ABSTRACT
Objetivo: establecer la calidad científica de las pruebas de campo utilizadas para calcular el consumo máximo de oxígeno (VO2max) en adultos sanos no entrenados. Materiales y métodos: se hizo una revisión sistemática de la literatura científica publicada en español, inglés y portugués, entre 1943 y 2013, sobre pruebas diagnósticas para calcular el VO2max por medio de pruebas de campo, con el propósito de sintetizar los resultados y establecer cuáles son las que mejor se correlacionan con la medición directa (ergoespirometría). Fueron consultadas las bases de datos MedLine, PubMed, ProQuest, Ovid, Hinari, Ebsco y BVS. Se siguieron las recomendaciones del Cochrane Handbook for Systematic Reviews of Interventions 2006. Resultados: inicialmente, 952 artículos, de los cuales después del proceso de descarte, se encontraron diez que cumplían con todos los requisitos. Las pruebas de campo analizadas que se correlacionan bien con el protocolo de laboratorio son el UMTT (1984) con r = 0,99, QCST y 1000m para hombres r = 0,95; el RWFT para hombres r = 0,93; 1,000m para mujeres y 1,5M r = 0,86; QCST para mujeres r = 0,83 y RWFT para mujeres r = 0,74; para adultos el UMTT r = 0,96 y 20m-SRT r=0,9. Conclusiones: dado el coeficiente de validez y el SEE, es posible utilizar pruebas de campo para calcular rápida y económicamente el VO2max en adultos sanos no entrenados. Según edad, sexo, condición física y patologías se recomiendan diferentes pruebas de campo.
Objective: To establish the scientific quality of the field tests used to calculate the maximum oxygen consumption (VO2max) in untrained healthy adults. Materials and methods: A systematic review of the scientific literature on diagnostic tests for calculating VO2max through field tests published between 1943 and 2013 in Spanish, English and Portuguese, , in order to synthesize the results and establish which are the best to correlate with direct measurement (ergospirometry). MedLine, PubMed, ProQuest, Ovid, Hinari, Ebsco and BVS databases were consulted. The recommendations of the Cochrane Handbook for Systematic Reviews of Interventions 2006 were followed. Results: Initially, 952 articles were found, after the elimination process was reached, ten of these met all requirements. Field tests analyzed to correlate well with the laboratory protocol are: UMTT (1984) r = 0.99, QCST and 1000m. men r = 0.95; RWFT men's r = 0.93; 1,000m. Women and 1.5M r = 0.86; QCST women r = 0.83 and RWFT for women r = 0.74, for adults UMTT r = 0.96 and 20m-SRT r = 0.9. Conclusions: Given the validity coefficient and the SEE, it is possible to use field tests to swiftly and economically calculate VO2max in untrained healthy adults. Different field tests are recommended according to age, gender, physical condition and pathologies.
Objetivo: Estabelecer a qualidade científica das provas de campo utilizadas para calcular o consumo máximo de oxigênio (VO2max) em adultos sãos não treinados. Materiais e métodos: se revisou sistematicamente a literatura científica publicada em espanhol, inglês e português, entre 1943 e 2013, sobre provas diagnósticas para calcular o VO2max através de provas de campo, com o propósito de sintetizar os resultados e estabelecer quais são as que melhor se correlacionam com a medição direta (ergoespirometria). Foram consultadas as bases de dados MedLine, PubMed, ProQuest, Ovid, Hinari, Ebsco e BVS. Seguiram-se as recomendações do Cochrane Handbook for Systematic Reviews of Interventions 2006. Resultados: Inicialmente 952 artigos, dos quais depois do processo de descarte encontramos dez que cumpriam com todos os requisitos. As provas de campo analisadas que se correlacionam bem com o protocolo de laboratório são: o UMTT (1984) com r = 0,99, QCST e 1000m para homens r = 0,95; o RWFT para homens r = 0,93; 1,000m para mulheres e 1,5M r = 0,86; QCST para mulheres r=0,83 e RWFT para mulheres r = 0,74; para adultos o UMTT r = 0,96 e 20m-SRT r = 0,9. Conclusões: Dado o coeficiente de validez e o SEE, é possível utilizar provas de campo para calcular rápida e economicamente o VO2max em adultos sãos não treinados. Segundo idade, sexo, condição física e patologias se recomendam diferentes provas de campo.
