Ricardo Serna-Muñoz

Introducción El hipoparatiroidismo posoperatorio es una de las complicaciones más relevantes tras la tiroidectomía total, con implicaciones clínicas que incluyen hipocalcemia sintomática, requerimientos prolongados de suplementación y, en casos graves, alteraciones neuromusculares crónicas. Su aparición se asocia principalmente con la resección inadvertida, la lesión térmica o la desvascularización de las glándulas paratiroides durante la disección […]

Effective airway management is essential for patient safety across prehospital, perioperative, and critical care settings. Traditional training, largely ba

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Artículo dE rEvisión resumen La hemorragia posparto (HPP) continúa siendo una de las principales causas mundiales de morbilidad y mortalidad materna. La atonía uterina representa el principal mecanismo subyacente, y el uso oportuno de agentes uterotónicos es clave en su prevención y manejo. Este artículo presenta una revisión detallada de los principales fármacos uterotónicos, incluyendo oxitocina, carbetocina, alcaloides del cornezuelo de centeno, prostaglandinas y calcio intravenoso, con énfasis en su farmacodinamia, farmacocinética, indicaciones clínicas y efectos adversos. Se discuten las diferencias en la dosificación recomendada para cesáreas electivas e intraparto, así como en pacientes con obesidad mórbida. Se destacan las ventajas de la carbetocina en contextos con recursos limitados y el potencial del calcio como coadyuvante, aunque aún sin evidencia robusta para su uso sistemático. Además, se aborda la importancia de protocolos estandarizados para el uso secuencial de uterotónicos de primera y segunda línea, con el fin de optimizar los resultados maternos y reducir la necesidad de intervenciones quirúrgicas. Este análisis proporciona herramientas prácticas para mejorar la atención obstétrica basada en evidencia, especialmente en escenarios quirúrgicos. Se concluye que

Introduction The laparoscopic approach has become the standard of care for many abdominal surgical procedures. Compared to laparotomy, laparoscopy allows for smaller incisions, reduces the perioperative stress response, minimizes post-operative pain, and shortens recovery time1,2. Laparoscopy relies on the establishment of a pneumoperitoneum, where a gas, typically carbon dioxide (CO2), is insufflated through the peritoneal […]

The knotting of an epidural catheter is an unusual complication that can result in disfunction of the catheter, difficult removal and may require surgical management.We report a case of knot formation on a lumbar epidural catheter, introduced at the L2-L3 level, which presented difficulty during withdrawal. Lumbar CT images were taken to evaluate the knot position and discuss posible solutions. The catheter was successfully removed without breakage, showing a simple knot 7 mm from its end. No neurological complications were observed. This case report demonstrates that knot formation in a lumbar epidural catheter is possible. Anesthesiology professionals should consider this complication when experiencing resistance during catheter withdrawal or injection.

The host immune response to SARS-CoV-2 appears to play a critical role in disease pathogenesis and clinical manifestations in severe COVID-19 cases. Until now, the importance of developing a neutralizing antibody response in the acute phase and its relationship with progression to severe disease or fatal outcome among hospitalized patients remains unclear. In this study, we aim to characterize and compare longitudinally the primary humoral immune host response in the early stages of the disease, looking for an association between neutralization, antibody titers, infective viral lineage, and the clinical outcome in hospitalized and non-hospitalized patients. A total of 111 patients admitted at INER from November 2021 to June 2022 were included. We found that patients with negative or low neutralization showed a significant reduction in survival probability compared to patients with medium or high neutralization. We observed a significant decrease in the median of neutralization in patients infected with viral variants with changes in RBD of the spike protein. Our results suggest that developing an early and robust neutralizing response against SARS-CoV-2 may increase survival probability in critical patients.