fibrinolysis in a patient with Covid- 19: Case report 新冠肺炎患者成功的全身纤维蛋白溶解-19:病例报告
Q3 Medicine Pub Date : 2021-03-09 DOI: 10.5554/22562087.E969
Beatriz Flores Cajal, Begoña Ortolá Rocher, Laura Betolaza Weimer, D. Gil Mayo, María León Núñez, Paloma Repáraz Grávalos, M. Gómez Rojo, Guillermo Bartolomé Rubio
The new coronavirus 2019-nCov or SARS-Cov-2 is responsible for the most important pandemic in the 21st century: the coronavirus disease (COVID-19). The 2019-nCov infection elicits a hyper-coagulable state, conditioning a worse outcome in these patients. The pathophysiology of the exaggerated coagulation activation in these patients is still unknown, and probably involves several mechanisms, different from those involved in sepsis-associated coagulopathy. This article discusses the case of a patient with no remarkable medical history, who after 7 days of fever, diarrhea and epigastric pain was diagnosed with COVID-19 bilateral pneumonia, further aggravated by severe Acute Respiratory Distress Syndrome. In this context, the patient experienced a massive acute pulmonary thromboembolism accompanied by an acute thrombus in the heart’s right ventricle, leading to hemodynamic instability. For the first time in our center in these patients, systemic fibrinolysis was successfully performed, with resolution of the intracavitary thrombus and the acute hemodynamic shock.
新型冠状病毒2019-nCov或SARS-Cov-2是21世纪最重要的流行病:冠状病毒疾病(新冠肺炎)的罪魁祸首。2019-nCov感染引发高凝状态,使这些患者的预后更糟。这些患者凝血激活过度的病理生理学尚不清楚,可能涉及多种机制,与败血症相关凝血病不同。本文讨论了一例无明显病史的患者,他在发烧、腹泻和上腹部疼痛7天后被诊断为新冠肺炎双侧肺炎,并因严重急性呼吸窘迫综合征而进一步加重。在这种情况下,患者经历了大量急性肺血栓栓塞,并伴有心脏右心室的急性血栓,导致血液动力学不稳定。在我们中心,这些患者首次成功地进行了系统性纤维蛋白溶解,腔内血栓和急性血液动力学休克得到了解决。
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引用次数: 1
Preferred display size and visual distance for ultrasound-guided radial artery cannulation 超声引导桡动脉插管首选显示尺寸和可视距离
Q3 Medicine Pub Date : 2021-03-09 DOI: 10.5554/22562087.E968
T. Hoshi
Introduction: In-line positioning of an ultrasound image provides higher success rates and less time to completion for radial arterial cannulation. But preferable size and distance of ultrasound display has not been previously discussed. Objective: To assess the ideal visual distance and display size when using a smart phone or tablet as the ultrasound image display. Methods: Four smart phones or tablets were used as ultrasound displays in six different configurations in a simulated radial artery puncture. In a questionnaire, 116 anaesthesiologists working in Ibaraki Prefecture, Japan, were asked which of the six configurations was preferable for radial artery cannulation. Results: Sixty anaesthesiologists answered the questionnaire. About half (53%) preferred the smaller display (4- or 5.5-inch) fixed at a distance of 30 to 40 cm, and most of the rest (44%) preferred the larger display (7.9- or 9.7-inch) placed posterior to the probe with a visual distance of 45 to 60 cm. Conclusions: Among the anaesthesiologists, the preferable size and visual distance for ultrasound-guided radial artery cannulation varied using a smart phone or tablet for in-line display.
