70 results on '"Claudio Nazar"'
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2. Recomendación clínica: evaluación preoperatoria
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Waldo Merino U, Camila Stuardo M, Claudio Nazar J, Ricardo Fuentes H, Patricio Vega G, and Ángela Parra P
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Medicine ,Anesthesiology ,RD78.3-87.3 - Published
- 2019
- Full Text
- View/download PDF
3. Nuevos anticoagulantes orales y antiagregantes plaquetarios, en el período perioperatorio de cirugía no cardíaca. Parte 2: Nuevos antiagregantes plaquetarios
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Claudio Nazar J, Maximiliano Zamora H, and Guillermo Lema F
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Anticoagulants ,Perioperative period ,Platelet Aggregation Inhibitors ,Bleeding risk ,Medicine ,Anesthesiology ,RD78.3-87.3 - Published
- 2018
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- View/download PDF
4. Nuevos anticoagulantes orales y antiagregantes plaquetarios, en el período perioperatorio de cirugía no cardíaca. Parte 1: Nuevos anticoagulantes directos
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Guillermo Lema F, Maximiliano Zamora H, and Claudio Nazar J
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Anticoagulants ,Perioperative period ,Direct oral anticoagulants (DOACs) ,Bleeding risk ,Medicine ,Anesthesiology ,RD78.3-87.3 - Published
- 2018
- Full Text
- View/download PDF
5. Implementación de la reforma curricular de la Escuela de Medicina de la Pontificia Universidad Católica de Chile: analizando la experiencia
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Marcela Cisternas, Javier Rodríguez, Carolina Llanos, Francisco Garrido, Claudio Nazar, Natalie Thone, Marisol Sirhan, Natalia Gana, Claudia Valdés, and Solange Rivera
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General Medicine - Published
- 2022
6. High-fidelity hybrid simulation not only optimizes skills acquisition but improves nontechnical skills
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Sebastián Irarrázaval, Pablo Besa, Catalina Vidal, Claudio Nazar, Julián Varas, Ignacio Villagrán, Cristian Ruz, Arnoldo Riquelme, and Eduardo Fuentes-López
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High fidelity ,Computer science ,education ,ComputingMilieux_COMPUTERSANDEDUCATION ,Technical skills ,behavioral disciplines and activities ,Simulation - Abstract
Introduction Knee arthrocentesis is frequently performed as a diagnostic or therapeutic procedure. Although considered a key competency for medical doctors, most students never execute the procedure during their training. We aimed to assess technical and nontechnical skills for knee arthrocentesis through high-fidelity hybrid simulation Methods Medical students and general physicians were recruited for training; orthopedic surgeons were recruited as experts. Trainees received educational documentation prior to training. Trainees took a medical history and obtained informed consent from a patient-actor, then encountered a simulated knee to execute the procedure. We adapted a direct observation scale to assess technical and nontechnical skill performance. Personalized feedback was received after each session. Performance among trainees (learning curves) and between trainees and experts was compared using a mixed-effects model. Results Trainees significantly improved from the first session to the second and third. The third session was the learning curve plateau. Performance obtained in the third and fourth sessions were similar to expert performance. The assessment tool evaluated technical and nontechnical skills with high internal consistency and showed high interobserver reliability. Discussion Learning curve analysis showed that high-fidelity simulation allowed trainees to become proficient in technical and nontechnical skills required to perform a safe knee arthrocentesis.Level of Evidence: Level II (Prospective Cohort Study)
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- 2022
7. Cómo diseñar y escribir un protocolo de investigación basado en simulación
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Daniela Regonesi P, Nicole Bloch G, Pablo Besa, Marcia Corvetto A, Francisca Lubi R, Lucas Oberpaur K, and Claudio Nazar J
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General Medicine ,Sociology - Published
- 2021
8. Recomendación clínica: evaluación preoperatoria
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P P Ángela Parra Ángela Parra, U U Waldo Merino Waldo Merino, J Claudio Nazar, M M Camila Stuardo Camila Stuardo, G G Patricio Vega Patricio Vega, and H Ricardo Fuentes
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lcsh:RD78.3-87.3 ,Anesthesiology and Pain Medicine ,lcsh:Anesthesiology ,lcsh:R ,lcsh:Medicine - Published
- 2019
9. La simulación como herramienta de evaluación de competencias y certificación
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Ricardo Fuentes H, Claudio Nazar J, and Nicole Bloch G
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General Medicine ,Psychology - Published
- 2019
10. Nuevos anticoagulantes orales y antiagregantes plaquetarios, en el período perioperatorio de cirugía no cardíaca. Parte 1: Nuevos anticoagulantes directos
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H Maximiliano Zamora, J Claudio Nazar, and F Guillermo Lema
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lcsh:RD78.3-87.3 ,Perioperative period ,Anesthesiology and Pain Medicine ,lcsh:Anesthesiology ,Bleeding risk ,lcsh:R ,Anticoagulants ,lcsh:Medicine ,Direct oral anticoagulants (DOACs) - Published
- 2018
11. Consideraciones perioperatorias en el paciente obeso
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J Claudio Nazar, P Ian Molina, H Ricardo Fuentes, D Roberto Coloma, and C José Ignacio Contreras
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medicine.medical_specialty ,education.field_of_study ,Glottis ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Laryngoscopy ,Population ,Apnea ,Perioperative ,medicine.disease ,Obesity ,medicine.anatomical_structure ,Anesthetic ,Emergency medicine ,medicine ,Surgery ,Airway management ,medicine.symptom ,business ,education ,medicine.drug - Abstract
Obesity is a condition of excessive accumulation of body fat to a level that is harmful to health. The prevalence of obesity is increasing worldwide at an alarming rate. Therefore it is essential to know the perioperative management and specific considerations in this population. The majority of obese patients who undergo surgical procedures have few additional pathology, so their perioperative risk is similar to eutrophic patients. Obesity Surgery Mortality Risk Stratification Score OS-MRS is a validated scale for assessing the risk of perioperative mortality in these patients. It is essential to look for the presence of respiratory sleep disorders in these patients, and for this purpose, the STOP-BANG questionnaire is the most valid today. During anesthetic induction it is recommended to place the patient in the “ramp” position as it significantly improves the visualization of the glottis during laryngoscopy. Also, this position optimizes the oxygenation and ventilatory mechanics of these patients, increasing the time of safe apnea. Regarding airway management, orotracheal intubation with controlled ventilation is the technique of choice in this population. Anesthetic drug doses should be calculated based on adjusted weight or lean weight, depending on the type of drug chosen. Finally, complete and frequent postoperative monitoring is recommended in the recovery unit, transferring these patients to their room only when they meet the criteria included in the White and Song scale.
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- 2018
12. Percepción de estudiantes de pregrado de Medicina de talleres de simulación de procedimientos médico-quirúrgicos
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Javier Uribe, Arnoldo Riquelme, Margarita Pizarro, Claudio Nazar, Rodrigo Tejos, Isabel Leiva, Cristian Ruz, Thomas Uslar, Javier Chahuan, Marisol Sirhan, Eduardo Fuentes-López, Romina Soza, Marcia Corvetto, Nancy Solís, Oslando Padilla, Pablo Achurra, Carlos Villafranca, Julián Varas, and Ignacio Villagrán
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Medical education ,Students, Medical ,Education, Medical ,media_common.quotation_subject ,education ,Delphi method ,Construct validity ,General Medicine ,Education ,Likert scale ,03 medical and health sciences ,0302 clinical medicine ,Cronbach's alpha ,Surveys and Questionnaires ,Perception ,Undergraduate student ,030211 gastroenterology & hepatology ,Clinical Competence ,030212 general & internal medicine ,Factorial analysis ,Psychology ,Reliability (statistics) ,media_common - Abstract
Background: Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students’ perception of simulation workshops. Aim: To adapt and validate an instrument to assess the undergraduate medical student’s perception of simulation workshops of clinical procedures. Material and Methods: Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach’s Alpha (0 to 1) for internal consistency of the instrument. Results: A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging from 32 to 35 and the Cronbach Alpha coefficient was 0.72, indicating a good reliability. Conclusions: The perception questionnaire is a useful and reliable instrument to assess students’ perceptions of clinical simulations.
