Nursing evaluation of pediatric preoperative anxiety: a qualitative study / Avaliação de enfermagem da ansiedade pré-operatória pediátrica: um estudo qualitativo? / Evaluación enfermera de la ansiedad prequirúrgica pediátrica: estudio cualitativo

Abstract Objective: to explore and describe how perioperative nurses assess and interpret the child's behavior before entering the operating room, identifying the strategies they use to reduce anxiety and the proposals for improvements. Method: descriptive qualitative study using semi-structured interviews and participant observation of daily routines. Thematic analysis of data. This study follows the recommended criteria for publication of articles of the qualitative methodology Consolidated Criteria for Reporting Qualitative Research. Results: four topics emerged from the data: a) assessment of anxiety or close communication with the child and their family; b) evaluating what was observed; c) managing anxiety and d) improving the assessment or proposals for improvements in daily practice. Conclusion: nurses assess anxiety in their daily practice through observation using their clinical judgment. The nurse's experience is decisive for the appropriate assessment of the preoperative anxiety in child. Insufficient time between waiting and entering the operating room, lack of information from child and their parents about the surgical procedure, and parental anxiety make it difficult to assess and properly manage anxiety.

Resumo Objetivo: explorar e descrever como as enfermeiras perioperatórias avaliam e interpretam o comportamento da criança antes de entrar na sala de cirurgia, identificando as estratégias que utilizam para minimizar a ansiedade e as propostas de melhoria. Método: estudo qualitativo descritivo utilizando entrevistas semiestruturadas e observação participante das rotinas diárias. Análise temática dos dados. O estudo segue os critérios recomendados para publicação de artigos da metodologia qualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: quatro temas emergiram dos dados: a) avaliação da ansiedade ou comunicação próxima com a criança e sua família; b) analisando o que foi observado; c) controlando a ansiedade e d) melhorando a avaliação ou propostas de melhoria na prática diária. Conclusão: as enfermeiras avaliam a ansiedade em sua prática diária por meio da observação e usando julgamento clínico. A experiência da enfermeira é decisiva na avaliação adequada da ansiedade pré-operatória da criança. A falta de tempo entre a espera e o momento de entrar na sala de cirurgia, a escassez de informação que a criança e os pais têm sobre o processo cirúrgico e a ansiedade dos pais, dificultam a avaliação e o controle adequado da ansiedade.

Resumen Objetivo: explorar y describir cómo las enfermeras perioperatorias evalúan e interpretan el comportamiento del niño antes de entrar a quirófano, identificando las estrategias que utilizan para minimizar la ansiedad y las propuestas de mejora. Método: estudio cualitativo descriptivo mediante entrevistas semiestructuradas y observación participante de las rutinas diarias. Análisis temático de los datos. El estudio sigue las recomendaciones de criterios para la publicación de artículos de metodología cualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: cuatro temas surgieron de los datos: a) evaluación de la ansiedad o comunicación estrecha con el niño y su familia; b) valorando lo observado; c) manejando la ansiedad y d) mejorando la evaluación o propuestas de mejora para la práctica diaria. Conclusión: enfermeras evalúan la ansiedad en su práctica diaria de forma observacional utilizando el juicio clínico. La experiencia de la enfermera es determinante en la adecuada evaluación de la ansiedad prequirúrgica del niño. La falta de tiempo entre la espera y el momento de entrar a quirófano, la mala información que tiene el niño y los padres sobre el proceso quirúrgico y la ansiedad de los padres dificultan la evaluación y el manejo correcto de la ansiedad.

Methods for evaluating liver reserve function before hepatectomy / 临床肝胆病杂志

At present, hepatectomy has become the preferred treatment modality for most benign and malignant hepatobiliary diseases. Liver failure is a common complication after hepatectomy, and for malignant diseases, how to remove the lesion to the maximum extent and reduce the incidence rate of liver failure after hepatectomy is the key problem at present. Accurate and adequate preoperative evaluation of liver reserve function can provide a basis for judging the progression, therapeutic outcome, and prognosis of liver diseases. There are currently various methods for evaluating liver reserve function and surgical feasibility, each with its own advantages and disadvantages, and there is still a lack of a single comprehensive evaluation method. This article reviews the characteristics of commonly used evaluation methods and related research advances.

