Suchergebnisse

La bioética comienza a conformarse como disciplina especializada hace casi cinco décadas. Los importantes avances experimentados por las ciencias biológicas y médicas, junto con el surgimiento de innovadoras biotecnologías, tornan urgente la adopción de criterios para la toma de decisiones moralmente complejas relacionadas con el ámbito de la salud. Los organismos gubernamentales y los diferentes centros de salud, frente a esta realidad, comprenden la importancia de la tarea de implementación de diversos mecanismos formales para abordar y analizar los problemas éticos que surgen de estos avances dinámicos y cambiantes en el campo de los cuidados médicos. Como resultado se produjo la creación de los comités de bioética, que tienen como finalidad principal alentar el diálogo y el debate sobre cuestiones dilemáticas relacionadas con la ética del cuidado de la salud. Estos comités son grupos interdisciplinarios en los cuales expertos de diferentes profesiones (médicos, enfermeras, psicólogos, filósofos, abogados y otros) analizan diferentes cuestiones de orden bioético con el fin de lograr un acuerdo teniendo siempre como fin la protección de los derechos del paciente. Este presente trabajo, que posee un carácter introductorio a estas temáticas, presentará una breve introducción al surgimiento y posterior desarrollo de la bioética como disciplina y luego se expondrán las funciones y composición de los comités hospitalarios de ética. ; The birth of bioethics as a discipline can be set approximately five decades ago. The significant scientific progress achieved by biological and medical sciences, along with the emergence of innovative biotechnology, brought to light the need to set criteria for the morally complex decisions that emerged from the health care and medical fields. Government agencies and health centers, faced with this reality, began to understand the importance of the task of implementing formal mechanisms to address and analyze ethical issues arising from these dynamic and ever changing developments in the health care field. The result was the establishment of bioethics committees, which are intended to encourage dialogue and debate on issues related to ethics of health care. These committees are interdisciplinary groups in which experts from different professions (doctors, nurses, psychologists, philosophers, lawyers and others) discuss various bioethical issues in order to reach an agreement with the purpose of protecting patient´s rights. This paper, which has an introductory character, presents a brief introduction to the emergence and development of bioethics as a discipline and explains the functions and composition of hospital ethics committees. ; Fil: Belli, Laura Florencia. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. Programa de Bioética; Argentina. Universidad de Buenos Aires. Facultad de Filosofia y Letras; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina ; Fil: Quadrelli, Silvia. Hospital Británico; Argentina

AbstractAntiplatelet therapy is mandatory for prevention of thrombotic events in patients with a recent history of acute coronary syndromes and/or percutaneous coronary interventions. However, if an urgent surgery is required during antiplatelet therapy, a compromise between the ischemic/thrombotic and hemorrhagic risk has to be reached. Different bridging schemes are reported in the literature, but there is no clear consensus on the optimal treatment strategy in terms of efficacy and safety. Although some indications about the perioperative management of antiplatelet therapy regarding specific surgical specializations are available, balancing the thrombotic and hemorrhagic risk on an individual basis, no evidence referring to neurosurgical or neuro-oncologic procedures is reported. Herein, we present our preliminary experience in the perioperative management of a patient who underwent a neurosurgical procedure for the resection of a primary malignant brain tumor using an intravenous P2Y12 inhibitor (cangrelor) as bridging therapy after a recent acute myocardial infarction treated with primary percutaneous coronary intervention and stenting. The oral P2Y12 inhibitor (clopidogrel) was withdrawn 5 days prior to the surgical procedure and continuous infusion of cangrelor was started 3 days before the surgery at a dose of 0.75 μg/kg/min. Cangrelor was discontinued 2 hours before surgery and resumed 72 hours after tumor resection for further 60 hours. Neither cangrelor-related bleeding nor cardiac ischemic events were observed in the perioperative period and the following 90 days, supporting data regarding the feasibility and safety of this bridging scheme. Further studies are needed to confirm our promising results.