- Published
- 2018
13. Manejo perioperatorio de pacientes usuarios de antiagregantes plaquetarios
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J Claudio Nazar, C José Ignacio Contreras, H Ricardo Fuentes, and P Ian Molina
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Thrombotic risk ,Aspirin ,Perioperative management ,business.industry ,Incidence (epidemiology) ,Perioperative ,Disease ,Clopidogrel ,medicine.disease ,Anesthesia ,medicine ,Surgery ,cardiovascular diseases ,Myocardial infarction ,business ,medicine.drug - Abstract
The use of antiplatelet drugs for primary and secondary prevention of cardiovascular disease events is a common clinical practice. Antiplatelet therapy significantly decreases the incidence of cardiovascular disease events, including acute myocardial infarction and cerebrovascular accident. It is increasingly common to face patients on antiplatelet therapy who will undergo some surgical procedure, so it is essential to know the perioperative management of these drugs, to reduce the risks and complications associated with the suspension or maintenance of these therapies in the perioperative period. The most common antiplatelet agents used in Chile are acetylsalicylic acid and thienopyridines, of which clopidogrel is the most frequent one. The perioperative management of these drugs has to be based on the individual thrombotic risk of each patient and the risk of hemorrhage of each surgery. In noncardiac surgeries, it is suggested to maintain acetylsalicylic acid, except in patients with low to moderate thrombotic risk who will undergo surgeries with a high risk of bleeding, in which case it is recommended to suspend it 5 to 7 days before surgery. Clopidogrel is suggested to be discontinued 5 days before surgery, except in patients with high thrombotic risk who will undergo surgical procedures with low to moderate risk of hemorrhage. In myocardial revascularization surgeries, it is recommended to maintain acetylsalicylic acid and to suspend clopidogrel 5 days before the procedure. Once assuring adequate surgical hemostasis, it is suggested to reinitiate acetylsalicylic acid 6 hours after surgery and to reinitiate clopidogrel during the first 24 postoperative hours.
- Published
- 2018
14. Manejo del dolor: Trastorno por uso de opiáceos de prescripción médica y su relación con la práctica clínica
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H Maximiliano Zamora, J Claudio Nazar, P Augusto Rolle, K Marcela Babul, A Sofía Herrera, and M Armando Maldonado
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Anesthesiology and Pain Medicine - Published
- 2017
15. Recomendación clínica: evaluación preoperatoria
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Ricardo Fuentes H., Ricardo Fuentes H., primary, Claudio Nazar J., Claudio Nazar J., additional, Patricio Vega G., Patricio Vega G., additional, Camila Stuardo M., Camila Stuardo M., additional, Ángela Parra P., Ángela Parra P., additional, and Waldo Merino U., Waldo Merino U., additional
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- 2019
- Full Text
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16. Manejo perioperatorio de pacientes usuarios de antidepresivos
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Claudio Nazar J, Angela Parra P, Ricardo Fuentes H, Martín Inzunza A, Patricia Díaz F, and Roberto Coloma D
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Desórdenes mentales ,Período perioperatorio ,Agentes antidepresivos tricíclicos ,03 medical and health sciences ,0302 clinical medicine ,Inhibidores de la recaptura de serotonina ,Inhibidores de la monoaminooxidasa ,030202 anesthesiology ,Surgery ,030227 psychiatry - Abstract
Resumen El uso de antidepresivos en el perioperatorio es muy frecuente, y la practica clinica indica que los pacientes usuarios de antidepresivos que son sometidos a cirugia tienen un riesgo perioperatorio aumentado. No existen en la actualidad guias clinicas basadas en la evidencia que orienten el manejo de este tipo de pacientes, por lo que las recomendaciones se basan en las escasas revisiones sistematicas y metaanalisis disponibles, reportes de casos y opinion de expertos, que en muchos casos resultan controversiales. La decision de mantener o suspender la medicacion antidepresiva implica considerar los riesgos tanto desde el punto de vista fisiologico (caracteristicas generales del paciente, riesgos asociados al antidepresivo utilizado, la cirugia propiamente como tal, la interaccion con farmacos frecuentemente utilizados en el perioperatorio, entre otros) como desde el punto de vista psiquiatrico (riesgo de sindrome de retirada, recaida de la enfermedad psiquiatrica, intentos suicidas), por lo que la decision debe ser tomada idealmente de forma multidisciplinaria entre cirujanos, anestesiologos y psiquiatras, con la idea de confeccionar un plan quirurgico, anestesico y de manejo perioperatorio seguro para el paciente.
- Published
- 2017
17. Cómo planificar, diseñar y organizar un centro de cirugía ambulatoria
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Claudio Nazar, Natalia de la Fuente, Maximiliano Zamora, Esteban del Río, and Alejandro González
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Operating rooms ,Ambulatory surgery ,Efficiency ,Structure design ,Diseño de infraestructura ,Pabellones quirúrgicos ,Centros de cirugía ambulatoria ,03 medical and health sciences ,Eficiencia ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Ambulatory surgery centers ,Surgery ,Cirugía ambulatoria ,030217 neurology & neurosurgery - Abstract
ResumenLos centros de cirugía ambulatoria han contribuido al progreso de esta cirugía y se caracterizan por ser eficientes, productivos, rentables y generar alta satisfacción. Construir un centro de cirugía ambulatoria requiere constituir un equipo multidisciplinario encargado de desarrollar un proyecto que evalúe la viabilidad económica, seleccione el tipo de centro a construir, determine el tamaño y el diseño del centro y defina la dotación de personal; con esta información se realiza la evaluación económica final que decide la factibilidad de construir el centro. Organizar el inicio de actividades y el funcionamiento de este servicio requiere determinar horarios, modalidad de trabajo, flujos de circulación y funciones del personal, a través de protocolos que definan, describan y coordinen todos los procesos clínicos y administrativos involucrados desde la indicación de la cirugía hasta el alta del paciente. La eficiencia del pabellón quirúrgico es determinante en el funcionamiento de un centro de cirugía ambulatoria. Varios factores contribuyen a la eficiencia de pabellón, y el más crítico de estos es el tiempo entre cirugías o tiempo de recambio de pacientes, el cual es factible de optimizar. La cirugía ambulatoria es una modalidad de trabajo quirúrgico que requiere un servicio clínico propio, adecuadamente planificado, diseñado y organizado para lograr sus objetivos y ventajas.AbstractAmbulatory surgery centers have contributed to the progress of ambulatory surgery and they are characterized by its efficiency, productivity and to produce high satisfaction. To build an outpatient surgery center a multidisciplinary team should be responsible to develop a project that to assess the economic viability, to select the type of center, to determine the size and the design of center and to set de staffing; with this information the final economic evaluation that decide the feasibility to build the center must be performed. To organize the launch activities and the operation of this service requires determining schedules, working mode, traffic flows and staff functions through protocols that to define, to describe and to coordinate all clinic and administrative process involved from the surgery indication to the patient discharge. The operating room efficiency is determining factor in the ambulatory surgery center functioning. Several factors contribute to the operating room efficiency, the most critical of which is the time between surgical procedures o turnover time and this time is feasible to optimize. Ambulatory surgery is a mode of surgical work requiring its own clinical service properly planned, designed and organized to achieve its objectives and advantages.
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- 2016
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18. Manual de primeros auxilios
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Helo, Maximiliano Zamora, Jara, Claudio Nazar, Müller, Fernando Pimentel, Helo, Maximiliano Zamora, Jara, Claudio Nazar, and Müller, Fernando Pimentel
- Published
- 2015
19. CIRUGÍA PLÁSTICA Y SUS COMPLICACIONES: ¿EN QUÉ DEBEMOS FIJARNOS?
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Eduardo Vega P, Juan Carlos de la Cuadra F, Maximiliano Zamora H, Susana Searle F, Claudio Nazar J, and Bruno Dagnino U
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medicine.medical_specialty ,liposucción ,Deep vein ,medicine.medical_treatment ,Cirugía plástica ,Population ,medicine ,morbilidad ,education ,Breast augmentation ,Surgical team ,education.field_of_study ,business.industry ,Perioperative ,medicine.disease ,Surgery ,Pulmonary embolism ,Plastic surgery ,anestésicos locales ,medicine.anatomical_structure ,Anesthesia ,Liposuction ,tromboembolismo ,mortalidad ,business - Abstract
Las cirugías plásticas son cada vez más frecuentes, abarcando todo tipo de población y realizándose incluso en la consulta médica. Las cirugías estéticas más frecuentemente realizadas son aumento mamario y liposucción corporal. Son procedimientos quirúrgicos sumamente electivos, pero poseen riesgos y complicaciones asociados, los cuales deben ser debidamente informados a los pacientes. La complicación más relevante es el tromboembolismo pulmonar, generalmente asociado a trombosis venosa profunda, el cual es la primera causa de mortalidad en este tipo de cirugías. Otras complicaciones destacadas son intoxicación por anestésicos locales secundaria al uso de solución tumescente para liposucción corporal, inadecuado manejo de fluidos endovenosos perioperatorios, hipotermia inadvertida y dolor intenso por deficiente analgesia postoperatoria. Estas complicaciones aumentan significativamente la morbimortalidad y estadía hospitalaria, por lo que su prevención es fundamental. Las medidas que han demostrado disminución significativa de los riesgos y complicaciones perioperatorios en cirugía plástica son tromboprofilaxis según categorización del riesgo trombótico de cada paciente, revisar que la solución tumescente administrada para liposucciones tenga concentraciones adecuadas de lidocaína (idealmente utilizando vasoconstrictores coadyuvantes), utilizar medidas adecuadas de monitorización y conservación de temperatura en pacientes con gran superficie corporal expuesta, ser acuciosos en el balance intraoperatorio de fluidos endovenosos y administrar analgesia postoperatoria multimodal, balanceada y acorde a la magnitud del dolor. Es vital una adecuada comunicación entre el equipo de cirujanos, anestesiólogos, enfermeros e instrumentadores quirúrgicos con el objetivo de conocer las particularidades de las distintas cirugías plásticas e implementar las medidas de monitorización, prevención de complicaciones y manejo analgésico antes descritas.