Anesthesia and breastfeeding / Lactancia materna y anestesia

Abstract The importance of breastfeeding with its positive impact on the wellbeing of the mother-infant pair is well established. Anesthesiologists should encourage the promotion of lactation by being willing to give reassurance during the preoperative period and preparing a plan that does not interfere with safe breastfeeding. There is concern regarding the transfer of drugs into breast milk, which may lead to inconsistent advice from many health professionals and to early discontinuation. However, evidence shows that most anesthetic drugs are safe in terms of transfer into breast milk, and hence, compatible with breastfeeding, which should be resumed after anesthesia as soon as the mother is alert and feels well enough to hold her infant, without the need to "pump and dump". This review provides pharmacokinetic information on commonly used anesthesia drugs and their passage into breast milk, to help practitioners discuss risks and benefits with the mother, emphasizing that anesthesia should not interfere with the benefits of breastfeeding. Four practical clinical scenarios are presented: pregnant women concerned about the effect of epidural analgesia on subsequent breastfeeding, spinal anesthesia for c-section and lactation, patients who will receive general anesthesia during cesarean section, and finally women who are breastfeeding and require anesthesia for elective or urgent surgery. Neuraxial anesthesia allows for better pain control and immediate skin-to-skin contact at the time of childbirth. Also, it interferes the least with the woman's ability to care for her infant. Regional techniques, opioid-sparing techniques and outpatient surgery are preferred. Drugs such as opioids and longer-acting benzodiazepines should be administered cautiously, particularly in repeat doses.

Resumen La lactancia materna tiene evidentes beneficios para el binomio maternofetal. El anestesiólogo debe ser un agente en la promoción de la lactancia, estar dispuesto a resolver dudas en el preoperatorio y elaborar un plan que no interfiera con su seguridad. Hay preocupación referente a la transferencia de los medicamentos (endovenosos y/o neuroaxiales) hacia la leche, que puede conducir a un consejo inconsistente de muchos profesionales de la salud, lo cual contribuye a la suspensión temprana de la lactancia materna. Sin embargo, existe evidencia de que la mayoría de los medicamentos que se utilizan en la anestesia (general y neuroaxial) son compatibles con la lactancia materna. Se debe iniciar la lactancia materna después de la anestesia tan pronto como la madre esté alerta y se sienta bien, sin necesidad de extraerla y eliminarla. Esta revisión entrega información farmacocinética sobre los medicamentos y técnicas anestésicas comúnmente utilizadas para que los profesionales realicen un balance riesgo-beneficio con la madre, enfatizando que la anestesia no debe interferir con los beneficios de la lactancia. Se presentan cuatro escenarios clínicos prácticos: embarazada preocupada por el efecto de la analgesia peridural en su lactancia posterior, anestesia raquídea para cesárea y efecto en lactancia, pacientes que requieren anestesia general para cesárea y, por último, paciente puérpera que requiere anestesia para cirugía. Las técnicas neuroaxiales permiten un mejor control del dolor y contacto piel con piel precoz en el parto vaginal o cesárea, lo que facilita que la madre inicie la lactancia más rápido. Si el escenario lo permite, se prefieren técnicas regionales, técnicas ahorradoras de opioides y cirugía ambulatoria, teniendo precaución con ciertos opioides y benzodiacepinas de acción larga especialmente ante dosis repetidas.

Application of precise hepatobiliary surgery technical system in complicated hepatolithiasis / 中华消化外科杂志

Precise hepatobiliary surgery technical system is a full-process and full-element surgical practice norm, which is based on the value of maximizing the benefit of patients, combining various technical means as its method, with safety, high efficiency and minimal trauma as the goal. Complicated hepatolithiasis is considered as benign disease but malignant prognosis because of its disease characteristics, such as difficult preoperative evaluation, difficult operation and difficult postoperative management. The precise hepatobiliary surgery technical system plays an important role in complicated hepatolithiasis. Based on the core of diseased biliary tree clearance, surgeons have improved the certainty of preoperative assessment and surgical operations through positioning, quantitative and structure technology. The author elaborates on the core, connotation of precise hepatobiliary surgery technical system and its application in complicated hepatolithiasis.

Valoración preoperatoria en cirugía no cardiaca: un abordaje por pasos / Preoperative evaluation in noncardiac surgery: a stepwise approach

Resumen La valoración preoperatoria en cirugía no cardiaca es fundamental para disminuir la tasa de complicaciones hospitalarias; su finalidad es identificar pacientes con riesgos mayores. La valoración preoperatoria no se debe limitar a los aspectos cardiovasculares, sino enfocarse en todos los órganos y sistemas e incluir la conciliación de medicamentos. El objetivo de este escrito es abordar la realización de una valoración preoperatoria en cirugía no cardiaca desde la perspectiva del médico internista, con el fin de ayudar a prevenir eventos adversos y mejorar el desenlace general.

Abstract Preoperative assessment in non-cardiac surgery is essential to reducing the rate of in-hospital complications. Its purpose is to identify patients with higher levels of risk. Preoperative assessment should not be restricted to cardiovascular aspects, but it should focus on all organs and systems and include medication reconciliation. The purpose of this article is to approach the performance of a preoperative assessment in non-cardiac surgery from the perspective of the internist, with the purpose to help prevent adverse events and improve the overall outcome.