简介:超声图像的在线定位为桡动脉插管提供了更高的成功率和更短的完成时间。但是,超声显示器的优选尺寸和距离以前没有讨论过。目的:评估使用智能手机或平板电脑作为超声图像显示器时的理想视觉距离和显示器尺寸。方法:在模拟桡动脉穿刺中,使用四部智能手机或平板电脑作为六种不同配置的超声显示器。在一份调查问卷中,116名在日本茨城县工作的麻醉师被问及六种配置中哪一种更适合桡动脉插管。结果:60名麻醉师回答了问卷。大约一半(53%)的人更喜欢固定在30到40厘米距离的较小显示器(4或5.5英寸),其余大多数人(44%)更喜欢放置在探头后面45到60厘米视觉距离的较大显示器(7.9或9.7英寸)。结论:在麻醉师中,超声波引导的桡动脉插管的优选尺寸和视觉距离使用用于在线显示的智能手机或平板电脑而变化。
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引用次数: 0
Juan Evangelista Manrique, the true pioneer of spinal anesthesia in Colombia Juan Evangelista Manrique,哥伦比亚脊椎麻醉的真正先驱
Q3 Medicine Pub Date : 2021-03-08 DOI: 10.5554/22562087.E967
P. Herrera, Herley Aguirre Serrano
Several findings paved the way to the use of the spinal approach for anesthesia. Information about the originators and dates of their discoveries is controversial. According to personal communications, doctors Juan Bautista Montoya y Florez, in Medellin, and Lisandro Leyva, in Bogota, in 1904 and 1905 respectively, would appear to be the pioneers of spinal anesthesia in Colombia. Pioneering cases of this procedure carried out in 1901 by doctor Juan Evangelista Manrique and which continued to be performed by his colleagues and assistants of the medical community at the time are documented in the Corporis Fabrica dissertation collection of the National University of Colombia.
一些发现为使用脊柱入路进行麻醉铺平了道路。关于发明者和发现日期的信息存在争议。根据个人通讯,麦德林的Juan Bautista Montoya y Florez医生和波哥大的Lisandro Leyva医生分别于1904年和1905年,似乎是哥伦比亚脊柱麻醉的先驱。1901年,Juan Evangelista Manrique医生进行了这种手术,当时他的同事和医学界助理继续进行这种手术,这些开创性病例记录在哥伦比亚国立大学的Corporis Fabrica论文集中。
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引用次数: 0
Lidocaine infusion, basics and clinical issues 利多卡因输注,基础知识和临床问题
Q3 Medicine Pub Date : 2021-03-04 DOI: 10.5554/22562087.E966
M. P. González-Obregón, Miguel Andrés Bedoya-López, A. Ramirez, Esteban Onésimo Vallejo-Agudelo
Optimum pain management, minimizing chronic complications and ensuring a good safety profile, is growing in importance day by day. Lidocaine infusion has an adequate safety profile and several desirable characteristics in the clinical setting. This review describes the characteristics of this drug, as well as its potential indications. Moreover, it describes the basic concepts around lidocaine use, mechanisms of action and clinical applications, as well as the use of infusions in acute pain and repercussions in chronic pain. A review of the literature in English and Spanish was conducted in several databases, with no publication date limit. Articles considered relevant, without including the grey literature, were selected independently. Lidocaine infusion is an option for acute postoperative pain control in major surgery and contributes to opioid sparing and reduced length of stay, with ample evidence in abdominal surgery, rendering it an option to recommend in various protocols. It has an acceptable safety profile in special populations and it is considered useful to diminish the incidence of persistent, chronic and neuropathic pain related to the surgical procedure.