- Published
- 2014
20. [Undergraduate student's perception of clinical simulation workshops: assessment of an instrument]
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Ignacio, Villagrán, Rodrigo, Tejos, Javier, Chahuan, Thomas, Uslar, Margarita, Pizarro, Julián, Varas, Pablo, Achurra, Isabel, Leiva, Claudio, Nazar, Marisol, Sirhan, Javier, Uribe, Cristian, Ruz, Carlos, Villafranca, Romina, Soza, Nancy, Solís, Eduardo, Fuentes-López, Oslando, Padilla, Marcia, Corvetto, and Arnoldo, Riquelme
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Students, Medical ,Delphi Technique ,Formative Feedback ,Surgical Procedures, Operative ,Surveys and Questionnaires ,Humans ,Reproducibility of Results ,Perception ,Clinical Competence ,Reference Standards ,Factor Analysis, Statistical ,Simulation Training ,Education, Medical, Undergraduate - Abstract
Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops.To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures.Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach's Alpha (0 to 1) for internal consistency of the instrument.A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging from 32 to 35 and the Cronbach Alpha coefficient was 0.72, indicating a good reliability.The perception questionnaire is a useful and reliable instrument to assess students' perceptions of clinical simulations.
- Published
- 2017
21. Prevención y tratamiento de pacientes con náuseas y vómitos postoperatorios
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E Javier Bastidas, D Roberto Coloma, H Maximiliano Zamora, H Ricardo Fuentes, and J Claudio Nazar
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business.industry ,Antieméticos ,Náuseas ,03 medical and health sciences ,0302 clinical medicine ,Postoperatorio ,Vómitos ,030202 anesthesiology ,Profilaxis ,Medicine ,Surgery ,030212 general & internal medicine ,business ,Humanities - Abstract
Resumen Las nauseas y vomitos postoperatorios (NVPO) son un problema frecuente en los pacientes quirurgicos. Cuando no son prevenidos adecuadamente pueden provocar mayor morbilidad, estadia prolongada en la unidad de recuperacion postoperatoria y hospitalizacion no planificada. El objetivo del equipo quirurgico debe ser la profilaxis de las NVPO mas que su tratamiento, con el fin de disminuir significativamente su incidencia y complicaciones asociadas. Los principales factores de riesgo para NVPO son: sexo femenino, historia de NVPO en cirugias previas y/o cinetosis, no fumar, uso de opioides sistemicos en el postoperatorio, someterse a ciertos tipos de cirugia (como colecistectomia, cirugia laparoscopica y cirugia ginecologica), utilizar anestesicos volatiles y/u oxido nitroso intraoperatorios, y duracion de la cirugia. Sugerimos objetivar el riesgo de NVPO utilizando las escalas de riesgo de NVPO de Apfel o Koivuranta. Los principales farmacos antiemeticos usados como profilaxis y tratamiento en el periodo perioperatorio son dexametasona, ondansetron y droperidol. Existen estrategias generales que se pueden utilizar para reducir el riesgo quirurgico basal de NVPO como evitar la anestesia general, privilegiando la anestesia regional, utilizar propofol para la induccion y mantencion de la anestesia, evitar el uso de oxido nitroso y/o anestesicos inhalatorios, minimizar el uso postoperatorio de opioides sistemicos y recibir una hidratacion intravenosa abundante durante la cirugia. La etiologia de las NVPO es multifactorial, por lo que la prevencion y tratamiento deben incluir diferentes clases de antiemeticos, que actuen sobre los diferentes receptores de nauseas y/o vomitos hasta el momento conocidos, junto con las estrategias generales antes mencionadas.
- Published
- 2017
22. Manejo perioperatorio de pacientes con tratamiento anticoagulante crónico
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H Ricardo Fuentes, Ian Molina, J Claudio Nazar, C José Ignacio Contreras, C Antonia Cárdenas, D Roberto Coloma, and H Pablo Miranda
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medicine.medical_specialty ,Perioperative management ,business.industry ,medicine.drug_class ,Anticoagulant ,Renal function ,Heparin ,Perioperative ,030204 cardiovascular system & hematology ,Vitamin K antagonist ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,In patient ,030212 general & internal medicine ,Hemorrhagic risk ,business ,medicine.drug - Abstract
Anticoagulant therapy is widely used in clinical practice, as prophylaxis in patients at risk of presenting thromboembolic phenomena or as treatment in those who have presented a thrombotic event. It is increasingly the number of patients on chronic anticoagulant therapy to undergo surgical procedures, so it is important and necessary to know the perioperative management of the different anticoagulant drugs to reduce the risks and complications associated with suspension or maintenance of these in the perioperative period. To achieve this goal, the risk of bleeding should be evaluated and balanced against the risk of thromboembolic events, considering the medical condition of each patient and the type of surgical procedure to which they have undergone. The recommendation for vitamin K antagonist oral anticoagulant drugs is to maintain them for surgeries at low risk of bleeding and to suspend them 5 days before surgical procedures with moderate and high bleeding risk, controlling ‘International Normalized Ratio’ the day before surgery. The new oral anticoagulants do not require routine monitoring, recommending suspending them 24-96 h prior to the surgical procedure, depending on the hemorrhagic risk of each surgery and renal function of patient. In relation to parenteral anticoagulants, unfractionated heparin in intravenous infusion is recommended to be discontinued 4-5 h prior to surgery, while the subcutaneous route, 12 h prior to surgery. Low-molecular-weight heparins in treatment doses should be suspended 24 h prior to surgery, while in prophylactic doses, only 12 h earlier.
- Published
- 2017
23. Delirium postoperatorio: una consecuencia del envejecimiento poblacional
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Claudio Nazar J, Eduardo Vega P, Marcela Carrasco G, Marcos Rattalino F, and Juan Pedemonte T
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medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,MEDLINE ,Delirium ,Cognition ,General Medicine ,Postoperative complications ,Geriatrics ,Intervention (counseling) ,Epidemiology ,medicine ,Postoperative delirium ,medicine.symptom ,Intensive care medicine ,Complication ,Psychiatry ,business - Abstract
Delirium (acute confusional state) is a common and disabling complication among surgical older people. It is often underdiagnosed and undertreated. Its incidence varies by type of intervention and it is associated with several complications such as functional impairment, cognitive dysfunction, prolonged hospitalization and institutionalization. These increase hospitalization costs and the risk of death. There are precipitating and predisposing risk factors, which increase the susceptibility for postoperative delirium. This condition should be considered as a syndrome of epidemiological importance, which needs to be prevented or treated in a timely manner through a multidisciplinary intervention. The perioperative care of elderly patients involves different medical specialties and is a subject of general knowledge.
- Published
- 2014
24. EXÁMENES PREOPERATORIOS DE RUTINA EN CIRUGÍA ELECTIVA: ¿CUÁL ES LA EVIDENCIA?
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Javier Bastidas E, Guillermo Lema F, and Claudio Nazar J
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Pregnancy test ,medicine.medical_specialty ,education.field_of_study ,Exámenes preoperatorios de rutina ,medicine.diagnostic_test ,business.industry ,Sedation ,Population ,Physical examination ,Perioperative ,Hematocrit ,Surgery ,intervención quirúrgica ,mortalidad ,Medicine ,morbilidad ,Elective surgery ,medicine.symptom ,business ,education ,período perioperatorio ,Invasive Procedure - Abstract
Todo paciente que se va a someter a un procedimiento quirúrgico, con anestesia, necesita una evaluación preoperatoria, siempre importante para el proceso quirúrgico. La mayoría de las veces, la evaluación clínica es suficiente para establecer el riesgo perioperatorio y determinar los factores de riesgo del paciente susceptibles de ser modificados durante el período cercano a la intervención, sin necesidad de recurrir a exámenes de apoyo complementarios ni interconsultas a especialistas. En la actualidad, la tendencia de los especialistas es solicitar los llamados exámenes preoperatorios "de rutina", muchas veces sin un análisis previo de la historia clínica y examen físico. Se ha demostrado que un paciente joven y sano, sometido a una cirugía de forma electiva, no necesita de exámenes previos a la intervención quirúrgica. Estos exámenes preoperatorios aumentan los costos en salud y casi nunca cambian significativamente la morbimortalidad perioperatoria. Exámenes como radiografía de tórax, electrocardiograma, hematocrito/hemoglobina, pruebas de coagulación, recuento de plaquetas, glicemia y test de embarazo tienen indicaciones precisas y no deben solicitarse rutinariamente a toda la población quirúrgica.