Application progress of enhanced recovery after surgery in perioperative anesthesia management / 局解手术学杂志

Enhanced recovery after surgery is the path of perioperative multi-modal management.It is coordinated by anesthesiologists, surgeons, nursing staff, nutritionists and rehabilitation physician to reduce the perioperative stress response of patients.Maintenance of the body and organ functions before and after surgery to achieve early rehabilitation.Enhanced recovery after surgery integrates a series of interventions during the perioperative period to maintain physiological function and promote postoperative recovery.Its core goal is to reduce trauma and stress, to reduce pain and complications of patient, shorten hospital stay and reduce hospitalization costs.The ultimate goal is to accelerate patients recovery. so it is the direction of perioperative medical development. As an indispensable part of anesthesia management,the professionalism and ability of anesthesiologists will be critical to accelerating the success of rehabilitation surgery.

Three-dimensional visual assessment and virtual reality study of centrally located hepatocellular carcinoma on the axis of blood vessels / 中华外科杂志

Objective@#To explore a novel method for preoperative precision assessment of centrally located hepatocellular carcinoma(HCC) with blood vessel as axis based on three-dimensional(3D) visualization and virtual reality(VR) technology and its application values.@*Methods@#High-quality thin-layer enhanced CT data were collected from 20 patients with centrally located HCC who treated at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from March 2017 to August 2018 diagnosed by preoperative examination. There were 18 males and 2 females, aged 28 to 69 years, all of Child-Pugh grade A. First of all, 3D reconstruction was performed by a 3D visualization software; then, the reconstructed 3D image was imported into VR development engine for VR research; afterwards, the analysis and evaluation system with blood vessel as axis was established based on 3D visualization classification of centrally located HCC; therefore, the relationship of the tumor to its major peripheral blood vessels was accurately judged and the surgical planning was formulated. Two images were brought into the operating room for navigation in surgery. The assessments results of preoperative data (CT and (or) MRI) and three-dimensional visualization of blood vessels in VR environment were compared; the values of the preoperative and postoperative hemoglobin, serum albumin and bilirubin were recorded and compared. Chi-square test, t-test and non-parametric test were used for the analysis of counting data, continuous measurement data and non-normal distribution measurement data, respectively.@*Results@#3D visualization modeling was completed in all of the 20 patients with centrally located HCC. According to the results of 3D visualization classification of centrally located HCC, there were 3 cases of type Ⅰ,1 case of type Ⅱ,4 cases of type Ⅲ,7 cases of type Ⅳ and 5 cases of type Ⅴ; according to the assessment and classification based on blood vessel as the axis, there were 6 cases of type Ⅰa,2 cases of type Ⅰb,2 cases of type Ⅱa,9 cases of type Ⅱb and 1 case of type Ⅱc. All patients underwent successful resection of tumor under the guidance of 3D visualization and VR technology. There were 15 cases whose assessment results based on preoperative CT/MRI were consistent with intraoperative findings, with a coincidence rate of 75.0%(15/20); while in VR environment, the assessment results of 3D visualization with blood vessel as axis were all consistent with the intraoperative findings, with coincidence rate of 100%(20/20). There was a statistically significant difference between the groups (χ2=5.714, P=0.017). There was no red blood cell transfusion in all patients during the operation. The preoperative hemoglobin was (128.8±14.9)g/L, and it was (119.8±12.5)g/L on postoperative day 1. There was no significant difference between these two sets of data (t=2.07, P=0.054). No death during the perioperative period and no complications such as hepatic failure, hemorrhage and biliary fistula after operation occurred.@*Conclusion@#Preoperative evaluation based on 3D visualization and VR technology with blood vessel as the axis has significant clinical value for preoperative planning and surgical navigation of centrally located HCC.

Value of three-dimensional visualization technology in preoperative evaluation of liver autotransplantation for end-stage hepatic alveolar echinococcosis / 中国血吸虫病防治杂志

Objective To evaluate the value of the three-dimensional visualization technology for the preoperative assessment of liver autotransplantation for end-stage hepatic alveolar echinococcosis. Methods A total of 8 patients with end-stage hepatic alveolar echinococcosis undergoing liver autotransplantation in Qinghai Provincial People’s Hospital from May 2013 to July 2017 were collected. All cases received preoperative abdominal CT scanning and dynamic three-phase enhanced CT scanning, and the original CT data were transferred to the human 3D visualization virtual surgical planning system. The volumes of Echinococcus multilocularis and pre-resected liver were measured using the 3D visualization reconstruction, and the relationship between the lesion and the neighboring tissues was observed. The value of the 3D visualization technology for the preoperative assessment of liver autotransplantation for end-stage hepatic alveolar echinococcosis was assessed by comparing with the intraoperative findings. Results The 3D visualization reconstruction model clearly displayed the adjacent relationship between the lesions of end-stage hepatic alveolar echinococcosis and the neighboring tissues, and no significant difference was seen between the pre-resected liver volume in 3D visualization reconstruction model and the actually resected liver volume (t = 1.083, P > 0.05). Conclusions 3D visualization technology is feasible to develop a reasonable scheme for liver resection and vascular anastomosis for end-stage hepatic alveolar echinococcosis prior to liver autotransplantation, which may increase the success of surgery and improve the prognosis.

