systemic vasopressors. Nevertheless, of the 13 anesthesiologists who responded to the survey, 6 chose continuous infusion and 7 chose intermittent boluses of catecholamines as temporizing measures. Postoperative follow-up reporting the results of these approaches would have been useful in highlighting any detrimental effect on flap outcome.One of the frustrating issues that the anesthesiologists faced was the poor visibility of the surgical field (away by 180 degrees) and hence the difficulty in identifying blood loss in timely fashion. We suggest overhead cameras integrated into the light handle over the operating room table to ameliorate this problem. We welcome the suggestion of using specialized drapes for sterile blood collection from the operative field and the use of cell savers.In a procedure as rare and extensive as facial transplantation, careful planning must be undertaken by both the surgical and anesthetic teams, and many challenges must be addressed. This review describes several of the anticipated issues that may be encountered by the anesthetic team. Long-term outcomes for these patients need to be reviewed before being able to establish specific guidelines to provide optimal care for these complicated procedures.R econstructive surgery, that which combines the principles of plastic and transplantation surgeries, is a growing multidisciplinary specialty. Upper-extremity transplantation is now performed at 7 centers in the United States. Although much information has been published on the immunologic and surgical aspects of upper-extremity transplantation, no studies on anesthetic management of this technology have been reported. This article discusses the challenges and considerations in upperextremity transplant anesthesia based on experience at the authors' institutions. The Pittsburgh Upper Extremity Transplant Anesthesiology Protocol (PUETAP) provides guidelines and recommendations for management of the transplant recipients.The protocol focuses on fluid management, intraoperative monitoring, and regional anesthesia strategies. For fluid management, the recommendation is to use an intravenous access via the internal jugular route with a large-bore catheter, a single-lumen infusion catheter inserted through the diaphragm of the introducer to monitor central venous pressure for a unilateral transplant, and a 7-gauge double-lumen central venous catheter in the jugular vein for bilateral hand transplantation. The trauma resuscitation protocol is followed with a ratio of 1 unit of packed red blood cells to 1 unit of fresh frozen plasma to 250 mL normal saline. This provides a hematocrit value of 26% to 28% in the rapid infusion system (RIS) reservoir. Every procedure must have at least 10 units of packed red blood cells and 10 units of fresh frozen plasma on hand along with adequate platelets. Any >-agonists should be avoided because they may affect graft perfusion. Dopamine is used when hypotension cannot be corrected by intravenous fluid or blood product infusions. Arterial blood gases, electroly...
Durante toda su obra, el filósofo Karl Popper crítico en fuertes términos el totalitarismo del siglo XX, el cual él vivió en carne propia. No dudamos que hoy, levantaría la voz ante el otro mal político que se observa en el horizonte ad portas de la tercera década del nuevo milenio, a saber, el fundamentalismo. Y si bien es cierto, el filósofo austriaco ataca los regímenes políticos totalitarios con la democracia, también es un crítico a ella cuando no da el ancho y a la vez, siendo un defensor a ultranza del diálogo, no duda en colocar ante la tiranía, los preceptos del tiranicidio
Democracy is a chimera for many who feel that she will never knock on her doors. But that democracy is already part of a past when it comes to seeing science move forward and the world begins a gap between those who have and those who do not have in every sense of thinking and acting of the human. In these new times of social media-fed cyber millennialism on the one hand and laboratories on the other hand, the new war for those who master thought will be fought at the bit level and Artificial Intelligence. This is where neurocracy begins its journey as -perhaps- the new way of living and living together. The objective of this essay is to make known how this new way of thinking, feeling, and acting of human coexistence is entering into our daily work. The results obtained when thinking about the work, is of having shown that the middle maas and AI have arrived to stay in an increasingly dystopian planetary scenario.
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