- Published
- 2014
25. Manejo preoperatorio de pacientes con Diabetes Mellitus
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Claudio Nazar J, Alejandro González A, and Christian Herrera F
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hiperglicemia ,manejo preoperatorio ,Surgery ,insulina ,Diabetes Mellitus 1 y 2 ,hipoglicemiantes orales - Abstract
La Diabetes Mellitus es una condición crónica de hiperglicemia que afecta al 9,4% de la población chilena. Estudios han encontrado que los pacientes con Diabetes Mellitus tienen mayor probabilidad de requerir cirugía en comparación a la población general. La hiperglicemia que presentan los pacientes se ha relacionado al desarrollo de complicaciones infecciosas y cardiovasculares en el período postoperatorio. Se ha demostrado que el adecuado control glicémico preoperatorio contribuye a disminuir el riesgo de desarrollar dichas complicaciones. Es por eso que se hace fundamental la evaluación preoperatoria para poder conocer los valores de glicemia que presenta el paciente y realizar los exámenes necesarios para determinar las consecuencias sistémicas que ha desarrollado la Diabetes Mellitus. De esta forma podremos realizar modificaciones en los tratamientos que utilizan los pacientes con el fin de optimizar su condición previo a la cirugía.
- Published
- 2013
26. Manejo preoperatorio de medicamentos en pacientes hipertensos
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Claudio Nazar J, Alejandro González A, and Christian Herrera F
- Subjects
Hipertensión arterial ,manejo preoperatorio ,medicamentos antihipertensivos ,Surgery - Abstract
La hipertensión arterial es una enfermedad con alta prevalencia en la población chilena, llegando a casi el 75% en el grupo de mayores de 65 años. En el ámbito quirúrgico, el número de pacientes de edad mayor y que padecen hipertensión arterial ha aumentado significativamente, lo que nos obliga a realizar una adecuada y detallada evaluación preoperatoria del paciente hipertenso con el fin de conocer su condición al momento de la cirugía, los medicamentos antihipertensivos que utiliza y solicitar los exámenes de laboratorio y/o de imágenes necesarios. Una adecuada asesoría al paciente respecto al manejo de su medicación antihipertensiva preoperatoria pretende disminuir las complicaciones en todo el período perioperatorio, tanto por su suspensión como por su mantención. De esta forma se busca establecer las medidas que permitan al paciente enfrentar el procedimiento quirúrgico en las mejores condiciones posibles.
- Published
- 2013
27. MANUAL DE PRIMEROS AUXILIOS
- Author
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Claudio Nazar, Maximiliano Zamora, Fernando Pimentel, Claudio Nazar, Maximiliano Zamora, and Fernando Pimentel
- Subjects
- First aid in illness and injury--Handbooks, manuals, etc
- Abstract
Manual de Primeros Auxilios presenta los principales temas y las técnicas más efectivas y comunes que se utilizan en la asistencia terapéutica de urgencia que se presta en caso de accidente o enfermedad repentina. Este texto es extremadamente útil y práctico, ya que prepara en la atención de urgencia a personas que no tienen formación médica, pero que en la mayoría de estas situaciones son las primeras en acudir al auxilio de las víctimas. Desde esta realidad nace la necesidad de preparación y entrenamiento en primeros auxilios, los cuales implican cuidados inmediatos, sencillos y provisorios, pero que requieren conocimientos específicos y la práctica de algunas maniobras. Esta obra es el resultado de un trabajo colaborativo entre estudiantes, internos, residentes y profesores de la escuela de Medicina de la Pontificia Universidad Católica de Chile y, a diferencia de otros textos médicos, está escrito y explicado de una manera directa y práctica, lo que extiende su aplicación más allá del área médica y permite una adecuada comprensión de parte del público general de las bases teóricas de los primeros auxilios y del manejo práctico de las situaciones de urgencia.
- Published
- 2015
28. Consideraciones perioperatorias en pacientes consumidores de drogas ilícitas de uso frecuente
- Author
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Claudio Nazar, Paulina Medina, and Ricardo Fuentes
- Subjects
Perioperative period ,Período perioperatorio ,business.industry ,Street drugs ,Drogadicción ,Manifestaciones clínicas ,Signs and symptoms ,03 medical and health sciences ,0302 clinical medicine ,Drogas ilícitas ,Medicine ,Surgery ,030212 general & internal medicine ,business ,Humanities ,Substance-related disorders ,030217 neurology & neurosurgery - Abstract
ResumenDebido al importante aumento del consumo de drogas ilícitas o recreativas en nuestra sociedad, es cada vez más probable que nos encontremos con pacientes usuarios de ellas en el contexto quirúrgico. Es importante conocer los principales efectos de las sustancias ilícitas más frecuentemente usadas por los pacientes sometidos a cirugía, como cocaína, marihuana, pasta base de cocaína y psicoestimulantes, como también los efectos más significativos que pueden producirse al combinar estas sustancias recreativas con fármacos relacionados a la cirugía y anestesia. Asimismo, es relevante tener en cuenta las principales consideraciones perioperatorias en el proceso quirúrgico y anestésico de los pacientes consumidores de estas drogas ilícitas.La cocaína altera principalmente los sistemas cardiovascular, respiratorio, nervioso central, gastrointestinal y renal, teniendo los pacientes adictos mayor riesgo de infarto agudo al miocardio, arritmias y crisis hipertensivas arteriales. La marihuana inhibe los receptores muscarínicos de acetilcolina, afectando principalmente los sistemas cardiovascular, respiratorio y neuropsiquiátrico, teniendo un rol importante en el manejo analgésico intra y postoperatorio. La pasta base de cocaína provoca un aumento transitorio en la neurotransmisión dopaminérgica, siendo similar a la cocaína por lo que se recomienda un manejo perioperatorio parecido. Las drogas psicoestimulantes tienen efecto simpaticomimético, afectando esencialmente los sistemas cardiovascular y metabólico.Esta revisión resume la evidencia médica vigente sobre el tema, con el fin de unificar criterios y sugerir pautas de manejo de estos pacientes durante el período perioperatorio, donde los efectos de estas drogas ilícitas posiblemente sean más significativos, pudiendo generar complicaciones graves y poniendo en riesgo la vida del paciente.AbstractDue to the significant increase of illicit or recreational drugs in our society, it is increasingly likely that we find patients using them in the surgical context. It is important to understand the main effects of illegal substances most commonly used by patients undergoing surgery, such as cocaine, marijuana, cocaine paste and psychostimulants, as the most significant effects that can be produced by combining these recreational drugs with related substances of surgery and anesthesia. It is also relevant to consider the major perioperative considerations (surgical and anesthetic) in consumer patients of these illicit drugs.Cocaine alters the cardiovascular, respiratory, central nervous, gastrointestinal and renal systems, addicted patients taking higher risk of acute myocardial infarction, arrhythmias and arterial hypertensive crisis. Marijuana inhibits muscarinic acetylcholine receptors, primarily affecting the cardiovascular, respiratory and neuropsychiatric systems, and has an important role in intra and postoperative analgesic management. The cocaine base paste causes transient increase in dopaminergic neurotransmission, being similar to cocaine so a similar perioperative management is recommended. The psychostimulant drugs are sympathomimetic effect, essentially affecting the cardiovascular and metabolic systems.This review summarizes the current medical evidence on the subject, in order to unify criteria and management guidelines suggest these patients during the perioperative period, where the effects of these illicit drugs are likely to be more significant, potentially leading to serious complications and endangering the patient's life.
- Published
- 2016
29. MANEJO PERIOPERATORIO DE PACIENTES CON PATOLOGÍA TIROIDEA Y TRATAMIENTO CRÓNICO CON CORTICOIDES
- Author
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Javier Bastidas E, Claudio Nazar J, Ricardo Fuentes H, Roberto Coloma D, and Maximiliano Zamora H
- Subjects
Gynecology ,glucocorticoides ,medicine.medical_specialty ,business.industry ,03 medical and health sciences ,hipertiroidismo ,0302 clinical medicine ,030202 anesthesiology ,medicine ,Surgery ,business ,Manejo preoperatorio ,030217 neurology & neurosurgery ,período perioperatorio ,hipotiroidismo - Abstract
Resumen Los trastornos tiroideos y el uso cronico de corticoides son frecuentes en la poblacion quirurgica, por lo que es necesario un manejo perioperatorio adecuado en este tipo de pacientes. No existe contraindicacion para una cirugia electiva en pacientes con hipotiroidismo asintomaticos y buen control, no siendo necesario mantener la dosis habitual de levotiroxina el dia de la cirugia, debido a las caracteristicas farmacocineticas del medicamento. Si los pacientes hipotiroideos se encuentran sintomaticos y/o no han alcanzado la fase eutiroidea, deben ser tratados y compensados previo al procedimiento quirurgico electivo. Los pacientes hipertiroideos deben mantener su tratamiento antitiroideo incluso el dia de la cirugia. En el hipertiroidismo sintomatico y/o descompensado existe mayor riesgo de desarrollar una tormenta tiroidea, por lo que no se recomiendacirugia electiva en este tipo de pacientes, la cual debe realizarse una vez logrado un estado eutiroideo. Una estricta monitorizacion en el periodo postoperatorio es clave para prevenir complicaciones. El uso cronico degluco corticoides es frecuente. En estos pacientes existe riesgo de desarrollar insuficiencia suprarrenal aguda ante el estres quirurgico, por lo que antes de una cirugia (electiva o de urgencia) es necesario suplementar concorticoides exogenos, en dosis dependientes del tipo de procedimiento quirurgico a realizarse.