A qualitative research on perceptions towards preoperative assessment of the elderly patients undergoing elective surgery among surgical nurses / 中国实用护理杂志

Objective@#To investigate the perceptions towards preoperative assessment of the elderly patients undergoing elective surgery among surgical nurses, providing scientific basis for standardizing preoperative assessment.@*Methods@#Eleven nurses were chosen in surgical ward. Data were collected by using semi-structured in-depth interviews and were analyzed with the Colaizzi method.@*Results@#Four themes were extracted: Necessity of surgical nurses for preoperative assessment of elderly patients undergoing elective surgery; Perceptions towards the contents of preoperative assessment; Current status of preoperative assessment; Suggestions for preoperative assessment.@*Conclusions@#Surgical nurses play an important role in preoperative assessment of elderly patients undergoing elective surgery and they emphasize the comprehensive preoperative assessment contents. However, comprehensive geriatric assessment is rarely used, lacking of uniform and standard criteria. We suggest to standardize preoperative assessment, improving the implementation rate and perioperative care, thus promoting rehabilitation.

Value of three-dimensional visualization technology in preoperative evaluation of liver autotransplantation for end-stage hepatic alveolar echinococcosis / 中国血吸虫病防治杂志

Objective To evaluate the value of the three-dimensional visualization technology for the preoperative assessment of liver autotransplantation for end-stage hepatic alveolar echinococcosis. Methods A total of 8 patients with end-stage hepatic alveolar echinococcosis undergoing liver autotransplantation in Qinghai Provincial People’s Hospital from May 2013 to July 2017 were collected. All cases received preoperative abdominal CT scanning and dynamic three-phase enhanced CT scanning, and the original CT data were transferred to the human 3D visualization virtual surgical planning system. The volumes of Echinococcus multilocularis and pre-resected liver were measured using the 3D visualization reconstruction, and the relationship between the lesion and the neighboring tissues was observed. The value of the 3D visualization technology for the preoperative assessment of liver autotransplantation for end-stage hepatic alveolar echinococcosis was assessed by comparing with the intraoperative findings. Results The 3D visualization reconstruction model clearly displayed the adjacent relationship between the lesions of end-stage hepatic alveolar echinococcosis and the neighboring tissues, and no significant difference was seen between the pre-resected liver volume in 3D visualization reconstruction model and the actually resected liver volume (t = 1.083, P > 0.05). Conclusions 3D visualization technology is feasible to develop a reasonable scheme for liver resection and vascular anastomosis for end-stage hepatic alveolar echinococcosis prior to liver autotransplantation, which may increase the success of surgery and improve the prognosis.

Application of three-dimensional visualization technology in preoperative assessment of hilar cholangiocarcinoma / 中国肿瘤临床

Objective:To investigate the application of three-dimensional visualization technology in preoperative assessment of hilar cholangiocarcinoma. Methods:Thirty-eight patients with hilar cholangiocarcinoma who underwent surgery from March 2014 to April 2016 were enrolled in the retrospective study. Among the cases, an observational group of 18 patients had preoperative three-dimensional visualization surgical planning, while a control group of 20 patients did not have the visualization surgical plan. The preoperative diagnostic results were analyzed with the actual intraoperative findings. Related surgicall indicators between the two groups were compared. Results:No significant difference in the accuracy rates of longitudinal and vertical infiltration of cholangiocarcinoma between was observed the observational group and control group. While the vascular and ductal branching pattern of all patients are consistent with intraoperative findings, the coincidence rate was higher in the observational group than that in the control group (100%vs. 70%, P<0.05). The estimated liver volumes were also exactly consistent with the actual liver volume (r=0.986, P<0.001). In comparison with the control group, the average intraoperative blood loss and operative time of the observational group were significantly lower. However, the potential curative resection between the two groups exhibited no significant difference. Conclusion:Three-dimensional visualization technology can accurately complete the preoperative evaluation of hilarcholangiocarcinoma.

