Comparison of post-anesthesia recovery time in sedated patients for colonoscopy using midazolam or fentanyl associated with propofol / Comparação do tempo de recuperação pós-anestésica em pacientes sedados para colonoscopia usando midazolam ou fentanil associados a propofol

ABSTRACT Objective: Comparison of post-anesthesia recovery time in sedated patients for colonoscopy using two drug combinations: midazolam and propofol or fentanyl and propofol. Method: Fifty patients ASA I and II, from 18 to 65 years of age, candidates for elective colonoscopy under sedation administered by an anesthesiologist, were randomized in two groups: Group A (midazolam and propofol) and Group B (fentanyl and propofol). Each patient was evaluated as for the length of the exam (Exam length), length of stay in the post-anesthesia care unit 1 and 2 (LSPACU1 and LSPACU2) and hospital discharge. Episodes of awakening, and of movement, drop in SpO2 < 90%, need for mechanical ventilation, propofol consumption, heart rate (HR) and mean blood pressure (MBP) were also evaluated. Results: Patients of group B had a recovery time in LSPACU1 statistically shorter than that for those in group A. In both groups, LSPACU1 was considered inversely proportional to LSPACU2. Hospital discharge time was similar between groups. Patients of group B had a significant decrease in MBP during and at the end of the exam, when compared to the initial measurement and that during sedation. Nevertheless, this variation was lower than 20%. No adverse event was observed. All patients were discharged on the same day, with no unexpected hospitalization. Conclusions: The combined use of fentanyl and propofol for colonoscopy sedation had a post-anesthesia recovery time in LSPACU1 shorter than that with the combination of midazolam and propofol. Nevertheless hospital discharge time was similar between groups.

RESUMO Objetivo: Comparar o tempo de recuperação pós-anestésica de pacientes sedados para colonoscopia usando duas combinações de fármacos: midazolam e propofol ou fentanil e propofol. Método: Cinquenta pacientes ASA I e II, entre 18 e 65 anos, candidatos a colonoscopia eletiva sob sedação administrada por anestesiologista, foram randomizados em dois grupos: Grupo A (midazolam e propofol) e Grupo B (fentanil e propofol). Cada paciente foi avaliado quanto ao tempo de realização do exame (TExame), tempo de permanência na sala de recuperação pós-anestésica 1 e 2 (TSRPA 1 e TSRPA2) e a alta domiciliar. Episódios de despertar, movimentação, queda de SpO2 < 90%, necessidade de assistência ventilatória, consumo de propofol, frequência cardíaca (FC) e pressão arterial média (PAM) também foram avaliados. Resultados: Pacientes do grupo B apresentaram tempo de recuperação na SRPA1 inferior estatisticamente ao grupo A. Em ambos os grupos o TSRPA1 foi considerado inversamente proporcional ao TSRPA2. O tempo de alta domiciliar foi semelhante entre os grupos. Pacientes do grupo B apresentaram redução significativa na PAM no tempos exame e final, em relação ao inicial e sedação. Entretanto, essa variação foi inferior a 20%. Não foram observados eventos adversos. Todos os pacientes evoluíram com alta domiciliar no mesmo dia, sem ocorrência de internação não prevista. Conclusões: O uso combinado de fentanil e propofol para sedação em colonoscopia produziu tempo de recuperação pós-anestésica na SRPA1 inferior a combinação midazolam e propofol. No entanto, o tempo de alta domiciliar foi semelhante entre os grupos.

Registro de paro cardiorrespiratorio perioperatorio en un hospital universitario en el período 2006-2017 / Registry of perioperative cardiac arrests in a clinical hospital in the period 2006-2017

Background: Perioperative cardiac arrest (PCA) is a rare but important event in the operating room. Aim: To describe PCA events at a Clinical Hospital in Santiago, Chile. Material and Methods: Registry of PCA that occurred in the operating room (OR) and during procedures not carried out in the OR between September 2006 and November 2017. Precipitating events, type of anesthesia and results of resuscitation maneuvers were described. Results: Eighty events (five outside of the OR) during 170,431 surgical procedures were recorded, resulting in an incidence of 4.4 events per 10,000 interventions. Hypotension/hypoperfusion was the most frequently found preexisting condition (42.5%). The main cause was the presence of preoperative complications (57.5%). Nineteen cases (23.8%) were attributable to anesthesia, with an incidence of 1.11 per 10,000 anesthetic procedures. Survival rate at hospital discharge was 52.5%. The figure for PCA caused by anesthesia was 84.2%. Conclusions: The incidence of PCA and its survival is similar to that reported abroad. In general, PCA has a better prognosis than other types of cardiac arrest, especially if it has an anesthetic cause.