- Published
- 2016
30. Dexametasona para profilaxis de náuseas y vómitos postoperatorios: efecto sobre la glicemia en pacientes con diabetes mellitus tipo 2 y en no diabéticos sometidos a cirugía laparoscópica
- Author
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Ghislaine C. Echevarria, Claudio Nazar, Hector J. Lacassie, Hernán Muñoz, and Rodrigo Flores
- Subjects
Linear mixed effect model ,business.industry ,medicine.medical_treatment ,General Medicine ,Placebo ,medicine.disease ,law.invention ,Randomized controlled trial ,law ,Diabetes mellitus ,Anesthesia ,medicine ,Cholecystectomy ,medicine.symptom ,business ,Laparoscopic cholecystectomy ,Postoperative nausea and vomiting ,Dexamethasone ,medicine.drug - Abstract
Background: Postoperative nausea and vomiting (PONV) prophylaxis with dexamethasone may produce significant hyperglycemia in the postoperative period. Aim: To evaluate if this effect is of greater severity in type 2 diabetics compared with non-diabetic patients. Material and Methods: Forty non-diabetic and thirty type 2 diabetic patients undergoing laparoscopic cholecystectomy were studied in a prospective and double-blind fashion manner. Patients were randomly distributed into 4 groups: Group I, non-diabetics control (n = 20), Group II, non-diabetics dexamethasone (n = 20), Group III, type 2 diabetics control (n = 15), and Group I V, type 2 diabetics dexamethasone (n = 15). Immediately after induction, patients in groups I and III received isotonic saline and patients in the dexamethasone groups received 8 mg iv of the steroid. Capillary blood glucose concentrations were measured at baseline and every 2 hours during the first 12 hours since the start of surgery. A linear mixed effect model, adjusted for baseline capillary glucose concentration, age and duration of surgery was used to analyze the data. Results: No effect of the presence of diabetes mellitus was observed in the evolution of glucose concentrations. There was a difference in capillary glucose concentrations between patients who received dexamethasone and placebo that started 2 hours post-intervention, reaching a mean maximum difference of 34 mg/dl (adjusted model, p < 0.001) at 10 hours post-intervention. Conclusions: In this study, Type 2 diabetic patients did not show a higher susceptibility than non-diabetics to develop postoperative hyperglycemia after the use of prophylactic dexamethasone for PONV.
- Published
- 2011
31. MANEJO PREOPERATORIO DE PACIENTES CON ENFERMEDADES RESPIRATORIAS CRÓNICAS
- Author
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Maximiliano Zamora H, Isabel Leiva R, Claudio Nazar J, and Roberto Coloma D
- Subjects
asma ,manejo preoperatorio ,tabaquismo ,Cirugía ,complicaciones postoperatorias ,Surgery ,EPOC - Abstract
Las enfermedades respiratorias cronicas son la tercera causa de muerte en Chile y su prevalencia esta aumentando significativamente en el mundo, por lo cual es muy frecuente que nos encontremos con pacientes con estas patologias sometiendose a procedimientos quirurgicos electivos. En estos casos las complicaciones perioperatorias son mas frecuentes que en la poblacion general, por lo cual es indispensable una adecuada evaluacion y manejo preoperatorio. La presencia de enfermedad pulmonar obstructiva cronica (EPOC) es un predictor mayor de complicaciones postoperatorias y deben indicarse broncodilatadores y corticoides inhalatorios preoperatorios en pacientes con esta patologia que seran sometidos a cirugia electiva, especialmente en la relacionada a cancer pulmonar. Asi mismo, los pacientes con EPOC que se someteran a cirugia de revascularizacion miocardica deben recibir ademas corticoides via sistemica en el periodo preoperatorio. El tabaquismo es otro factor de riesgo independiente para desarrollar complicaciones respiratorias postoperatorias en cirugia toracica, por lo que los pacientes deberian suspender el consumo de tabaco por lo menos 4 semanas antes de la cirugia programada con el fin de disminuir significativamente dichas complicaciones. El asma bronquial mal controlada tambien es un factor de riesgo especifico para desarrollar complicaciones pulmonares postoperatorias, por lo cual estos pacientes deben tratarse preoperatoriamente con broncodilatadores inhalatorios, asociados a corticoides inhalatorios u orales segun la gravedad del asma.
- Published
- 2015
32. PACIENTE ADULTO MAYOR Y CIRUGÍA NO CARDÍACA: ¿QUÉ DEBEMOS SABER?
- Author
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Claudio Nazar J, Ricardo Fuentes H, Maximiliano Zamora H, and Guillermo Lema F
- Subjects
medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,fragilidad ,Perioperative ,adulto mayor ,Surgical procedures ,delirium ,Cirugía ,Non cardiac surgery ,Medicine ,Delirium ,mortalidad ,Surgery ,morbilidad ,medicine.symptom ,Cognitive decline ,business ,Elderly patient ,Intensive care medicine ,Cognitive deficit ,período perioperatorio - Abstract
Los procedimientos quirúrgicos en pacientes adultos mayores son cada vez más frecuentes. Se caracterizan por tener mayor morbimortalidad que los realizados en pacientes más jóvenes, por lo que es esencial una apropiada evaluación preoperatoria, una acuciosa monitorización intraoperatoria y un adecuado manejo del período postoperatorio. La edad conlleva una serie de cambios fisiológicos y una mayor incidencia de enfermedades crónicas, que en conjunto determinan una disminución de las reservas fisiológicas y la capacidad funcional. En la evaluación preoperatoria son importantes una valoración exhaustiva de las comorbilidades y fármacos de uso habitual, la posible "fragilidad" de estos pacientes ante el proceso quirúrgico y su riesgo de desarrollar déficit cognitivo postoperatorio. El tipo de cirugía y su grado de urgencia, las condiciones actuales del paciente, y las características del centro asistencial son los principales factores a considerar al momento de elegir el tipo de anestesia. Problema frecuente del período postoperatorio es el desarrollo de delirium y deterioro cognitivo, donde los esfuerzos deben dirigirse a su prevención, más que al tratamiento, ya que aumentan considerablemente la morbilidad perioperatoria.
- Published
- 2015
33. ALERGIA AL LÁTEX EN EL PERÍODO PERIOPERATORIO
- Author
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Arturo Borzutzky S, Daniela Sandoval M, Claudio Nazar J, and Ricardo Fuentes H
- Subjects
biology ,business.industry ,alergia al látex ,Allergen avoidance ,medicine.disease ,biology.organism_classification ,Látex ,Risk groups ,Clinical history ,Latex allergy ,Natural rubber latex ,Immunology ,medicine ,Anaphylactic shock ,Allergic dermatitis ,Surgery ,Hevea brasiliensis ,business ,período perioperatorio - Abstract
El látex o caucho natural es un producto vegetal procesado que se obtiene a partir del árbol tropical Hevea Brasiliensis. Esta materia prima es ampliamente usada, estando presente en hasta 40.000 productos médicos y de uso diario. La alergia al látex es una patología relevante en el ámbito quirúrgico, que surgió posterior a la instauración de las precauciones universales en la década del 90. Dentro de los grupos de riesgo se encuentran trabajadores de la salud y pacientes con espina bífida con una prevalencia que oscila entre 2,9 a 17% y 30 a 70%, respectivamente. La presentación clínica de alergia al látex tiene un espectro amplio, pudiendo presentarse como reacciones por hipersensibilidad tipo IV o tipo I. En el primer grupo, las reacciones son gatilladas por los químicos adicionados al látex, siendo la dermatitis alérgica de contacto su presentación más frecuente. En el segundo grupo, las reacciones son secundarias al contacto con proteínas del látex, pudiéndose manifestar desde urticaria hasta shock anafiláctico y muerte. El diagnóstico de alergia al látex se basa en una historia clínica y/o examen físico compatible asociado a un examen confirmatorio, como el prick test (alergia al látex tipo I) y el parche cutáneo (alergia al látex tipo IV). Actualmente no existe una cura definitiva para la alergia al látex y su tratamiento se basa en evitar la exposición al alérgeno.
