Resultados tras implantación de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario / Results after implementation of a sedoanalgesia protocol for procedures in hospital environment

INTRODUCCIÓN: Se analiza la efectividad y seguridad de un protocolo específico de sedoanalgesia para procedimien tos, y evalúa la satisfacción del personal sanitario con cada procedimiento. PACIENTES Y MÉTODO: Estudio prospectivo de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario en menores de 18 años, con una estrategia individualizada según la situación basal del paciente, el tipo de procedimiento y la experiencia del pediatra responsable de la sedación. Se registraron las variables: diagnóstico que motiva el procedimiento, tipo de procedimiento, datos antropométri cos, alergias, medicación, estado ASA y enfermedad de base, tiempo de ayuno, auscultación pul monar, temperatura, saturación de oxígeno, frecuencia respiratoria, frecuencia cardiaca, tensión arterial, lugar de sedación, tipo de fármaco, dosis, tipo de vía, escala de sedación Ramsay, duración de la sedación, tipo y tratamiento de efectos adversos, presencia de familiares durante todo el pro cedimiento y satisfacción del paciente. RESULTADOS: Se realizaron 279 sedaciones. Los fármacos más usados fueron óxido nitroso (62,7%) y midazolam (16,5%); las vías de administración más utili zadas fueron la inhalada (62,4%) y la intravenosa (15,8%). La satisfacción fue alta para el pediatra (92,5%), el enfermero (94,3%), los familiares (96,8%) y los pacientes (93,6%), con una buena correlación entre ellos, y fue significativamente menor al usar midazolam y las vías nasal y bucal. La tasa de efectos adversos fue del 3,2%, y ninguno fue grave. CONCLUSIONES: La implementación de un protocolo específico de sedoanalgesia para procedimientos en el ámbito hospitalario consigue una alta efectividad y seguridad, además de un alto nivel de satisfacción, tanto en familiares como en personal sanitario.

INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

Es la relación anestesiólogo-paciente una herramienta terapéutica útil y perfectible? / Is the anesthesiologist-patient relationship and perfected a useful therapeutic tool?

Introducción: El paciente -en un sistema médico deshumanizado-, el anestesiólogo -inmerso en los cambios sociales y la propia vorágine de su particular actividad- y toda la sociedad a través de sus instituciones, pueden beneficiarse con una mejor calidad de atención médica. Objetivo: Iniciar un debate acerca de las características peculiares, su importancia, métodos para mejorar la Relación Médico-Paciente en anestesia (RMPa), y llevar a cabo una búsqueda bibliográfica sobre el tema. Desarrollo: La búsqueda bibliográfica relacionada al tema arrojó escasos resultados, por lo que se amplió sus límites sin definición de año y se utilizó los títulos de las referencias bibliográficas de los trabajos localizados, y las palabras clave de éstos, para nuevas búsquedas. Los actores de esta relación son el anestesiólogo, el paciente y la sociedad. El objetivo de nuestro trabajo como anestesiólogos es disminuir el sufrimiento del paciente ante la cirugía o anestesia, actuando sobre las respuestas del estrés en todos los planos (desde combatir la incertidumbre derribando mitos y falsos paradigmas en relación con la anestesia, hasta la planificación y ejecución de una correcta técnica anestésica y plan analgésico). Diversos autores demostraron que la evaluación preanestésica tiene igual o mayor efectividad clínica que los ansiolíticos usados en la medicación anestésica previa, para minimizar la ansiedad y el estrés prequirúrgico y anestésico. Y según el Dr. Wikinski, con la dificultad agregada que el paciente conoce su cirujano, su diagnóstico, el lugar de la cirugía, de postoperatorio y hasta quizá su pronóstico, y debe conocer y confiar en las dotes humanas, habilidades, conocimientos y aptitudes del anestesiólogo luego de una breve entrevista...

Patient perceptions about anesthesia and anesthesiologists before and after surgical procedures / Percepção do paciente sobre a anestesia e o anestesiologista antes e depois do procedimento cirúrgico

