LA POSICIÓN SENTADA EN NEUROCIRUGÍA. PLAN DE CUIDADOS INTRAQUIRÚRGICOS

One of the main functions of the surgical nurse is to guarantee security and comfort for the patient who undergoes an intervention. In addition to this, the surgical nurse should make sure that no nervous or vascular commitments by compression of structures exist during the positioning of the patient in the surgical table. A correct respiratory and circulatory operation must also be assured, as well as the skin integrity avoiding possible positions and fixing suitable catheters soundings and routes. Sometimes, the boarding of the later grave for the tumor resection or later cervical approaches in pathology of rachis requires a sitting surgical position of the patient. The sitting position, nowadays, means a challenge for nursing professionals and the rest of the surgical team. It is true, that this position is in disuse and that has great detractors that choose other positions for concordant the infratentorial approach or rachis cervical later, they may be prone position or lateral position. We will deal in this work with the cares that should receive these patients during the surgery, at the same time that we will value the advantages and disadvantages, as well as its possible alternatives. Although this route of boarding can be used in occipitocervicals interventions or rachis cervical later, the patients type are usually those that present a LOE that requires an approach of later fossa. This is indicated in tumors of the pontocerebellum angle, neurinomas of the hearing aid, tumors of trocoencephalon, and cerebellum.Una de las principales funciones de la enfermera quirúrgica es velar por la seguridad y el confort del enfermo que es sometido a una intervención. Debe asegurarse de que no exista ningún compromiso nervioso o vascular por compresión de estructuras durante el posicionamiento del enfermo en la mesa quirúrgica. Debe también garantizar un correcto funcionamiento respiratorio y circulatorio, así como garantizar la integridad de la piel evitando posibles decúbitos y fijando adecuadamente catéteres sondas y vías. En ocasiones el abordaje de la fosa posterior para la resección de tumores o abordajes cervicales posteriores en patología de raquis requieren una posición quirúrgica sedeste del enfermo. La sedestación supone actualmente un reto para el profesional de enfermería y el resto del equipo quirúrgico. Cierto es que esta posición está en desuso y que tiene grandes detractores que optan por otras posiciones para el abordaje infratentorial o de raquis cervical posterior como son la posición prona o concorde o el decúbito lateral. Trataremos en este trabajo sobre los cuidados que deben recibir estos enfermos durante la cirugía, a la vez que valoraremos sus ventajas e inconvenientes, así como sus posibles alternativas. Aunque esta vía de abordaje se puede utilizar en intervenciones occipitocervicales o del raquis cervical posterior, los pacientes tipo suelen ser aquellos que presentan una LOE que requiere un abordaje de la fosa posterior. Esta indicada en tumores del ángulo pontocerebeloso, neurinomas del acústico, tumores del trocoencéfalo, y del cerebelo

Comodulation Masking Release Determined in the Mouse (Mus musculus) using a Flanking-band Paradigm

Comodulation masking release (CMR) has been attributed to auditory processing within one auditory channel (within-channel cues) and/or across several auditory channels (across-channel cues). The present flanking-band (FB) experiment—using a 25-Hz-wide on-frequency noise masker (OFM) centered at the signal frequency of 10 kHz and a single 25-Hz-wide noise FB—was designed to separate the amount of CMR due to within- and across-channel cues and to investigate the role of temporal cues on the size of within-channel CMR. The results demonstrated within-channel CMR in the Naval Medical Research Institute mouse, while no unambiguous evidence could be found for CMR occurring due to across-channel processing (i.e., “true CMR”). The amount of within-channel CMR was dependent on the frequency separation between the FB and the OFM. CMR increased from 4 to 6 dB for a frequency separation of 1 kHz to 18 dB for a frequency separation of 100 Hz. The large increase for a frequency separation of 100 Hz is likely to be due to the exploitation of changes in the temporal pattern of the stimulus upon the addition of the signal. Temporal interaction between both masker bands results in modulations with a large depth at a modulation frequency equal to the beating rate. Adding a signal to the maskers reduces the depth of the modulation. The auditory system of mice might be able to use the change in modulation depth at a beating frequency of 100 Hz as a cue for signal detection, while being unable to detect changes in modulation depth at high modulation frequencies. These results are consistent with other experiments and model predictions for CMR in humans which suggested that the main contribution to the CMR effect stems from processing of within-channel cues