- Published
- 2015
34. CIRUGÍA AMBULATORIA: SELECCIÓN DE PACIENTES Y PROCEDIMIENTOS QUIRÚRGICOS
- Author
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Maximiliano Zamora H, Alejandro González A, and Claudio Nazar J
- Subjects
selección de cirugías ,medicine.medical_specialty ,Hospital readmission ,business.industry ,General surgery ,anestesia ambulatoria ,Outpatient surgery ,cuidados perioperatorios ,Surgery ,Lower incidence ,Hospital admission ,Health care ,Ambulatory ,evaluación de riesgos ,medicine ,selección de pacientes ,factores de riesgo ,business ,Cirugía ambulatoria ,American society of anesthesiologists - Abstract
La cirugía ambulatoria se realiza cada vez con mayor frecuencia debido a sus importantes beneficios, como menores costos y menor morbimortalidad, y requiere una cuidadosa selección de pacientes y procedimientos quirúrgicos a realizar. Para seleccionar qué pacientes se pueden operar en forma ambulatoria es necesaria una adecuada evaluación preoperatoria quirúrgica y anestésica. Respecto a los riesgos asociados al paciente, destacan sus comorbilidades y clasificación American Society of Anesthesiologists. Los riesgos asociados a la cirugía se dividen según su riesgo cardiovascular y duración del procedimiento. Entre los riesgos del paciente y la cirugía se pueden definir cuáles son aptos para una cirugía ambulatoria. Las complicaciones graves y mortalidad asociadas son muy infrecuentes hoy en día, por lo que se hace necesario tener en cuenta otro tipo de indicadores, como la hospitalización no programada, hospitalización post alta y retardo del alta hospitalaria. Existen ciertos pacientes que requieren una evaluación más específica de la indicación de cirugía ambulatoria, como los ancianos y obesos, entre otros.
- Published
- 2015
35. Anestesia neuroaxial en trabajo de parto y cesárea en pacientes con antecedentes de mielomeningocele operado
- Author
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Patricio Mellado T, Andrea González S, Héctor Lacassie Q, Claudio Nazar J, Maximiliano Zamora H, and Javier Bastidas E
- Subjects
Meningomielocele ,embarazo ,Meningomyelocele ,trabajo de parto ,obstetrical anesthesia ,anestesia epidural ,Obstetrics and Gynecology ,pregnancy ,anestesia obstétrica ,epidural anesthesia ,obstetric labor - Abstract
Los desórdenes del desarrollo del tubo neural son el segundo mayor grupo de malformaciones congénitas conocidas y con una incidencia de 1/1000 nacidos vivos. El meningomielocele es una de las malformaciones más frecuentes. Se define como una falla en el cierre del tubo neural con herniación de meninges y elementos neurales. El embarazo en estas pacientes es complicado por las deformidades físicas y complicaciones neurológicas secundarias, pudiendo dificultar la técnica anestésica neuroaxial en el trabajo de parto y operación cesárea. Existen escasos reportes de pacientes con meningomielocele en trabajo de parto y analgesia neuroaxial. Presentamos una revisión de esta patología y las técnicas anestésicas utilizadas en el trabajo de parto y operación cesárea de pacientes con antecedente de meningomielocele, basados en un caso clínico del cual participamos. Neural tube defects are the second most common type of congenital birth defects with an incidence of 1/1000 newborns. Meningomyelocele is one of the most common clinical presentations. It is defined as a failed closure of the neural arch with herniation of the meninges and neural elements. Pregnancy among these patients can be complicated with physical deformity and coexisting neurological defects, which may challenge neuroaxial anesthetic technique in obstetric labor and cesarean delivery. There are few reports involving patients with meningomyelocele in obstetric labor and neuroaxial anesthesia. We discuss some key points of this disease and the anesthetic technique of choice in obstetric labor and cesarean delivery in patients with history of meningomyelocele, based on a case in which we participated.
- Published
- 2014
36. Obesidad y embarazo: implicancias anestésicas
- Author
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Javier Bastidas E, Hector J. Lacassie, Claudio Nazar J, and Maximiliano Zamora H
- Subjects
embarazo ,cesarean section ,trabajo de parto ,cesárea ,obstetrical anesthesia ,Obesidad ,anestesia general ,Obstetrics and Gynecology ,Obesity ,pregnancy ,labor ,anestesia obstétrica ,general anesthesia - Abstract
La obesidad es una epidemia a nivel mundial, con más de 2.000 millones de adultos con sobrepeso u obesidad, por lo que cada vez es más probable enfrentarse a una embarazada obesa en la práctica clínica del equipo obstétrico. La obesidad incrementa los cambios fisiológicos del embarazo a nivel cardiovascular, respiratorio, metabólico y gastrointestinal, lo que tiene implicancias clínicas que aumentan los costos en salud y la morbimortalidad materna y fetal. Las embarazadas obesas son un constante desafío para el equipo obstétrico, anestesiológico y de salud, debiendo ser enfrentadas de forma multidisciplinaria para la obtención de mejores resultados obstétricos y perinatales. El anestesiólogo debe tener especial cuidado en el manejo analgésico del trabajo de parto y en la técnica anestésica para la operación cesárea. El objetivo central de la siguiente revisión es explicar, analizar y desarrollar las principales implicancias anestésicas a las cuales se ve enfrentado el especialista en una embarazada obesa. Obesity is a global epidemic, with more than 2,000 million overweight or obese adults, so it is very likely to have an obese pregnant in the clinical practice of the anesthesiologist. Obesity increases the physiological changes of pregnancy in the cardiovascular, respiratory, metabolic and gastrointestinal system, which has clinical implications that increase health care costs and maternal and fetal morbidity and mortality. Obese pregnant are a constant challenge for the obstetric, anesthesiology and health team, and must be considerate in a multidisciplinary way to obtain better maternal and perinatal outcomes. The anesthesiologist should take special care in the labor analgesia and anesthetic technique for caesarean section. The focus of the following review is to present and develop the main anesthetic implications to which the anesthesiologist is confronted in obese pregnant patient.
- Published
- 2014
37. Infecciones respiratorias altas y suspensión de cirugía electiva
- Author
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Guillermo Lema F, Ricardo Fuentes H, Claudio Nazar J, and Maximiliano Zamora H
- Subjects
Surgery - Published
- 2014
38. Dexamethasone for postoperative nausea and vomiting prophylaxis: effect on glycaemia in obese patients with impaired glucose tolerance
- Author
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Rodrigo A López, Hector J. Lacassie, Hernán Muñoz, and Claudio Nazar
- Subjects
Adult ,Blood Glucose ,Male ,Gastric bypass ,Gastric Bypass ,Dexamethasone ,law.invention ,Impaired glucose tolerance ,Diabetes Complications ,Randomized controlled trial ,Double-Blind Method ,law ,medicine ,Humans ,Obesity ,business.industry ,Perioperative ,medicine.disease ,Anesthesiology and Pain Medicine ,Anesthesia ,Hyperglycemia ,Postoperative Nausea and Vomiting ,Antiemetics ,Female ,medicine.symptom ,business ,Postoperative nausea and vomiting ,medicine.drug - Abstract
Dexamethasone given to prevent postoperative nausea and vomiting may produce significant hyperglycaemia in the perioperative period. The effect of dexamethasone on patients with impaired glucose tolerance is unknown.Thirty obese patients with impaired glucose tolerance undergoing laparoscopic Roux-en-Y gastric bypass surgery were studied in a double-blind fashion. Patients were randomly distributed into two groups: the dexamethasone group (n = 15) received dexamethasone 8 mg intravenously after induction of anaesthesia; the control group (n = 15) received isotonic saline. Fingerprick capillary blood glucose concentrations were measured at baseline and every 2 h during the first 12 h after the start of surgery.In both groups, all blood glucose concentrations measured after the beginning of surgery were higher than baseline values. However, the dexamethasone group showed higher glucose concentrations than the control group from the 6th to the 12th hour of the study. In addition, the maximum blood glucose value in the dexamethasone group (10.4 +/- 1.6 mmol l(-1)) was higher than in the controls (8.8 +/- 1.7 mmol l(-1)) (P0.05).Dexamethasone, 8 mg, intravenously administered at the beginning of laparoscopic bariatric surgery in patients with impaired glucose tolerance is associated with significantly increased postoperative blood glucose concentrations.
- Published
- 2009
39. PACIENTE ADULT O MAY OR Y CIRUGÍA NO CARDÍACA: ¿QUÉ DEBEMOS SABER?
- Author
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Claudio Nazar J., Maximiliano Zamora H., Ricardo Fuentes H., and Guillermo Lema F.
- Abstract
The surgical procedures in elderly patients are and will be more common. They are characterized by greater morbidity and mortality than those in younger patients, so it is essential an appropriate preoperative evaluation, a diligent intraoperative monitoring and a proper management of the postoperative period. The old age has a number of physiological changes and an increased incidence of chronic diseases and together determine a decline in physiological reserve and functional capacity. In the preoperative evaluation is important a systematic assessment of comorbidities and drugs routinely prescribed, "ragility" of these patients due to the surgical procedure and the risk of developing postoperative cognitive deficit. Type of surgery, degree of urgency and patient conditions are the main factors to consider at time to choose type of anesthesia. Common complications include the development of postoperative delirium and postoperative cognitive decline, where efforts should be directed at prevention rather than treatment, because it significantly increases perioperative morbidity. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
40. ALERGIA AL LÁTEX EN EL PERÍODO PERIOPERATORIO.
- Author
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Ricardo Fuentes H., Daniela Sandoval M., Arturo Borzutzky S., and Claudio Nazar J.