CONTEXT AND OBJECTIVE: Anesthesiologist-patient relationships are established preoperatively and intraoperatively. These are opportunities for providing correct information about anesthesia/anesthesiologists, thereby improving outcomes. The aim here was to evaluate patients' perceptions about anesthesiologists before anesthesia and to identify whether the anesthetic care would change such perceptions. DESIGN AND SETTING: Prospective cross-sectional study using data obtained in 2007-2008, at a tertiary university hospital. METHODS: 518 patients aged 16 years or over were interviewed before and after anesthesia exposure. A questionnaire was used to determine patient characteristics and perceptions of anesthesia/anesthesiologists. RESULTS: The patients were 16-89 years of age and 59.8 percent had attended elementary school. 79.1 percent said that anesthesiologists were specialized physicians. Anesthesiologists' roles were associated with loss of consciousness (35.5 percent pre-anesthesia; 43.5 percent post-anesthesia), pain relief (29.7 percent pre-anesthesia, 31.7 percent post-anesthesia), vital sign monitoring (17.6 percent pre-anesthesia, 35 percent post-anesthesia; P < 0.05); and drug administration (10.8 percent pre-anesthesia, 43.9 percent post-anesthesia; P < 0.05). The level of confidence in the physician was rated high (82.2 percent and 89.8 percent pre- and post-anesthesia, respectively; P < 0.05) or intermediate (5.8 percent and 6.6 percent pre- and post-anesthesia, respectively; P < 0.05). The care provided by anesthesiologists was classified as: elucidating (52.8 percent), encouraging (52.6 percent), neutral (10.2 percent) and careless (0.8 percent). CONCLUSION: Patients' perceptions of anesthesiologists' roles were fairly good, but improvements in this relationship still need to be pursued, to achieve better outcomes. Anesthetic care was important in providing information, confidence and reassurance among patients, regarding their perceptions. Anesthesiologists should not miss opportunities to provide excellent professional care for patients, thereby improving anesthesia outcomes and their image.

CONTEXTO E OBJETIVO: A relação anestesiologista-paciente é estabelecida no pré-operatório e intraoperatório, oportunidades que proporcionam informações corretas sobre anestesia/anestesiologista, melhorando seus resultados. O objetivo foi avaliar a percepção dos pacientes sobre o anestesiologista antes da anestesia e se os cuidados anestésicos poderiam mudar essa percepção. TIPO DE ESTUDO E LOCAL: Estudo prospectivo transversal com dados em 2007-2008, em hospital universitário terciário. MÉTODOS: Foram entrevistados 518 pacientes com 16 anos ou mais antes e depois da exposição à anestesia. Um questionário determinou as características do paciente e da percepção da anestesia/anestesiologista. RESULTADOS: Os pacientes tinham entre 16 e 89 anos e 59,8 por cento possuíam ensino fundamental, 79,1 por cento responderam que o anestesiologista é um médico especializado. O papel do anestesiologista foi associado à perda de consciência (35,5 por cento pré-anestesia, 43,5 por cento pós-anestesia), alívio de dor (29,7 por cento pré-anestesia, 31,7 por cento pós-anestesia), monitorização dos sinais vitais (17,6 por cento pré-anestesia, 35 por cento pós-anestesia; P < 0,05), e administração de medicamentos (10,8 por cento pré-anestesia, 43,9 por cento pós-anestesia; P < 0,05). O nível de confiança no médico foi considerado alto (82,2 por cento e 89,8 por cento no pré e pós-anestesia, respectivamente, P < 0,05) ou intermediário (5,8 por cento e 6,6 por cento no pré e pós-anestesia, respectivamente, P < 0,05). A assistência prestada pelo anestesiologista foi classificada como: elucidativa (52,8 por cento), encorajadora (52,6 por cento), indiferente (10,2 por cento) e displicente (0,8 por cento). CONCLUSÃO: A percepção sobre o papel do anestesiologista foi satisfatória, mas as melhorias nessa relação ainda são necessárias para se conseguirem melhores resultados. O atendimento anestésico foi importante para a informação, confiança e segurança do paciente sobre essa percepção. O anestesiologista não deve perder oportunidades de exercer excelentes cuidados profissionais para os pacientes, melhorando os resultados de sua anestesia e sua imagem.

Frequency of anxiety in patients reporting for pre-anaesthesia assessment

To study the frequency of anxiety in patients who reported for pre-anaesthesia assessment pre-operatively in Combined Military Hospital [CMH] Malir Cantt and to establish any association of anxiety with demographic characteristics. A cross-sectional study. The study was performed in the Deptts of Psychiatry and Anaesthesiology, CMH, Malir Cantt, from October 2007 to March 2008. One hundred consecutive patients who reported for pre-anaesthesia prior to planned surgeries were included in the study. Inclusion and exclusion criteria were setup. A questionnaire in Urdu language based on Beck Anxiety Inventory was filled up by each patient. Results were summed and statistically analyzed using SPSS 11.0. A total of 100 patients took part in the study ranging from 18 years to 60 years of age. Twenty nine [29%] were males and 71 [71%] were females. Fifty five [55%] were up to 30 years of age and forty five [45%] above 30 years of age. Forty two percent had no anxiety while 58% had varying grades of anxiety; 35% had mild, 17% moderate and 6% had severe anxiety. The frequency of anxiety in males was 48% as compared to 62% in females [P>0.118]. Moreover 40% of patients up to 30 years of age had anxiety as compared to 80% in patients above 30 years of age [P<0.001]. Anxiety was a common problem in patients who were assessed pre-operatively. during pre-anaesthesia. Association of anxiety with gender was insignificant while there was a significant association of anxiety with different age groups