Condutas em lipoaspiraçã o entre cirurgiões brasileiros / Liposuction Practices among Brazilian Surgeons

Introdução: Desde a década de 1980, com Illouz, a lipoaspiração ganhou popularidade e representa hoje um dos procedimentos mais realizados no mundo. Algumas de suas complicações são graves e potencialmente letais. Não existe, contudo, uma uniformidade em sua prática ou no seu ensino. A avaliação das técnicas empregadas por cirurgiões plásticos pode ser o início de uma padronização. Métodos: Foi aplicado um questionário sobre lipoaspiração no 52º Congresso Brasileiro de Cirurgia Plástica para cirurgiões plásticos de diferentes faixas etárias e regiões do Brasil, presentes no evento. Resultados: Foram contabilizados 243 questionários preenchidos (n = 243). O número médio de incisões foi de 9 (2 - 16). Duzentos e quarenta e um cirurgiões (99%) realizam incisões na linha mediana/ paramediana anteriormente e 236 (97%) incisam na linha mediana/paramediana na região posterior. Aproximadamente metade dos questionados utilizam a anestesia geral. Duzentos e nove cirurgiões (86%) posicionam o paciente em decúbito ventral durante o procedimento. A lipoaspiração superficial é realizada por 146 (60%) entrevistados, sendo que 22 (9%) fazem a aspiração apenas desta camada adiposa. Oitenta e cinco (35%) participantes relatam controlar a pressão do aparelho durante o procedimento. Conclusão: A lipoaspiração realizada no Brasil apresenta grande variação técnica. Essa constatação nos faz refletir sobre a necessidade de uma uniformização de sua prática e ensino a fim de aumentar o controle e a segurança do procedimento.

Introduction: Since the 1980s, with Illouz, liposuction has gained popularity and represents one of the most commonly performed procedures in the world today. Some of the complications are serious and potentially lethal. Nevertheless, uniformity in its practice or the manner in which it is taught does not exist. Evaluating techniques employed by plastic surgeons may be the start toward standardization. Methods: A questionnaire on liposuction was given to plastic surgeons of different age groups and from regions of Brazil who were present at the 52nd Brazilian Conference for Plastic Surgery. Results: Two hundred forty-three questionnaires were filled out (n = 243). The average number of incisions was 9 (2­16). Two hundred fortyone surgeons (99%) made incisions along the anterior median/ paramedian line, and 236 (97%) made incisions on the posterior median/paramedian line. Approximately half of those surveyed utilized general anesthesia. Two hundred nine surgeons (86%) placed the patient in the prone position during the procedure. One hundred forty-six (60%) interviewees performed superficial liposuction, with 22 (9%) performing liposuction only on this adipose layer. Eighty-five (35%) participants reported controlling the apparatus's pressure during the procedure. Conclusion: Liposuction procedures performed in Brazil have significant technical variations. This finding encourages us to reflect on the need to standardize liposuction practice and the manner in which it is taught so as to increase control over the procedure and its safety.

Importance of using basic statistics adequately in clinical research / Importância do uso adequado da estatística básica nas pesquisas clínicas

Abstract Background and objective The inadequate use of basic statistics is the main responsible for scientific article misinterpretation. The purpose of this review article was to review some basic statistical topics to alert authors and readers about the importance of basic statistics proper reporting. Content A bibliographical and cross-sectional study was carried out, which analyzed publications in books and articles in the following databases: SciELO (Scientific Electronic Library Online) and PubMed (Available from the National Center for Biotechnology Information). Medical research is not free from the risk of false positive and false negative results due to the choice of statistical tests and presence of small sample sizes. Conclusion Understanding the correct use of basic statistics leads to fewer errors in reporting the results of studies performed and in the interpretation of their conclusions.

Resumo Justificativa e objetivo O uso inadequado da estatística básica é o maior responsável pelo erro de interpretação dos artigos científicos. O objetivo deste artigo de revisão foi rever alguns tópicos básicos de estatística para alertar autores e leitores sobre a importância do relato adequado da estatística básica. Conteúdo Foi feita pesquisa bibliográfica e transversal que analisou publicações em livros, artigos nas bases de dados SciELO (Scientific Electronic Library Online) e PubMed, do National Center for Biotechnology Information. Pesquisas na área médica não estão livres do risco de resultados falso positivos e falso negativos devido à escolha dos testes estatísticos e à presença de pequenos tamanhos de amostra. Conclusão A compreensão acerca do uso adequado da estatística básica propicia menores erros nos relatos dos resultados de estudos executados e na interpretação das suas conclusões.

Assessment of operative times of multiple surgical specialties in a public university hospital / Avaliação dos tempos operatórios das múltiplas especialidades cirúrgicas de um hospital universitário público

ABSTRACT Objective To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. Methods It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. Results The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. Conclusion This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays.