Predictive value of contrast-enhanced ultrasound for peripancreatic vascular invasion in pancreatic carcinoma / 中华医学超声杂志（电子版）

Objective To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in predicting peripancreatic vascular invasion in pancreatic carcinoma through comparison with the findings on surgical exploration. Methods A total of 94 pancreatic cancer patients (confirmed by pathological examination) were included in this study. The CEUS data were analyzed retrospectively. The enhancement characteristics of lesions were documented. And the peripancreatic vascular invasion were analyzed. The main features of peripancreatic vascular invasion on CEUS were as followings: 1) peripancreatic arteries to be embedded, trapped in the tumor or surrounded by tumor, or to have intraluminal infiltration or luminal stenosis. 2)superior mesenteric vein, portal vein to be surrounded by tumor or to be narrow, distorted or occluded. The CEUS findings were compared with postoperative pathological results. Results 94 patients were diagnosed with pancreatic cancer by pathological examination, including 62 cases of pancreatic head carcinoma, 32 cases of pancreatic tail carcinoma. The imaging of contrast-enhanced ultrasound showed 6 cases (6.4%) of high uneven enhancement, 78 cases (83%) of low uneven enhancement, and 10 cases (10.6%) of heterogeneous enhancement in parenchyma phase, respectively. Twenty-five cases (26.6%) of CA invasion were detected by CEUS, while no invasion was observed in 69 cases (73.4%). Compared with pathological findings, the predictive sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS were 63.6%, 79.7%, 84.7%, 56.0%, 88.0%, respectively. Twenty-seven cases (28.7%) of SMA invasion were detected by CEUS, while no invasion were observed in 67 cases (71.3%). Compared with pathological findings, the predictive sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS were 66.6%, 77.6%, 80.2%, 44.0%, 91.0%, respectively. Besides, PV invasion features were found in 27 cases (28.7%), while 67(71.3%) cases were detected without invasion features. Compared with pathological findings, sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS in predicting PV invasion were 86.6%, 94.6%, 98.4%, 96.2%, 94.0%, respectively. Furthermore, CEUS detected SMV invasion in 26 cases (27.6%), while no invasion features in 68 (72.4%) cases. The sensitivity, accuracy, specificity, positive predictive value, negative predictive value for CEUS were 75.0%, 87.2%, 92.4%, 80.7%, 89.7%, respectively. Conclusion Due to its good diagnostic and predictive performance in detecting malignant pancreatic tumors and peripancreatic vascular invasion, CEUS could be served as an effective predictive modality in assessing the resectability of pancreatic carcinoma.

Research advance of preoperative assessment in patients with auto liver transplantation / 中华肝胆外科杂志

Auto liver transplantation (ALT) is a treatment option for patients with liver space-occupying lesion that could not be removed by conventional surgery and severe liver trauma,which also helps alleviate the shortage of donor liver.But many problems like the preoperative assessment,the tolerance of patients to surgery and anesthesia,delayed postoperative recovery of the liver function,primary non-function,liver failure and hepatic encephalopathy and even death still need to be addressed.Thus,it is particularly important to evaluate the operative indication,completely and accurately assess the preoperative liver function and liver function reserve,and reduce the perioperative mortality and complication in order to improve the prognosis of ALT.Combined with literalure and the experience in our center,this paper summarized the research advance of preoperative assessment in patients with ALT.

Preoperative patient education: can we improve satisfaction and reduce anxiety? / Informação pré-operatória ao paciente: podemos melhorar a satisfação e reduzir a ansiedade? / Información preoperatoria al paciente: ¿podemos mejorar la satisfacción y reducir la ansiedad?

BACKGROUND AND OBJECTIVES: Patients' knowledge deficits concerning anesthesia and the anesthesiologist's role in their care may contribute to anxiety. The objective of this study was to develop anesthesia patient education materials that would help improve patient's satisfaction regarding their knowledge of the perioperative process and decrease anxiety in a community hospital with a large Spanish-speaking population. METHODS: A survey (Survey A) in English and Spanish was administered to all adult anesthesiology preoperative clinic patients during a 4-week period. The data were analyzed and then a patient education handout was developed in both English and Spanish to assist with our patients' major concerns. A second survey (Survey B) was administered that was completed after the education handout had been put into use at the clinic. The survey asked for basic demographic information and included questions on satisfaction with regard to understanding of anesthesia as well as worries regarding surgery and pain. RESULTS: In the patients who received the handout, statistically significant improvement was found in the questions that asked about satisfaction with regard to understanding of type of anesthesia, options for pain control, what patients are supposed to do on the day of surgery, and the amount of information given with regard to anesthetic plan. There was no difference in anxiety related to surgery in patients who received the educational handout compared to those patients who did not. CONCLUSIONS: Patient education handouts improved patient's satisfaction regarding their knowledge of the perioperative process but did not reduce anxiety related to surgery. .