Pain and anxiety assessment in topical vs. peribulbar anesthesia in cataract surgery

The aim of this study was to compare topical with peribulbar anesthetic technique as regards pain and anxiety in patients undergoing phacoemulsification cataract surgery. Hundred patients undergoing phacoemulsification procedure were enrolled in the study. Patients were divided into two groups, topical and peribulbar anesthesia was used for group I and II respectively. Pain assessment was done using visual analogue pain scale following administration of the local and topical anaesthesia, immediately after surgery, 2 hours postoperatively and overall pain experience. The Hamilton Anxiety Rating Scale [HARS] was used to assess the overall level of anxiety in the two studied groups. Pain score was significantly higher for Peribulbar group immediately after the block and over all pain experience [P value <0.01]. The two groups did not show any significant difference in the level of pain during the surgery and in the early post operative period. The topical group reported less perioperative anxiety compared to the Peribulbar group, but this difference did not reach significant level [P value= 0.6]. Patients undergoing phacoemulsification procedure under topical anesthesia experience less pain than patients received peribulbar blockade. Both techniques produce mild level of anxiety with less extent in topical group

Surgery information reduces anxiety in the pre-operative period

PROPÓSITO: Pacientes que vão ser operados não devem sofrer ansiedade. Este estudo tem por objetivo comparar o grau de ansiedade no dia anterior à cirurgia entre pacientes que têm informação sobre seu diagnóstico, cirurgia e anestesia. MÉTODOS: Pacientes referiram seu conhecimento sobre o diagnóstico, a cirurgia e a anestesia. O inventário de Spielberger, State-Trait Anxiety Inventory (STAI), mediu a ansiedade. RESULTADOS: Cento e quarenta e nove pacientes foram selecionados, 82 mulheres e 38 homens foram entrevistados. Vinte e nove pacientes foram excluídos do estudo por analfabetismo. A ansiedade-estado foi semelhante para homens e mulheres, (36,10 ± 11,94 vs. 37,61 ± 8,76) (mean ± SD). A ansiedade-traço foi maior entre mulheres (42,55 ± 10,39 vs. 38,08 ± 12,25, P = 0,041). O nível de educação não influenciou a ansiedade-estado mas mostrou-se inversamente relacionado à ansiedade-traço. O diagnóstico fora claro para 91,7 por cento dos pacientes entrevistados, cirurgia para 75 por cento e anestesia para 37,5 por cento. O desconhecimento da cirurgia elevou a ansiedade-estado (P = 0,021) cujo menor índice foi encontrado entre pacientes que não conheciam seu diagnóstico, mas sabiam sobre a cirurgia (P = 0,038). CONCLUSÕES: O conhecimento sobre a cirurgia a ser realizada pode reduzir o estado de ansiedade.

La información anestésica quirúrgica: su efecto sobre la ansiedad y el dolor de los pacientes toracotomizados / Information on surgery and anesthesia: its effect on anxiety and pain in thoracic surgery patients

Introducción: La cirugía es una experiencia estresante por una variedad de razones. Las condiciones de recuperación y la evolución del evento quirúrgico pueden variar en función de la situación emocional del paciente. Para muchos profesionales de la salud, la información acerca del proceso quirúrgico provocaría un beneficio emocional al paciente. Objetivo: El propósito de este estudio fue evaluar el efecto que ejerce la información estructurada y detallada de una cirugía de tórax en pacientes del Instituto Nacional de Enfermedades Respiratorias que son sometidos a ella. Método: A los pacientes se les aceptó mediante un consenso médico-quirúrgico para ser operados (toracotomía). Se les incluyó en el estudio bajo los siguientes criterios: alfabetas, edad entre 18 a 65 años y de cualquier sexo; se les aplicaron los instrumentos de medición de su situación emocional: escala HAD (mide ansiedad y depresión), IDARE (mide ansiedad), una escala análoga visual para ansiedad y otra para dolor (EVA); una escala prequirúrgica (APAIS) y un cuestionario de personalidad (EPQ). Los pacientes fueron asignados aleatoriamente para recibir, o no, información por parte de dos investigadoras ajenas a la evaluación emocional; 24 horas después de la cirugía se les aplicaron los instrumentos para medir ansiedad y dolor, el IDARE y EVA y una semana después el HAD. Resultados: De 33 pacientes, 14 recibieron la maniobra experimental (caso) y 19 la control. Los resultados arrojan algunas diferencias entre los grupos, pero no son estadísticamente significativas. Parece que además de la información del proceso quirúrgico, se requieren de otras intervenciones para modificar la situación emocional del paciente.