Subject(s)
Humans , Oxygen Consumption , Exercise , Diagnostic Tests, Routine , Data AnalysisABSTRACT
Introducción: Los síntomas laringofaríngeos (SLF) son comunes en anestesia. La incidencia de morbilidad laringofaríngea varía en la literatura. Objetivos: Determinar la incidencia de SLF al usar máscara laríngea y tubo endotraqueal en la primera y a las 24h posoperatorias y estimar la asociación de factores de riesgo. Métodos: Estudio de cohorte cerrada que incluyó 451 pacientes. Se indagó la presencia de odinofagia, disfonía y disfagia. Se utilizaron modelos marginales para estimar asociación con variables en estudio. Resultados: La incidencia de SLF durante la primera y 24h posoperatorias fue del 26 y del 13%, respectivamente. A las 24 h, la incidencia disminuyó significativamente. Conclusiones: La incidencia en un centro hospitalario colombiano de SLF en cirugía ambulatoria es importante. Existen diferencias en la reducción con el tubo endotraqueal y la máscara laríngea en el tiempo.
Introduction: To determine cumulative incidence of sore throat complaints (STCs) which occur with the insertion of the laryngeal mask (LM) and endotracheal tube (ETT) during the first hour and 24 hours after elective surgery. In addition, to establish risk factors associated with its occurrence. Methods: In a cohort study, a total of 451 patients scheduled for elective non-cardiac surgery were included consecutively for 6 months (ASA I-II-III, >18 years old) who underwent LM or ETT airway management for general anesthesia. Through a questionnaire with indirect and direct questions the presence of sore throat, hoarseness, dysphagia and the composite endpoint STCs were assessed one and 24 hours after surgery. Marginal models were used to identify risk factors. Results:We found an incidence of STCs of 26.8% and 13.5% at first and 24 postoperative hours respectively. At first hour, they were classified as sore throat (23.9%), hoarseness (6.7%) and dysphagia (6.4%). Each compound was not mutually exclusive. At 24 hours of follow up, incidence of STCs and its compounds decreases significantly but differently to ETT and LM. STCs were associated with female gender (OR=1.53 95%CI 1.00-2.37, p=0.05), ETT intubation (OR=4.20 95%CI 2.19-8.04, p<0.01) and bloodstain on airway device at extubation (OR=2.00 95%CI 1.18-3.36, p<0.01). Conclusions: The incidence of STCs remains important. There are differences in the pattern of reduction between ETT and LM over time and this study confirms risk factors for postoperative STCs like use of ETT, presence of blood during the airway device extraction and female gender.
Subject(s)
HumansABSTRACT
El manejo analgésico de los pacientes con trauma bilateral de hombro o tercio proximal del brazo es difícil. La estrategia multimodal basada en administración de anestésicos locales en el plexo braquial parece ser la más efectiva, pero hacer bloqueos bilaterales tiene riesgos asociados, como son: la parálisis del nervio frénico, la toxicidad por anestésicos locales y el neumotórax bilateral. Estos pueden ser disminuidos con una aproximación supraclavicular al plexo braquial y el uso de ultrasonografía. Describimos el manejo de un paciente con trauma bilateral de hombro y tercio proximal de húmero, quien es llevado a cirugía de osteosíntesis bilateral de húmero y presenta dolor postoperatorio severo que no responde a dosis altas de opiáceos y antiinflamatorios. Es manejado inicialmente con bloqueo supraclavicular bilateral guiado por ecografía con volumen bajo de anestésico local y posteriormente administración continua de bupivacaína, con una valoración del dolor de 2/10 a las 24 h y 3/10 a las 48 h. Concluimos que el bloqueo supraclavicular bilateral es una opción para el manejo del dolor agudo en cirugía de hombro y tercio proximal de húmero. La administración continua de anestésicos locales al plexo braquial contribuye a mantener la respuesta analgésica.
Analgesic management in patients with bilateral trauma to the shoulder or the proximal third of the arm is difficult. The multimodal strategy based on the administration of local analgesics to the brachial plexus appears to be the most effective; however, there are risks associated with bilateral blocks, including phrenic nerve palsy, toxicity due to local anesthetics, and bilateral pneumothorax. These risks may be diminished using an ultrasound-guided supraclavicular approach to the brachial plexus. This paper describes the management of a patient with bilateral injury to the shoulder and the proximal third of the humerus. The patient is taken to bilateral humeral fixation surgery and develops severe post-operative pain which does not respond to high-dose opioids and anti-inflammatory agents. He is managed initially with bilateral ultrasound-guided supraclavicular block using a low volume of a local anesthetic followed by continuous administration of bupivacaine. Pain assessment was 2/10 at 24 hours and 3/10 at 48 hours. We concluded that bilateral supraclavicular blockade is an option in the acute management of pain after surgery to the shoulder and the proximal third of the humerus. Continuous administration of local anesthetics to the brachial plexus helps maintain the analgesic response.