最佳的疼痛管理,最大限度地减少慢性并发症和确保良好的安全性,日益重要。利多卡因输注在临床环境中具有足够的安全性和几个理想的特性。这篇综述描述了这种药物的特点,以及它的潜在适应症。此外,它还描述了利多卡因使用的基本概念,作用机制和临床应用,以及在急性疼痛和慢性疼痛中输液的使用。在几个数据库中对英文和西班牙文文献进行了审查,没有出版日期限制。被认为相关的文章,不包括灰色文献,被独立选择。利多卡因输注是大手术术后急性疼痛控制的一种选择,有助于阿片类药物节约和缩短住院时间,在腹部手术中有充分的证据,使其成为各种方案的推荐选择。它在特殊人群中具有可接受的安全性,并且被认为有助于减少与外科手术相关的持续性、慢性和神经性疼痛的发生率。
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引用次数: 0
Giant pulmonary artery aneurysms 巨大肺动脉动脉瘤
Q3 Medicine Pub Date : 2021-03-02 DOI: 10.5554/22562087.E959
S. Khanna, T. Ong, C. Chow, Carlos Trombetta
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引用次数: 0
Intravenous lidocaine infusion for the treatment of acute pain in the pediatric intensive care unit: case series 静脉输注利多卡因治疗儿科重症监护室急性疼痛:病例系列
Q3 Medicine Pub Date : 2021-02-24 DOI: 10.5554/22562087.E965
L. Izquierdo, N. Moreno, S. Ruiz
Introduction: The use of intravenous lidocaine infusion has increased over the past decade as part of a multimodal approach to analgesia in adults; however, information about its safety and tolerability in the pediatric population is limited. Methods: Acute pain management using lidocaine infusion in eleven patients treated in the pediatric intensive care unit. Results: Five cases of postoperative abdominal pain and six cases of non-operative abdominal pain. Two cases were cancer patients affected by neutropenic colitis. Analgesic control achieved was good. Conclusion: Lidocaine infusions are apparently a safe option for the management of acute pain, either post-operative or not, in the pediatric population.
引言:在过去十年中,作为成人多模式镇痛方法的一部分,静脉输注利多卡因的使用有所增加;然而,关于其在儿科人群中的安全性和耐受性的信息是有限的。方法:在儿科重症监护室接受治疗的11名患者中,使用利多卡因输注进行急性疼痛管理。结果:术后腹痛5例,非手术性腹痛6例。两例为癌症患者,受中性粒细胞减少性结肠炎影响。镇痛控制效果良好。结论:在儿科人群中,利多卡因输注显然是治疗急性疼痛的安全选择,无论是否是术后疼痛。
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引用次数: 1
The current COVID-19 Pandemic legacy for Latin American anesthesiologists 当前COVID-19大流行给拉丁美洲麻醉师留下的遗产
Q3 Medicine Pub Date : 2021-02-16 DOI: 10.5554/22562087.E960
G. Calabrese
• Actively participate during, and after the pandemic, in reorganizing the work of the anesthesiologist in an organized and safe manner (10), and avoid the patients' "avalanche" effect Calabrese G Update on biological risk for anesthetists taking care of patients affected by SARS-CoV2, COVID19 (10) These are some of the new working conditions for anesthesiologists in Latin America, albeit the inequalities: • More frequent exposure to SARS-CoV-2/ COVID-19 patients, and to asymptomatic carriers Calabrese G The "new occupational normality" for anesthetists: beyond the SARS-CoV-2 COVID19 pandemic [Extracted from the article] Copyright of Colombian Journal of Anesthesiology / Revista Colombiana de Anestesiología is the property of Sociedad Colombiana de Anestesiologia y Reanimacion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )
•在大流行期间和之后,积极参与以有组织和安全的方式重组麻醉师的工作(10),避免患者的“雪崩”效应(10)。Calabrese G关于麻醉师照顾受SARS-CoV2和covid - 19影响的患者的生物风险的最新情况(10)以下是拉丁美洲麻醉师的一些新的工作条件,尽管存在不平等:•更频繁地接触SARS-CoV-2/ COVID-19患者和无症状携带者。版权归哥伦比亚麻醉学杂志/ Revista Colombiana de Anestesiología所有,未经版权所有者明确书面许可,不得将其内容复制或通过电子邮件发送到多个网站或发布到listserv。本摘要可能被删节,不保证副本的准确性,用户应参考材料的原始出版版本(版权适用于所有摘要)
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引用次数: 0
Anesthetic considerations and postoperative pain management in radical penectomy: Case report 根治性阴茎切除术的麻醉考虑和术后疼痛处理:病例报告
Q3 Medicine Pub Date : 2021-02-15 DOI: 10.5554/22562087.E964
M. Ghiringhelli, M. Lopez
Radical penectomy (RP) is infrequently performed as it is reserved for specific cases of penile cancer, hence the paucity of reports regarding surgical and anesthetic considerations. Acute postoperative pain, chronic post-surgical pain, concomitant mood disorders as well as a profound impact on the patient’s quality of life have been documented. This case is of a patient with diabetes and coronary heart disease, who presented with advanced, overinfected penile cancer, depressive disorder and a history of pain of neuropathic characteristics. The patient underwent radical penectomy using a combined spinal-epidural technique for anesthesia. Preoperatively, the patient was treated with pregabalin and magnesium sulphate, and later received a blood transfusion due to intraoperative blood loss. Adequate intra and postoperative analgesia was achieved with L-bupivacaine given through a peridural catheter during one week. Recovery was good, pain was stabilized to preoperative levels and the patient received pharmacological support and follow-up by psychiatry and the pain team.