- Abstract
Copyright of Revista Chilena de Cirugia is the property of Sociedad de Cirujanos de Chile 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.)
- Published
- 2015
- Full Text
- View/download PDF
41. CIRUGÍA AMBULATORIA: SELECCIÓN DE PACIENTES Y PROCEDIMIENTOS QUIRÚRGICOS.
- Author
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Claudio Nazar, J., Maximiliano Zamora, H., and Alejandro González, A.
- Abstract
Outpatient surgery is being performed with increasing frequency due to its significant benefits, including lower costs in health care, and lower incidence of complications and mortality, requiring an appropriate selection of patients and surgeries to be performed in this setting. To select patients and surgeries to be operated on an ambulatory basis, it is relevant an adequate preoperative evaluation. Regarding the risks of patient, it is important the comorbidities and the American Society of Anesthesiologists classification. Risks associated with the type of surgery are divided according to their cardiovascular risk and duration of the procedure. Both will define those suitable for outpatient surgery. Serious complications and associated mortality are infrequents nowadays, therefore it is necessary to take into account other indicators, such as unanticipated hospital admission, hospital readmission and prolonged postoperative stay. There are some patients that require more specific preoperative evaluation, such as the elderly, obese, among others. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
42. CIRUGÍA PLÁSTICA Y SUS COMPLICACIONES: ¿EN QUÉ DEBEMOS FIJARNOS?
- Author
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Claudio Nazar, J., Maximiliano Zamora, H., Eduardo Vega, P., de la Cuadra, F. Juan Carlos, Susana Searle, F., and Bruno Dagnino, U.
- Abstract
Plastic surgeries are becoming more popular, being performed on a varied type of population and often as office-based procedures. Despite being highly elective procedures, they have risks and complications, which should be reported to patients by the health personnel. The most frequently performed procedures are breast augmentation and body liposuction. The most relevant complications associated with plastic surgery are pulmonary embolism and deep vein thrombosis, which is the leading cause of mortality in this type of surgery. Other complications are local anesthetics intoxication secondary to the use of tumescent solution in body liposuction, inadequate management of perioperative intravenous fluids, mild hypothermia and severe pain after surgery caused by poor postoperative analgesia. It is essential to prevent the described complications, which significantly increase morbidity, mortality and hospital stay. The perioperative measures that have demonstrated effectiveness in reducing perioperative risk are thromboprophylaxis, depending on the thrombotic risk categorization of each patient and the use of adequate concentrations of lidocaine and vasoconstrictor in the tumescent solution. Appropriate temperature monitorization and use of conservation measures in patients with exposure of large body surfaces is also an important issue, as is diligence in intraoperative fluid balance and administration of intravenous multimodal analgesia, adjusted to the magnitude of the surgery. In order to achieve this, proper communication between the surgical team, anesthesiologists and nurses is vital, as it permits implementation of specific measures that permit adequate monitorization, prevention of complications and analgesic management described above. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
43. CARTA AL EDITOR.
- Author
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Claudio Nazar, J.
- Published
- 2015
- Full Text
- View/download PDF
44. Canine antibody response to Lutzomyia longipalpis saliva in endemic area of visceral leishmaniasis.
- Author
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Luís Fábio da Silva Batista, Vânia Lúcia Ribeiro da Matta, Thaise Yumie Tomokane, Acácio Duarte Pacheco, Fernando Tobias Silveira, Claudio Nazaretian Rossi, Mary Marcondes, and Márcia Dalastra Laurenti
- Subjects
Canine leishmaniasis ,Anti-Lutzomyia longipalpis saliva antibody ,Transmissibility ,Arctic medicine. Tropical medicine ,RC955-962 - Abstract
Abstract: INTRODUCTION: Canine exposure to Lutzomyia longipalpis bites and the potential of Leishmania infantum transmissibility for the vector were evaluated. METHODS Immunoglobulin G (IgG) anti-Lu longipalpis saliva and -L. infantum, and blood parasite load were determined in dogs from endemic areas of visceral leishmaniasis. RESULTS Blood parasitism was similar between symptomatic and asymptomatic dogs. IgG anti-L. infantum was higher in symptomatic dogs, but IgG anti-Lu. longipalpis saliva was mostly observed in higher titers in asymptomatic dogs, indicating vector preference for feeding on asymptomatic dogs. CONCLUSIONS Our data suggest a pivotal role of asymptomatic dogs in L. infantum transmission in endemic areas.
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- 2016
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45. Clinical and epidemiological characterization of sporotrichosis in dogs and cats (São Paulo, Brazil)
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Claudio Nazaretian Rossi, Juliana Odaguiri, and Carlos Eduardo Larsson
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Sporotrichosis ,Mycosis ,Epidemiology ,Dogs ,Cats ,Agriculture (General) ,S1-972 - Abstract
The present study retrospectively characterized canine and feline sporotrichosis in male and female individuals of various ages. The patients had been attended at the Dermatology Service of a university veterinary hospital and the diagnosis had been confirmed by isolation and identification of Sporothrix spp in culture media. The study obtained and analyzed medical records from a period of 19 years (1993- 2011). From the evaluated sample, 37 animals were considered for the study, including eight (21.6%) dogs and 29 (78.4%) cats. The patients were mostly male (30/37-86.5%) and had mean ages of 79.5 months for dogs and 36.3 months for cats. Most of the patients had no defined breed (25/37-67.6%). The localized cutaneous form of the disease was most prevalent (25/37-67.6%), and all cases presented positive histopathological diagnoses. Among the cats with sporotrichosis, infection was also observed in animals and/or humans that lived with these cats in 17/37 (45.9%) cases. However, none of the affected dogs appeared to spread the infection, as there were no clinical signs that were consistent with the disease. Sporotrichosis was most prevalent among male mixed-breed cats, most of which had a clinical presentation that was consistent with the localized cutaneous form of the disease. In the studied sample, cats constituted an important source of infection for animals and humans living in the same household.
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- 2014
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46. Retrospective study of canine cases of leishmaniasis attended in São Paulo, Brazil (1997-2007)Estudo retrospectivo de casos caninos de leishmaniose atendidos na cidade de São Paulo, Brasil (1997-2007)
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Márcia Cristina Sonoda, Claudio Nazaretian Rossi, Márcia Dalastra Laurenti, and Carlos Eduardo Larsson
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Leishmaniose ,Cães ,Epidemiologia ,Aspectos clínicos. ,Agriculture (General) ,S1-972 - Abstract
Leishmaniasis is zoonosis caused by pleomorphic protozoa of the genus Leishmania. The spread of the disease in Brazil lead to this retrospective survey of canine visceral leishmaniasis diagnosed at the Service of Dermatology and Medical Clinics of the Small Animal Hospital-USP. We evaluated the records of 36 dogs naturally infected with Leishmania sp, which diagnosis included disease characterization during anamnesis, physical and dermatologic examination, hematology, biochemistry, imaging, serology (Enzyme-Linked Immunosorbent Assay – ELISA and/or Indirect Fluorescent Reaction – RIFI), skin histopathology and/or agent isolation from aspiration biopsy samples of lymph nodes and/or bone marrow, and immunohistochemistry. All cases were allochtonous without gender predilection; 52.8% were 13 to 48 months old, with greater occurrence in pure breed dogs (66,7%), mostly Poodles and Labradors (20.8% each). Regarding origin: Campinas, Campo Limpo Paulista, Holambra, Ilha Bela, São Roque, Sorocaba, Ubatuba and Uberaba (one case / city). The remaining 28 cases from the State of São Paulo were located in cities with reported canine-human transmission (Araçatuba – three, Bauru – one), intra-canine transmission (Cotia – five, Embu – four) or cities under investigation (São Paulo – 11, Mogi das Cruzes – one). Portugal (one) and Minas Gerais (Belo Horizonte – two) reported caninehuman transmission. Prior to the leishmaniasis development dogs remained for short or long periods in 14 cities in the State of São Paulo (Araçatuba, Birigui, Caraguatatuba, Cotia, Eldorado, Embu e Embu Guaçu, Guarujá, Ilha Bela, Itapecerica da Serra, Peruíbe, Presidente Prudente, São Roque and São Paulo) and five other Brazilian States (Maranhão, Minas Gerais, Paraná, Rio de Janeiro and Santa Catarina. Most animals were oligosymptomatic (50%), 47.2% symptomatic and 2.8% asymptomatic.A leishmaniose constitui-se em zoonose causada por protozoário pleomórfico do gênero Leishmania. Em face da magnitude de alastramentro da doença no Brasil, foi realizado um levantamento retrospectivo de casos de leishmaniose canina diagnosticados nos Serviços de Dermatologia e de Clínica Médica de cães e gatos do HOVET/USP. A amostragem compôs-se de 36 casos caninos naturalmente infectados por Leishmania sp, cujo diagnóstico fora estabelecido pela caracterização por pelos dados anamnésticos, de exames físico e dermatológico, complementados por exames hematológicos, bioquímicos e imagéticos, afora sorologia (Ensaio Imunoenzimático Indireto – ELISA e/ou Reação de Imunofluorescência Indireta – RIFI), histopatologia de pele e/ou pela evidenciação do protozoário em exames parasitológicos de biópsia aspirativa de linfonodos e/ou medula óssea e pela técnica de imuno-histoquímica. Não houve predisposição por um determinado sexo; a faixa etária (52,8%) mais prevalente foi aquela dos 13 a 48 meses de vida, com maior acometimento de cães de raça definida (66,7%), principalmente Poodles e Labradores (20,8% cada). Pôde-se concluir que todos os casos foram alóctones. Quanto aos municípios de origem os animais provieram de: Campinas, Campo Limpo Paulista, Holambra, Ilha Bela, São Roque, Sorocaba, Ubatuba e Uberaba (um caso / município). Os demais 28 cães do Estado de São Paulo originaram-se de municípios com transmissão: canina e humana (Araçatuba – três, Bauru – um), canina (Cotia – cinco, Embu – quatro) ou sob investigação (São Paulo – 11, Mogi das Cruzes – um). Já Portugal (um) e Minas Gerais (Belo Horizonte – dois) são locais caracterizados como de transmissão canina e humana. Puderam-se evidenciar deslocamentos breves ou longos a 14 municípios paulistas (Araçatuba, Birigui, Caraguatatuba, Cotia, Eldorado, Embu e Embu Guaçu, Guarujá, Ilha Bela, Itapecerica da Serra, Peruíbe, Presidente Prudente, São Roque e São Paulo) e a cinco Estados (Maranhão, Minas Gerais, Paraná, Rio de Janeiro e Santa Catarina). De acordo com a classificação sintomatológica, 50% eram oligossintomáticos, 47,2% sintomáticos e 2,8% assintomáticos.
