Anestesia para pacientes pediátricos con COVID-19 / Anesthesia and COVID-19 pediatric patients

Since December 2019, the world has faced the rapid spread of a new virus: SARS-CoV-2. Originating in Wuhan, it has spread quickly to hundreds of countries in the five continents, becoming a pandemia as of March 2020. We confront a highly contagious virus, capable of collapsing healthcare systems. Nearly 2% of infected individuals worldwide are children. They are usually asymptomatic, thus playing an important role in viral transmission. Less frequently, they can become critically ill. In this article we describe the epidemiology, available to this date, of COVID-19 in the pediatric population. This information will enable to suspect and detect possible COVID-19 (+) cases in the perioperative period and plan ahead patient management and protection of healthcare providers. Twenty-five to 30% of COVID-19 (+) cases worldwide occur in healthcare workers. It is for this reason that special personal protection equipment (PPE) must be used, together with usual contact and droplet precautions. Anesthesia procedures that involve airway management can produce infectious aerosol. In order to reduce risks, we make a series of recommendations on perioperative management of children at this time of pandemia, which are to be complemented with those already released by the Chilean Society of Anesthesiology (SACH).

Desde diciembre de 2019 el mundo se ha enfrentado a la rápida extensión de un nuevo virus: el SARS-CoV-2. Originándose en Wuhan (China), se ha extendido a centenares de países, por lo que desde marzo de 2020 ya fue calificada como pandemia. Estamos frente a un virus nuevo de alta contagiosidad que ha llevado al colapso de los sistemas sanitarios. Alrededor del 2% de la población mundial de afectados son niños, los que en mayor frecuencia son asintomáticos, siendo relevantes en la transmisión de la enfermedad. En un bajo porcentaje pueden llegar a cuadros severos. En este artículo describimos la epidemiología pediátrica de COVID-19 reportada hasta ahora. Así, sabremos cuándo sospecharla en el perioperatorio y, por lo tanto, cómo manejar al paciente y proteger al personal de salud de contraer la infección. En este último punto, se ha recomendado el uso de elementos de protección personal (EPP) especiales y tomar precauciones de gotitas y contacto, ya que se conoce que entre el 25% y 30% de los contagiados en el mundo son trabajadores de la salud. En anestesia, el manejo de la vía aérea expone al contagio por aerosoles del virus. Por esta razón presentamos una serie de recomendaciones de manejo de niños en perioperatorio, las que son un complemento de las recomendaciones en población general publicadas ya por la Sociedad de Anestesiología de Chile (SACH).

Neurofeedback, aplicaciones y eficacia / Neurofeedback, applications and efficiency

El objetivo del estudio que se informa fue describir la técnica de neurofeedback, sus aplicaciones y usos, como así también determinar su eficacia a lo largo de los estudios revisados. De esta forma se encuentra la compilación de 53 artículos científicos acerca de la técnica, que describen cómo los autores han demostrado su funcionalidad, cuando se trata de proyectar de manera tangible el rendimiento de algún tipo de población para la posterior formulación de un tratamiento o intervención particular. En la presente revisión se describe la definición del método y las ondas cerebrales analizadas por el mismo, para luego mencionar su uso y aplicación en distintas áreas de las neurociencias. Se concluye que el neurofeedback es una técnica efectiva y no invasiva usada como tratamiento y entrenamiento en diversos campos cuyo resultado ha sido satisfactorio.

Neurofeedback emerges as a way to teach the individual to modify some aspects of brain activity. The brain activity works through the brain waves: Delta, Theta, Alpha, Beta, and Sensoriomotor Rhythm (SMR), which results in behavior, such as sleep, arousal and even anxiety. The theoretical basis of the technique in the early cognitive learning model is located and works according to the principles of operant conditioning. The individual learns how to influence the electrical activity of the brain by different states like relaxation and others, making the technique a chance to educate the brain. Another objective of neurofeedback is to improve performance, based on partnerships between those measurements recorded, and those behaviors or states of concentration that refers wave pattern; the emotional states, relaxation and concentration of an individual can make the rate and wavelength go faster or slower, depending on the case, and how they influence the voltage amplitude. The electroencephalogram (EEG) is the best instrument to measure the cerebral activity marked by brain waves, this record is used to establish under what factors (voltage, frequency, etc.) is the brain working which goes from the ideal mental state through pathological cases, identifying the pattern of neuronal interaction. This in order to achieve multiple objectives of science: improvement of cognitive activity, optimizing performance in athletes (archery, golf, sky, tennis, swimming), stimulation of the artists skills, (performers and dancers) treating disorders of attention deficit hyperactivity disorder (ADHD), epilepsy, addiction disorder, posttraumatic stress disorder (PTSD) and autism, even cognitive functions such as concentration and memory, and other variables, as emotional control and personality. This paper allows the reader to discover detailed aspects of multiple studies on the topic of neurofeedback as it use and technique. This review of articles applied to sporting, artistic and even cognitive domain, presented and described all of their results. These studies suggest the application of technical features such as low global connectivity and neuroplasticity, most of these studies may be trained simultaneously with the application of neurofeedback and other techniques such as training mental skills and visualization; and in most cases are evaluated by psychometric instruments to notice the advances simultaneously with the results of EEG, for integral intervention. It is also possible the application of the technique in order to find the reduced biological predisposition to certain diseases by stimulating the brain activity of the affected hemisphere, for each case has specific protocols depending on the type of wave, and obtains results performing the treatment from 20 through 40th session. In the case of learning disabilities, it has been reported, an increase of 12 to 19 IQ points after training with neurofeedback. No significant side effects are reported, they may occur in the event that the sessions are too prolonged for the participant, including: headache, fatigue and anxiety, which are momentary states so that will not be considered risk factors to finalize the treatment. Moreover, the article suggests how to study a population or a specific study on an individual, as describe how authors have demonstrated it functionality to design treatments for a particular intervention in any population. Through the review of 53 scientific articles, it provides the definition of the method, analyzed brain waves and application in different areas of neuroscience. The purpose of this article is expose neurofeedback. We conclude that neurofeedback is an effective noninvasive technique, and used as treatment and training in various fields whose outcomes has been satisfactory. As general recommendations for future research, there is a need to create and implement protocols to support technical for each particular situation, increasing its use, due to it has successfully demonstrated its effectiveness so far. technique, applications, uses and effectiveness.