JUSTIFICATIVA E OBJETIVOS: A falta de conhecimento dos pacientes em relação à anestesia e ao papel do anestesiologista em sua assistência pode contribuir para a ansiedade. O objetivo deste estudo foi desenvolver materiais explicativos para o paciente sobre a anestesia que poderiam ajudar a melhorar a satisfação do paciente em relação ao seu conhecimento do processo perioperatório e a diminuir a ansiedade em hospital comunitário com uma grande população de língua espanhola. MÉTODOS: Durante quatro semanas, uma pesquisa (Pesquisa A) em inglês e espanhol foi feita no período pré-operatório com todos os pacientes adultos que seriam submetidos à anestesia. Os dados foram analisados e, posteriormente, um folheto explicativo foi desenvolvido em inglês e espanhol para esclarecer as principais preocupações dos pacientes. Uma segunda pesquisa (Pesquisa B) foi feita após a colocação do folheto explicativo em uso na clínica. A pesquisa investigou as informações demográficas básicas e incluiu perguntas sobre a satisfação relacionada à compreensão da anestesia, bem como as preocupações com a cirurgia e a dor. RESULTADOS: Nos pacientes que receberam o folheto houve melhoria estatisticamente significativa em relação às perguntas sobre a satisfação com a compreensão do tipo de anestesia, as opções para o controle da dor, o que os pacientes deveriam fazer no dia da cirurgia, bem como a quantidade de informações prestadas sobre o plano anestésico. Não houve diferença na ansiedade relacionada à cirurgia entre os pacientes que receberam e os que não receberam o folheto educativo. CONCLUSÕES: Os folhetos explicativos melhoraram a satisfação do paciente em relação ao conhecimento do processo perioperatório, mas não reduziram a ansiedade relacionada à cirurgia. .

JUSTIFICACIÓN Y OBJETIVOS: La falta de conocimiento de los pacientes con relación a la anestesia y al papel del anestesista en su asistencia puede contribuir a la ansiedad. El objetivo de este estudio fue desarrollar materiales explicativos para el paciente sobre la anestesia que podrían ayudar a mejorar la satisfacción del paciente respecto a su conocimiento del proceso perioperatorio y a disminuir la ansiedad en un hospital comunitario con una gran población de hablantes de lengua española. MÉTODOS: Durante un período de 4 semanas, se llevó a cabo una investigación (investigación A) en inglés y en español en el período preoperatorio con todos los pacientes adultos que se iban a someter a la anestesia. Se analizaron los datos analizaron y posteriormente se confeccionó un folleto explicativo en inglés y en español para aclarar las principales preocupaciones de los pacientes. Una segunda investigación (investigación B) fue realizada después de que se completó el folleto explicativo que se estaba usando en la clínica. La encuesta solicitó información demográfica básica e incluyó preguntas sobre la satisfacción relacionada con la comprensión de la anestesia y también sobre las preocupaciones relacionadas con la cirugía y el dolor. RESULTADOS: En los pacientes que recibieron el folleto hubo una mejoría estadísticamente significativa con relación a las preguntas sobre la satisfacción con la comprensión del tipo de anestesia, las opciones para el control del dolor, lo que los pacientes deberían hacer el día de la cirugía, como también la cantidad de informaciones prestadas sobre el plan de anestesia. No hubo diferencia en la ansiedad relacionada con la cirugía entre los pacientes que recibieron y los que no recibieron el folleto educativo. CONCLUSIONES: Los folletos explicativos mejoraron la satisfacción del paciente respecto al conocimiento del proceso perioperatorio, pero no redujeron la ansiedad relacionada con la cirugía. .

Apnea del sueño como factor de riesgo en intervenciones quirúrgicas / Sleep Apnea as a Risk Factor in Surgery

La prevalencia de síndrome de apnea - hipopnea de sueño (SAHS) en la población general oscila entre 2 al 6% según el grupo etario y género. Pocos pacientes tienen diagnóstico confirmado y muchos menos se encuentran en tratamiento. En el transcurso de la vida deberán ser sometidos a distintos tipos de cirugías. El aumento del riesgo quirúrgico ha sido demostrado en varios estudios. Un meta-análisis confirmó el aumento de complicaciones (desaturación posoperatoria, insuficiencia respiratoria aguda, eventos cardíacos y la necesidad de traslado a UTI) en esta población. Se destaca además el auge de la cirugía bariátrica para tratar pacientes obesos mórbidos, que además tienen una alta incidencia de SAHS. Se revisan los múltiples mecanismos fisiopatológicos implicados tanto en el pre y postoperatorio, la influencia del tipo de cirugía, los efectos de medicamentos sedantes, anestésicos y analgésicos sobre la función respiratoria. Se recomienda una correcta evaluación preoperatoria. Cuestionarios validados, Berlín, STOP-BANG, P-SAP pueden ayudar en esta tarea, junto con el criterio clínico. El posoperatorio es el momento más crítico y que requiere mayores controles. Parece racional y prudente el uso de los equipos de CPAP para los pacientes que previamente los utilizan en su hogar. No está totalmente validada esta recomendación para los enfermos que no estén adaptados. Su uso podría disminuir las complicaciones relacionadas.

