Revisión de metadona intraoperatoria para el manejo de dolor posquirúrgico / Intraoperative methadone for the management of postsurgical pain a review

Pain management associated with surgery is a constant concern of the health team as well as the patient. Multiple proposals for analgesia have been made in the perioperative context. The use of opioids with rapid effect and easy titration in the intraoperative period are currently frequent; to then perform a postoperative analgesic control with drugs with a longer half-life, usually achieving adequate pain management. However, sometimes the standard analgesic scheme is not enough. The problems associated with this situation have led to the need for high doses of opioids in the postoperative period, with the requirement for monitoring, health personnel, and the adverse effects that these involve. Methadone is a long-acting, rapid-onset opioid, the latter secondary to its long elimination half-life. It is presumed that these characteristics have led patients to report adequate pain management, which has been related to a decrease in the need and dose of rescue opioids, in addition to delaying the requirement of these if necessary during the postoperative. These properties allow methadone to be a potential solution to perioperative pain management.

El manejo del dolor asociado a la cirugía es una preocupación constante del equipo de salud al igual que del paciente. Se han planteado múltiples propuestas de analgesia en el contexto perioperatorio, siendo actualmente frecuente el uso de opioides de rápido efecto y fácil titulación en el intraoperatorio; para luego realizar un control analgésico postoperatorio con fármacos de mayor vida media, logrando habitualmente un manejo adecuado del dolor. Sin embargo, a veces el esquema analgésico estándar no es suficiente. La problemática asociada a esta situación ha llevado a la necesidad de altas dosis de opioides en el posoperatorio, con el requerimiento de monitorización, personal de salud y efectos adversos que estos involucran. La metadona es un opioide de inicio de acción rápido y larga duración, este último secundario a su vida media de eliminación prolongada. Se presume que estas características han logrado que los pacientes reporten un adecuado manejo de su dolor, lo que se ha relacionado a una disminución en la necesidad y dosis de opioides de rescate, además de retrasar el requerimiento de éstos en el caso de ser necesarios durante el postoperatorio. Estas propiedades permiten que la metadona pueda ser una potencial solución al manejo del dolor perioperatorio.

Simulación de eventos críticos en anestesia: lecciones y aprendizaje desde la aviación para mejorar la seguridad del paciente / Simulation of critical events in anesthesia: lessons and learning from aviation to improve patient safety

: Durante décadas, las industrias de alto riesgo tales como la aviación comercial, las plantas nucleares y la ingeniería militar han sido entrenadas en el manejo de eventos críticos. En salud, la aplicación de los conceptos del entrenamiento del equipo de aviación y Crew Resource Management ("manejo de los recursos en crisis"), particularmente en anestesia, se han utilizado para mejorar la seguridad del paciente. Los eventos críticos, definidos como el punto en el curso de una enfermedad en la que se produce un cambio decisivo que conduce a la recuperación o a la muerte, tienen muchas características ideales para el entrenamiento por simulación.En esta revisión narrativa, nuestro objetivo es definir los conceptos y la relación entre eventos críticos y simulación en anestesia, determinando su uso en el manejo de dichos eventos y la evidencia existente para apoyarlo.(AU)

For decades, high-risk industries such as commercial aviation, nuclear plants and military engineering have been trained successfully in managing critical events. In healthcare, translating concepts of aviation team training and Crew Resource Management particularly to anesthesia has been used to improve patient safety. Critical events, defined as the point in the course of a disease at which a decisive change occurs, leading either to recovery or death, have many features that are fulfilled by simulation training. In this narrative review we aim to define the concepts and the relation between critical events and simulation in anesthesia, determining the uses of simulation in managing critical events and the evidence to support it.(AU)

De la anestesia a la seguridad de la atención: experiencia de 6 años en el análisis de reportes de incidentes en un hospital universitario / Analysis of incident reports in an anesthesiology unit of a university hospital

Background: Incident reporting is an effective strategy used to enhance patient safety. An incident is an event that could eventually result in harm to a patient. Aim: To classify and analyze incidents reported by an Anesthesiology division at a University hospital in Chile. Material and Methods: A retrospective analysis of the reported incidents registered in our institutional database from January 2008 to January 2014. They were classified according to three variables proposed by the World Health Organization system to determine the type of incident and patients’ potential harm. Results: There were 297 reports registered. Etiologic classification according to the WHO system showed that 29% (n = 85) were related with management, 20% (59) with drugs, 20% (59) with medical devices, 16% (48) with procedures and 15% (46) with human factors. Seventy two percent (58) of incidents caused low or moderate harm and 28% (22) resulted in a severe adverse event or death. Conclusions: Our analysis highlights that a high rate of incidents are associated with management, the leading cause of reports in our center. Due to the low incident report rate in our country, it is difficult to perform appropriate comparisons with other centers. In the future, local incident reporting systems should be improved.

Sobrevida alejada de pacientes operados por cáncer gástrico incipiente / Long term survival of patients operated for early gastric cancer

Background: Early gastric cancer involves mucosa and submucosa, independent of lymph node involvement. Radical gastrectomy is the standard treatment. Aim: To assess long term survival of patients operated for an early gastric cancer. Material and methods: Retrospective Rev iew of medical and pathology records of patients subjected to a gastrectomy for an early gastric cancer, between 1975 and 2002. All were treated using a standardized protocol and staged according to 2002 TNM classification of the American Joint Committee of Cáncer (AJCC). Demographic and pathologic features, operation performed and long term survival were recorded. Survival was analyzed using Kaplan-Meier method. Results: The series is comprised by 64 males and 41 females aged 61 + 1 years. Tumor was located in the upper third of the stomach on 33 subjects and a total gastrectomy was performed in 53. Pathology showed an intestinal type adenocarcinoma in 82 and a diffuse type in 23. In patients with involvement of mucosa and submucosa, 24 ± 14 and 22 ± 14 lymph nodes were excised, respectively. Lymph node involvement was present in 8 percent and 22 percent of patients with involvement of mucosa and submucosa, respectively. Five years survival was 94 percent and 78 percent in patients without and with lymph node involvement, respectively. Survival among patients in stage IA and IB was 94 percent and 76 percent, respectively. Multivariate analysis showed that the lymph node involvement was an independent mortality risk factor. Conclusions: Total gastrectomy in patients with early gastric cancer is associated with a good survival. Lymph node involvement is a mortality risk factor.