Knowledge and fears of anaesthesia and surgery. The Jamaican perspective

This study was undertaken to assess patients' knowledge and perceptions, fears and concerns regarding perioperative management. 300 patients were interviewed consecutively and a questionnaire was completed for each patient. 25admitted to having anxiety about their upcoming operation. The prevalence of preoperative fear was significantly higher in younger patients (age < 40 years, p < 0.05) and in more educated patients (secondary and tertiary levels, p < 0.001). The commonest fears were those of a morbid nature (e.g. death on the operating table). 34of the patients did not realize that anaesthetists were qualified doctors, and only 10recognized the central role played by anaesthetists in the monitoring of vital signs throughout an operation. There is continuing need for public education on the role of the anaesthetists in health care, and anaesthetists must ensure that preoperative concerns of their patients are adequately addressed.

Influência da presença da mäe na qualidade da induçäo anestésica em cirurgia pediátrica / The influence of the mother's presence on the quality of the anesthetic induction in pediatric surgery

Justificativa e objetivos - A participaçäo da mäe na induçäo anestésica é uma conduta que vem sendo estimulada visando diminuir o estresse, permitindo assim uma induçäo menos traumática. O objetivo deste trabalho foi verificar se a presença da mäe torna a induçäo mais tranquila e altera a frequência cardíaca, a pressäo arterial e a glicemia, parâmetros que traduzem hiperatividade adrenérgica. Método - Dois grupos de crianças (grupo 1, n=22 e grupo 2, n=24 com idade entre 2 e 12 anos foram induzidas com uma mistura de halotano e óxido nitroso/oxigênio (50 por cento). No grupo 1 a mäe esteve presente durante a induçäo. No grupo 2, näo. Foram verificadas a pressäo arterial, a frequência cardíaca, a glicemia e as características da induçäo. Resultados - Induçäo tranquila foi observada em 19 crianças do grupo 2, na ausência da mäe predominando induçäo agitada no grupo 1, na presença da mäe (13 crianças). Antes da induçäo a maioria das crianças apresentou taquicardia e hipertensäo arterial. Näo houve diferença significativa na glicemia, entre os dois grupos. Conclusöes - Os resultados obtidos levam à conclusäo de que nas condiçöes experimentais deste trabalho, na cirurgia ambulatorial, a maioria das crianças apresenta sinais de hiperatividade adrenérgica quando chegam ao centro cirúrgico; a presença ou ausência da mäe durante a induçäo näo parece influenciar o nível de glicemia; no entanto, sua presença parece deterior a qualidade da induçäo

A survey of pre-anaesthetic information needs in Jamaican patients

The study was designed to primarily assess the desire for information in patients awaiting elective surgery at the University Hospital of the West Indies and to see what factors affected this desire. Secondarily, the patients' knowledge of anaesthesia, and the impact of an audiovisual presentation about anaesthesia was assessed. Three hundred and eighty-nine patients were interviewed on the day prior to surgery and a questionnaire completed for each patient. The results showed that the Jamaican patients had an overall positive desire for information concerning anaesthesia and surgery. Priority was given by patients to the more practical aspects of anaesthesia and surgery such as moving around and eating and drinking. Younger patients (< 40 years), female patients and patients with no previous operative experience had a greater wish to receive more information. Meeting the anaesthetist was high in the list of priorities and from the reasons advanced, many patients sought to derive some reasurrance from this meeting. Most patients (63 percent) had a simple understanding of what the anaesthetic was, approximately half of the study population thought that a patient always had to be put to sleep in order to have surgery. If a patient was female, tertiary-level educated, had had a previous operation or had been visited by an anaesthetist prior to the interview, he/she was more likely to have relevant information on the anaesthetic. The vast majority of patients (94 percent) thought that it was a patients' right to have all information, if they wished to do so. Only a small percentage of the population recalled seeing the audiovisual programme but of that number, approximately half thought it was very good. The further use of this medium for presentation of information was recommended.