The prevalence of obstructive sleep apnea (SAHS) in the general population ranges from 2 to 6% by age group and gender. Few patients with confirmed diagnosis and fewer are treated. In the course of life must be subjected to different types of surgeries. The increased surgical risk has been demonstrated in several studies. A meta-analysis confirmed the increased complications (postoperative desaturation, acute respiratory failure, cardiac events and the need for transfer to ICU) in this population. The rise of bariatric surgery for morbidly obese patients, who also have a high incidence of SAHS is further underlined. Multiple pathophysiological mechanisms involved before and after surgery, the influence of the type of surgery, the effects of sedative drugs, anesthetics and analgesics on respiratory function are reviewed. Proper preoperative evaluation is recommended. Validated questionnaires, Berlin, STOP-BANG, P-SAP can help in this task, along with clinical judgment. Postoperative time is the most critical and requires greater controls. It seems prudent and rational use of CPAP equipment for patients who previously used in the home. Not fully validated this recommendation for patients who are not suitable. Its use could reduce related complications.

Manejo preoperatorio de medicamentos en pacientes hipertensos / Preoperative pharmacological management of hypertensive patients

The proportion of older hypertensive patients that require a surgical procedure has increased in the last years. These patients require a through preoperative assessment, considering the medications in use, laboratory and images. An adequate pharmacological management of patients with hypertension in the perioperative period will prevent cardiovascular complications. Therefore the health care team must assure that patients with hypertension will be operated in optimal conditions.

La hipertensión arterial es una enfermedad con alta prevalencia en la población chilena, llegando a casi el 75 por ciento en el grupo de mayores de 65 años. En el ámbito quirúrgico, el número de pacientes de edad mayor y que padecen hipertensión arterial ha aumentado significativamente, lo que nos obliga a realizar una adecuada y detallada evaluación preoperatoria del paciente hipertenso con el fin de conocer su condición al momento de la cirugía, los medicamentos antihipertensivos que utiliza y solicitar los exámenes de laboratorio y/o de imágenes necesarios. Una adecuada asesoría al paciente respecto al manejo de su medicación antihipertensiva preoperatoria pretende disminuir las complicaciones en todo el período perioperatorio, tanto por su suspensión como por su mantención. De esta forma se busca establecer las medidas que permitan al paciente enfrentar el procedimiento quirúrgico en las mejores condiciones posibles.

Control glucémico en el proceso perioperatorio de los pacientes con diabetes mellitus / Glycemia control in the perioperative process of patients presenting with diabetes mellitus

El paciente diabético requiere con frecuencia algún tipo de cirugía o la realización de un proceder diagnóstico invasivo, que puede, incluso, ser realizado de urgencia. En la actualidad el riesgo quirúrgico del diabético ha disminuido gracias a los avances en las técnicas anestésicas y al control metabólico perioperatorio, aunque las complicaciones aún son más frecuentes, y generan una hospitalización prolongada y una tasa mayor de invalidez. En la evaluación preoperatoria se deben precisar las características de la diabetes, el tipo de proceder quirúrgico, el riesgo anestésico quirúrgico, y realizar los ajustes necesarios al tratamiento habitual. La infusión continua de insulina endovenosa con aporte de glucosa es el método más racional y fisiológico en la mayoría de las intervenciones quirúrgicas, lo que implica monitoreo glucémico frecuente con ajustes inmediatos. Algunas situaciones especiales, como las cirugías complejas o las de urgencia, requieren esquemas terapéuticos específicos, por lo que cada equipo debe tener su protocolo de trabajo, según las particularidades de las intervenciones quirúrgicas que realicen. El control metabólico perioperatorio es esencial para evitar las alteraciones metabólicas e hidroelectrolíticas agudas y favorecer la evolución satisfactoria en el posoperatorio. Por su importancia, se realiza una revisión con un enfoque actual, que ayude a mejorar la calidad de la atención al paciente diabético que requiere de una intervención quirúrgica(AU)

The diabetic patients require frequently some type of surgery or the implementation of an invasive diagnostic procedure which may even be carried out as an emergence. Nowadays the surgical risk of the diabetic patient has decrease thanks to the advances in the anesthetic techniques and to the perioperative metabolic control, although the complications are more frequent and to generate a lengthy hospitalization and a great disability rate. In the preoperative assessment it is necessary to specify exactly the diabetes's features, the type of surgical procedure, surgical anesthetic risk and to perform the fitting necessary in the habitual treatment. The continuous infusion of intravenous insulin with glucose is the more rational and physiologic method in most of surgical interventions, involving the frequent glycemia monitoring with immediate fittings. Some special situations including complicated surgeries or those of emergence, require specific therapeutical schemes, thus each staff must to have its work protocol, according the peculiarities of the surgical interventions performed. The perioperative metabolic control is essential to avoid the metabolic and acute hydroelectrolytic alterations and to favor the satisfactory course during the postoperative period. Due its significance, authors carried out a review with the current approach helping to improve the quality of care of diabetic patient requiring a surgical intervention(AU)

Preoperative assessment and optimization in periampullary and pancreatic cancer.

