Ultrasonido Perioperatorio: El reto de aplicar una vieja tecnología en nuevos escenarios clínicos / Perioperative Ultrasound: The challenge of applying an old technology in new clinical settings

In anaesthesia, anticipating problems and responding quickly and effectively to peri-operative risks to the patient is crucial. As a result of recent technological advances over the last few decades, ultrasound has emerged as a tool to guide a huge number of procedures in the practice of various specialties. In particular in anaesthesia, it has become critical in establishing vascular accesses, providing regional anaesthesia, performing interventional procedures for acute and chronic pain relief, and for gathering relevant qualitative information for the diagnosis or treatment of low output syndromes, hypovolemia, acute pulmonary events, and for the assessment of gastric content as a risk for aspiration, and assessment of the airway, among other things.

Descripción de técnica anestésica con dexmedetomidina más anestesia controlada por el paciente de alfentanilo para litotripsia extracorpórea en tratamiento de urolitiasis / Description of anesthetic technique with dexmedetomidine plus anesthesia controlled by the alfentanil patient for extracorporeal lithotripsy in treatment of urolithiasis

La litotripsia extracorpórea es un procedimiento frecuente en el ejercicio de la urología para el manejo no invasivo de la enfermedad litiásica renal. Desde el punto de vista anestésico, para la litotripsia extracorpórea se han utilizado la anestesia general, la regional y técnicas analgésicas. En una serie de casos se describe la técnica de dexmedetomidina más anestesia controlada por el paciente (PCA), con alfentanilo como analgesia intravenosa para dicho procedimiento; se observó una adecuada analgesia y aceptación por parte del paciente y el urólogo, con excelente seguridad. Este reporte de casos es la base para estudios aleatorios posteriores para comparar las técnicas utilizadas actualmente y esta nueva técnica.

The shock wave lithotripsy is a frequent procedure in the exercise of urology. From the anesthetic point of view, the following procedures have been used for the shock wave lithotripsy: general, regional anesthesia, regional anesthesia and analgesic techniques. We describe, in a case series, the technique of dexmedetomidina and Patient Controlled Analgesia (PCA) with alfentanil intravenous analgesia for this procedure, being observed a suitable analgesia and acceptance on the part of the patient and the practitioner with excellent security. This case report is the base to randomized study to compare the actual technical used and this new technique.

Evaluación de la vía aérea en el paciente crítico / Evaluation of the airway in the critical patient

El manejo de la vía aérea (MVA) debe ser prioridad en el cuidado de pacientes críticos, las intervenciones en vía aérea tienen como finalidad asegurarla o controlar la ventilación ademas de evitar complicaciones.1,2,3 La evaluación de vía aérea (EVA) previa es un prerrequisito, con el fin de determinar la dificultad de la maniobra, los posibles riesgos y complicaciones a las que se ve enfrentado el médico y el paciente.4,5,6,7 Surgen interrogantes con respecto a la EVA como parte del MVA en las unidades de cuidado intensivo, como los siguientes: ¿Con qué frecuencia realizamos esta evaluación?, ¿es nuestra evaluación completa y adecuada?, si es así, ¿con qué certeza podemos afirmar que la evaluación nos puede dar información cierta? y ¿qué tan confiados podemos sentirnos a la hora de intubar nuestro paciente? El siguiente texto tiene como finalidad discutir la importancia de las actitudes adecuadas y los procesos a seguir previos al MVA en el paciente crítico.

Airway management (MVA) must be priority in the care of critical patients. Airway intervention is needed to assure or control the ventilation.1,2 The Airway evaluation (EVA) is a requirement, with the purpose of determining the difficulty of the orotraqueal intubation maneuver, the possible risks and complications for the physician and the patient.4,5,6,7 There is some questions with respect to EVA like part of the MVA in the intensive care units; ¿how frequently we made this evaluation?, ¿Is it a complete and suitable evaluation?, if it is thus, ¿how certain could we affirm that the evaluation can give true information to us? and ¿how trusted can we feel at the time of patient intubation? The following text has the purpose of discuss the importance of suitable attitudes and the processes to follow previously to the MVA in the critical patient.

Aspectos Perioperatorios del Trasplante Renal / Aspects Perioperatorios of the Transplant