根治性阴茎切除术(RP)很少进行,因为它是为特定情况下的阴茎癌保留,因此缺乏关于手术和麻醉考虑的报道。急性术后疼痛、慢性术后疼痛、伴随的情绪障碍以及对患者生活质量的深刻影响都有文献记载。本病例为糖尿病合并冠心病患者,其表现为晚期、过度感染的阴茎癌、抑郁症和神经性疼痛史。患者接受根治性阴茎切除术,采用脊髓-硬膜外联合麻醉技术。术前,患者接受普瑞巴林和硫酸镁治疗,后因术中失血接受输血。l -布比卡因在一周内通过硬膜外导管给予足够的内、术后镇痛。恢复良好,疼痛稳定到术前水平,患者接受了精神病学和疼痛小组的药物支持和随访。
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引用次数: 0
Continuous erector spinae plane block at lumbar level for relief of severe pain due to hip fracture: case series 腰段连续性竖脊肌平面阻滞治疗髋部骨折引起的剧烈疼痛:病例系列
Q3 Medicine Pub Date : 2021-02-08 DOI: 10.5554/22562087.E962
Alejandro Tovar-Gutiérrez, Julio Ernesto Camelo-Rincón, O. I. Vásquez-Gómez, Adriana Cadavid-Puentes
Introduction: Hip fracture pain is frequently acute and disabling and increases perioperative complications in the patient; hence it requires a multimodal analgesia approach. This case series describes the continuous erector spinae plane block at the lumbar level for hip fracture analgesia. Methods: A search was conducted of patients with hip fracture referred to the pain service of Hospital Universitario San Vicente Fundacion (HUSVF) from August 2019 to March 2020, who had undergone continuous erector spinae plane block as part of their analgesic regimen. Results: A total of 6 patients, 4 females and 2 males with an average age of 75 years were identified. A reduction in pain intensity from acute to mild or absent was observed in every case, up to 24 hours after the initial injection. 66 % experienced a relapse of severe pain after 24 hours and 2 patients the catheter functionality failed after 24 hours. One patient underwent dermatome pinprick assessment. Conclusions: The continuous erector spinae plane block with a single injection provided analgesic efficacy similar to other single injection peripheral blocks, although continuous analgesia for more than 24 hours was not achieved. Some variations in the block technique described may improve the analgesic effectiveness in patients with hip fracture pain.
简介:髋部骨折疼痛通常是急性和致残的,并增加患者的围手术期并发症;因此,它需要一个多模式的镇痛方法。本病例系列描述腰椎水平连续竖脊肌平面阻滞用于髋部骨折镇痛。方法:检索2019年8月至2020年3月在圣文森特大学基金会医院(HUSVF)疼痛服务中心就诊的髋部骨折患者,这些患者接受了连续勃起脊柱平面阻滞作为镇痛方案的一部分。结果:共发现6例患者,其中女4例,男2例,平均年龄75岁。在每次注射后24小时内,疼痛强度从急性到轻度或无疼痛都有所减轻。66%的患者在24小时后出现剧烈疼痛复发,2例患者在24小时后导管功能失效。1例患者接受皮肤穿刺评估。结论:单次注射连续立肌脊柱平面阻滞镇痛效果与其他单次注射外周阻滞相似,但未达到24小时以上的连续镇痛效果。所描述的阻滞技术的一些变化可能会改善髋部骨折疼痛患者的镇痛效果。
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引用次数: 0
期刊
Colombian Journal of Anesthesiology
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