Perioperative management of pancreatic and periampullary cancer poses a considerable challenge to the pancreatic surgeon, anesthesiologist, and the intensive care team. The preoperative surgical evaluation of a pancreatic lesion aims to define the nature of the lesion (malignant or benign), stage the tumor, and to determine resectability or other non-surgical treatment options. Patients are often elderly and may have significant comorbidities and malnutrition. Obstructive jaundice may lead to coagulopathy, infection, renal dysfunction, and adverse outcomes. Routine preoperative biliary drainage can result in higher complication rates, and metal stents may be preferred over plastic stents in selected patients with resectable disease. Judicious use of antibiotics and maintaining fluid volume preoperatively can reduce the incidence of infection and renal dysfunction, respectively. Perioperative fluid therapy with hemodynamic optimization using minimally invasive monitoring may help improve outcomes. Careful patient selection, appropriate preoperative evaluation and optimization can greatly contribute to a favorable outcome after major pancreatic resections.

Aspectos gerais da avaliação pré-operatória do paciente idoso cirúrgico / General features of the preoperative assessment of surgical elderly patient

As intervenções cirúrgicas em pacientes idosos têm se tornado cada vez mais frequentes, uma vez que esta população vem apresentando crescimento em número significativo nas últimas décadas e consequentemente expondo-se por mais tempo às morbidades de resolução cirúrgica. Apesar de um número importante de idosos apresentarem envelhecimento saudável e tolerarem o ato cirúrgico sem muitas intercorrências, sabe-se também que a morbi-motalidade que envolve a operação é mais frequente no indivíduo idoso e requer muito mais cuidado naquele com comorbidades. O presente trabalho se propõe a rever alguns aspectos que merecem ser mais cuidadosamente observados, porque envolvem modificações morfológicas e funcionais do organismo senescente, que guardam relação com o aumento da morbidade e da mortalidade em todo o período peri-operatório. A avaliação pré-operatória, portanto, deve pautar-se em exame criterioso de toda história clínica do paciente com vistas a estabelecer medidas de prevenção de eventos mórbidos, evitar iatrogenias, estabelecer critérios que alertem para um maior risco e desenvolver enfoque multidisciplinar.

The surgical interventions in elderly patients have become more frequent once this population have presented expressive increase in last decades, resulting a longer exposure to surgical resolution morbidities. Despite a large number of elder people presents a healthy aging and support the surgical act well, the morbidity and mortality that involves the surgery is more often in elderly and request more care to ones with comorbidities. The present work purpose to review some aspects that must be more carefully observed because involves morphological and functional changes from senescent organism that bring into relation with the increase of morbidity and mortality in preoperative period. Thus, the preoperative evaluation must be based on carefully clinical examination in order to prevent morbid events, iatrogenic ones, to set up risk criteria and to development a multidisciplinary focus.

Establishment of a new scoring system for preoperative evaluation of operative risks in the elderly patients with hip fractures / 中华创伤杂志

Objective To develop a new scoring system,Daping orthopedics operation risk scoring system for senile patient(DORSSSP),for preoperative evaluation of operative risks in the elderly patients with hip fractures based on acute physiology and chronic health evaluation(APACHE)Ⅱ scoring system and physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM)and compare the new scoring system with APACHE Ⅱ and POSSUM in assessing surgical risks and predicting postoperative complications and mortalities.Methods A total of 260 patients with hip fractures treated in our department in recent five years were retrospectively and respectively evaluated with DORSSSP,POSSUM,progressed POSSUM(P-POSSUM)and APACHE Ⅱ scoring system to compare the value of three scoring systems in preoperative evaluation of operative risks and prediction of postoperative mortality and complications.Results POSSUM and DORSSSP predicted complications in 119 and 92 patients respectively,while the actual complication occurred in 84 patients.The prediction value of POSSUM was significantly higher than the actual value,while the prediction value of DORSSSP showed no statistical difference compared with the actual value.POSSUM,P-POSSUM and APACHEⅡ scoring systems predicted 16,10 and 12 deaths respectively,but there were six deaths in fact,with prediction value obviously higher than the actual value.DORSSSP predicted nine deaths,the closest value to the actual.Conclusions DORSSSP has good correlation with postoperative complications and mortalities.Compared with POSSUM and APACHE Ⅱ scoring system,more simple and practicable DORSSSP can more accurately evaluate the preoperative risks and predict the postoperative complications and mortalities in the elderly patients with hip fractures.