El Trasplante de órganos es una opción terapéutica para algunas patologías de carácter irreversible. En el mundo durante los últimos años se han ampliado las indicaciones para trasplante renal. Pacientes con enfermedades de mal pronostico como Diabetes Mellitus (DM), Nefroesclerosis Hipertensiva, Glomerulonefritis y Enfermedad Quística renal, causantes de enfermedad renal Terminal, y pacientes con patologías asociadas como disfunción ventricular enfermedades autoinmunes, enfermedad de células falciformes, obesidad y hepatitis B según el antígeno que expresen, ven en el trasplante renal una opción para aumentar tiempo y calidad de vida. Todo mediante un procedimiento seguro, hoy en día la mortalidad del receptor es cercana al 0.03 por cien.1 El éxito del trasplante es indirectamente proporcional al tiempo de dependencia de diálisis pretrasplante y el entendimiento de la fisiopatología de la falla renal Terminal redunda en el pronóstico de estos pacientes.2 El paciente nefrópata en estadio terminal plantea al anestesiólogo un reto en la visualización del panorama clínico y sus implicaciones anestésicas. La siguiente revisión pretende abarcar aspectos del ámbito perioperatorio del trasplante renal en forma clara y concisa, enfatizando en aspectos importantes y nombrando someramente algunos otros. Es un tema extenso, parcialmente inexplorado y donde la medicina basada en evidencia tiene aun un largo camino por recorrer.

Frecuencia relativa de Boophilus microplus (Acari: Ixodidae) en bovinos (Bos taurus y B. indicus) en ocho zonas ecológicas de Costa Rica / Relative frequency of Boophilus microplus (Acari: Ixodidae) in bovines (Bos taurus and B. indicus) in 8 ecological zones of Costa Rica

The research on the relative abundancy of Boophilus microplus took place in ten farms, distributed in eight ecological zones (EZ) and two rainfall systems of Costa Rica. Monthly visits were made to pick up ticks larger than 4 mm from the right side of the animals. The total number of ticks was increased by two and divided between the total of sampled bovines per farm. Farm visits were adjusted to animals bath to allow the recovery of the tick population. B. microplus was detected in all sampled farms throughout the year. Media comparison statistic analyses were made and no differences were found among EZ, farms and seasons. On the contrary, there were important statistical differences between rainfall systems. The rainfall system 1, that included rain seasonality, showed larger tick infestations (p = 0.03). An isothermal and low variability regarding relative humidity situations were present in some of the areas included in this research. Bath intensity was lower to other past studies. Even though no differences were found between production systems, it is important to emphasize that bath intensity was higher in european cattle farms, in comparison to others of the same EZ, but of crossbred. A tick manual removable system was recommended in dual-purpose and specialized dairy farms with no more than 30-35 animals, as an alternative feasible system that significantly reduced acaricide use.

Abundancia relativa de Amblyomma spp. (Acari: Ixodidae) en bovinos (Bos taurus y B. indicus) de Costa Rica / Relative abundance of Amblyomma spp. (Acari: Ixodidae) in bovines (Bos taurus and B. indicus) from Costa Rica

The research describe the big amount of ticks of the Amblyomma genus, found on bovines through monthly samplings carried out in ten farms in eight ecological zones (EZ) of Costa Rica. Ticks larger than 4 mm were picked up from the right side of the animals during the visit. The study compiled meteorological information for some farms located in the experiment, showing that the most fluctuant variable is rainfall. The most important Amblyomma species found was A. cajennense. Amblyomma nymphs were found only from January to May, which coincides with the lower humidity season in the rain seasonality area; as for it is expected only one generation per year. In the lab work Amblyomma nymphs are kept to measure the moulting season and the surviving time under controlled conditions, but no major differences were found between both sexes. The surviving periods show that it is not possible to do a grazing land handling, in order to control this genus species. Adults of the genus Amblyomma are present through all the year, not showing any specific preference for a season. The research divided the investigation areas in rain seasonability and not-seasonality systems. The highest amount of Amblyomma is found given in the rain seasonality system or of pacific influence. A. maculatum is present only in the EZ of Tropical Humid Forest transition to pre-mountainous. Likewise, Ixodes boliviensis is found in the EZ of low mountainous Very Humid Forest.

Prevalence of different types of anemia in Ecuador

1. We present the results of a study of the prevalence of anemia and its causes in the population of Ecuador. The following parameters were used: blood cytology, reticulocyte count, serum iron, iron biding capacity, ferritin, folic acid and vitamin B 12 concentration. 2. The study was carriede out on 4 groups: 426 individuals of both sexes and all ages from the rural population of the lowlands, with a warm and humild climate; 226 individuals from the highlands, with a cold and dry climate; 1000 individuals of the urban working group from the lowlands; and 1000 individuals of the urban working group from the highlands. All subjects were chosen randomly. 3. The prevalence of anemia was 31.4% in the rural group from the lowlands, 27.9% in the rural group from the highlands, 5.5% in the urban group from the lowlands, and 2.7% in the urban group from the highlands, with an overall estimated prevalence of 20.6% for the population of Ecuador as a whole. Iron deficiency was the most frequent cause of anemia (91.3%); 18.7% of the total population), followed by bone marrow failure (6%; 1.2% of the total population), hemolysis (2.2%); 0.5% of the total population), and finally megaloblastic anemia (0.5%; 1.1% of the population). 4. Since iron deficiency with and without anemia is very frequent, we believe it is justified to establish mechanisms for food iron enrichment for liable groups such as children and pregnant women from marginal areas