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- 2013
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47. In situ CUTANEOUS CELLULAR IMMUNE RESPONSE IN DOGS NATURALLY AFFECTED BY VISCERAL LEISHMANIASIS
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Claudio Nazaretian ROSSI, Thaise Yumie TOMOKANE, Luis Fábio da Silva BATISTA, Mary MARCONDES, Carlos Eduardo LARSSON, and Márcia Dalastra LAURENTI
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Canine visceral leishmaniasis ,Cutaneous lesion ,Histopathology ,Cellular immune response ,Arctic medicine. Tropical medicine ,RC955-962 ,Infectious and parasitic diseases ,RC109-216 - Abstract
SUMMARY Thirty-eight dogs naturally affected by visceral leishmaniasis were recruited in Araçatuba, São Paulo State, Brazil - an endemic area for visceral leishmaniasis. The animals were distributed into one of two groups, according to their clinical and laboratory features, as either symptomatic or asymptomatic dogs. Correlations between clinical features and inflammatory patterns, cellular immune responses, and parasitism in the macroscopically uninjured skin of the ear were investigated. Histological skin patterns were similar in both groups, and were generally characterized by a mild to intense inflammatory infiltrate in the dermis, mainly consisting of mononuclear cells. There was no difference in the number of parasites in the skin (amastigotes/mm²) between the two groups. Concerning the characterization of the cellular immune response, the number of positive inducible nitric oxide synthase (iNOS+) cells was higher in the dermis of symptomatic than in asymptomatic dogs (p = 0.0368). A positive correlation between parasite density and macrophages density (p = 0.031), CD4+ T-cells (p = 0.015), and CD8+ T-cells (p = 0.023) was observed. Furthermore, a positive correlation between density of iNOS+ cells and CD3+ T-cells (p = 0.005), CD4+ T-cells (p = 0.001), and CD8+ T-cells (p = 0.0001) was also found. The results showed the existence of a non-specific chronic inflammatory infiltrate in the dermis of dogs affected by visceral leishmaniasis, characterized by the presence of activated macrophages and T-lymphocytes, associated to cutaneous parasitism, independent of clinical status.
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- 2016
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48. Serological cross-reactivity of Trypanosoma cruzi, Ehrlichia canis, Toxoplasma gondii, Neospora caninum and Babesia canis to Leishmania infantum chagasi tests in dogs
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Maurício Franco Zanette, Valéria Marçal Felix de Lima, Márcia Dalastra Laurenti, Claudio Nazaretian Rossi, Juliana Peloi Vides, Rafael Felipe da Costa Vieira, Alexander Welker Biondo, and Mary Marcondes
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Diagnosis ,Serology ,Visceral leishmaniasis ,Arctic medicine. Tropical medicine ,RC955-962 - Abstract
Introduction: The aim of this study was to evaluate the serological cross-reactivity between Leishmania sp. and other canine pathogens. Methods: Positive serum samples for Ehrlichia canis, Babesia canis, Toxoplasma gondii, Neospora caninum and Trypanosoma cruzi were tested using three serological methods enzyme linked immunosorbent assay (ELISA), indirect immunofluorescent antibody test (IFAT) and Kalazar Detect™, for canine visceral leishmaniasis. Results: Of the 57 dog samples tested, 24 (42.1%) tested positive using one of the three serological methods: 10/57 (17.5%) for ELISA, 11/57 (19.3%) for IFAT and 3/57 (5.3%) for Kalazar Detect™. Conclusions: Our results demonstrated that the presence of other infectious agents may lead to cross-reactivity on leishmaniasis serological tests.
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- 2014
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49. Estado neurológico e cardiorrespiratório de filhotes de cães nascidos de parto normal ou de cesariana sob anestesia geral inalatória com sevofluorano Neurological and cardiocirculatory investigation of dog neonates born by normal parturition or cesarean section on sevoflurane inhalation anesthesia
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Daniela Tozadore Gabas, Lidia Mitsuko Matsubara, Valéria Nobre Leal de Souza Oliva, Leandro Rodello, Cláudio Nazaretian Rossi, and Silvia Helena Venturolli Perri
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cão ,parto normal ,cesariana ,neonato ,anestesia ,dog ,normal parturition ,cesarean section ,neonate ,anaesthesia ,Agriculture ,Agriculture (General) ,S1-972 - Abstract
A anestesia obstétrica possibilita um procedimento mais seguro para a mãe e para os fetos. Em medicina veterinária, no entanto, a literatura científica a respeito do assunto é deficiente. Este trabalho teve como objetivo avaliar o grau de depressão neurológica, hemodinâmica e respiratória fetais provocado pelo agente anestésico, em que as mães foram submetidas ao parto normal ou à cesariana, utilizando-se sevofluorano como agente de manutenção anestésica, comparando-o com o parto normal. Foram realizados seis partos normais (GN) e seis cesarianas (GC), avaliando-se um total de 36 filhotes. As cesarianas foram realizadas utilizando-se acepromazina, propofol e sevofluorano (GC) e os neonatos foram avaliados clinicamente ao primeiro, quinto e décimo minuto de nascimento, nos dois grupos. Observou-se maior depressão respiratória nos filhotes nascidos de cesariana. Contudo, apesar dessa depressão, o protocolo anestésico empregado não comprometeu de maneira importante a viabilidade e a saúde das mães e dos filhotes, demonstrando ser seguro em cadelas gestantes.The obstetric anesthesia must be safe for mother and puppies and about this, the literature is pour. This study was aimed at evaluating the neurological, hemodinamic and respiratory changes in neonates provoked by the anestesic agent as a result of normal parturition and cesarean section employing sevoflurane as the maintenance agent. Six deliveries (GN) and six cesarean sections (GC) were performed. The cesarean sections were performed under general anesthesia using acepromazina maleate, propofol and sevoflurane. Thirty six puppies were evaluated and the neurologic reflexes were worse in that were born through cesarean section. However, we concluded that despite the anesthetic depression, the protocol employed didn,t affect in any important way the viability and health of the mothers and puppies, being suitable for cesarean sections.
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- 2006
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50. Leishmaniose visceral no Brasil
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Mary Marcondes and Claudio Nazaretian Rossi
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Leishmania infantum ,Leishmania chagasi ,Cães ,Gatos ,Epidemiologia ,Animal culture ,SF1-1100 - Abstract
A leishmaniose visceral (LV) está entre as mais importantes doenças transmitidas por vetores que ocorrem no Brasil, principalmente devido ao seu caráter zoonótico. Atualmente, está presente em quase todo o território brasileiro, e seu controle é um desafio tanto para médicos veterinários como para agentes de saúde pública. O agente etiológico da doença é a Leishmania infantum (syn chagasi), e o principal vetor no Brasil é a Lutzomyia longipalpis. De todos os animais identificados como reservatórios da LV, o cão é considerado o reservatório doméstico mais importante. Apesar da doença já ter sido identificada em gatos, o papel epidemiológico desta espécie animal ainda é incerto. O presente artigo apresenta uma breve revisão sobre a situação epidemiológica da doença, a sua forma de transmissão, os aspectos clínicos nos cães e gatos, bem como possíveis fatores de risco associados à ocorrência da doença no Brasil.
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- 2013
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