RESUMO Objetivo Avaliar os indicadores de tempo da anestesia, da operação e da permanência do paciente em sala de diversas especialidades do centro cirúrgico de um hospital universitário. Métodos Foi realizado em estudo descritivo transversal a partir da base de dados do centro cirúrgico e mensuradas as seguintes etapas: duração de anestesia, tempo do procedimento e tempo de permanência do paciente em sala das diversas especialidades. Foram incluídas as operações realizadas em sequência na mesma sala, das 7h às 17h, eletivas ou de urgências. Realizamos o calculo do percentil 80 da duração das etapas, onde 80% dos procedimentos ficaram abaixo deste valor obtido. Resultados O estudo incluiu 8.337 operações realizadas no período de 1 ano de 12 especialidades cirúrgicas. A média geral da duração da anestesia de todas as especialidades foi de 178,12±110,46 minutos, e o percentil 80 foi de 252 minutos. A média do tempo operatório foi 130,45±97,23 minutos, e o percentil 80 foi de 195 minutos. A média do tempo total do paciente em sala operatória foi de 197,30±113,71 minutos, e o percentil 80 foi de 285 minutos. A variação da média geral em relação ao percentil 80 foi de 41% na anestesia, 49% nas operações e 44% no tempo de sala. Na média geral, a anestesia ocupou 88% do tempo de sala e a operação, 61%. Conclusão Este estudo identificou padrões nas durações das etapas das operações. A informação das médias históricas das especialidades pode auxiliar no planejamento do centro cirúrgico e diminuir os atrasos.

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.

The State of Anesthetic Services in Korea: A National Survey of the Status of Anesthesia Provider in the 2011-2013 Period

Active involvement of anesthesiologists in perioperative management is important to ensure the patients' safety. This study aimed to investigate the state of anesthetic services in Korea by identifying anesthetic service providers. From the insurance claims data of National Health Insurance for 3 yr, the Korean state of anesthetic services was analyzed. The claims for anesthesia from the medical institutions which hire their own anesthesiologist or with an anesthesiologist invitation fee are assumed to be the anesthesia performed by anesthesiologists. The annual anesthetic data were similar during the study period. In 2013, total counts of 2,129,871 were composed with general anesthesia (55%), regional anesthesia (36%) and procedural sedation with intravenous anesthetics (9%). About 80% of total cases of general anesthesia were performed in general hospitals, while more than 60% of the regional anesthesia and sedation were performed in the clinics and hospitals under 100 beds. Non-anesthesiologists performed 273,006 cases of anesthesia (13% of total) including 36,008 of general anesthesia, 143,134 of regional anesthesia, and 93,864 of sedation, mainly in the clinics and hospitals under 100 beds. All procedural sedations in the institutions without direct employed anesthesiologist were performed by non-anesthesiologists. Significant numbers of anesthesia are performed by non-anesthesiologist in Korea. To promote anesthetic services that prioritize the safety of patients, the standard to qualify anesthetic service is required. Surgeons and patients need to enhance their perception of anesthesia, and the payment system should be revised in a way that advocates anesthesiologist-performed anesthetic services.

Sobrevida postoperatoria en pacientes nonagenarios: Estudio pronóstico en cohorte retrospectiva 2001-2010, Clínica Dávila / Postoperative survival among nonagenarians: A retrospective study

Background: As the Chilean population ages, anesthesiologists are regularly faced with elderly and even nonagenarian people undergoing surgical procedures. Aim: To determine the postoperative survival time in nonagenarians and its risk factors at a private clinic. Material and Methods: Review of medical records of the clinic, searching for patients aged 90 years or older, which were subjected to a surgical procedure between 2001 and 2012. Certification ofsurvival or death was obtainedfrom the clinical records or death certification at the National Identification Service. Survival analysis was made using Kaplan-Meier and Gompertz regression. Results: The medical records of167 patients, aged 90 to 101 years (64% women), were reviewed. Sixty four percent had an underlying cardiovascular disease; in 37%, cognitive impairment. Hip fracture surgery was the most common procedure. One intraoperative death occurred. Five percent ofpatients died one month after surgery. The median survival time was two years and the longest, seven years. According to Gompertz probability regression, the predictors of death were the presence of cardiac disease (Hazard ratio (HR): 1.91, 95% confidence intervals (95% CI): 1.16; 3.16), cognitive impairment (HR: 2.10,95% CI: 1.32; 3,22), cancer (HR:2.10,95% CI: 1.32; 3.22), requirement of transfusion (HR: 1.79, 95% CI: 1.13; 2.83) and an American Society of Anesthesiologists (ASA) Class III classification (HR: 1.95, IC95%: 1.21; 3.15). Conclusions: In nonagenarian patients undergoing surgery; 50% mortality was observed 2 years after surgery. The presence of cardiac disease, cognitive impairment, cancer, transfusion and a Class IIIASA classification were predictors of death.

Incidência de parada cardíaca e mortalidade pediátrica durante a anestesia em hospital universitário de atendimento terciário no período de 2005 a 2010 / Pediatric cardiac arrest and mortality incidence in pediatric patients during anesthesia in a tertiary care university hospital from 2005 to 2010

A população pediátrica apresenta incidência mais elevada de parada cardíaca e de óbito perioperatório em relação à adulta. O objetivo do presente estudo foi avaliar a incidência, os fatores desencadeantes e as causas de parada cardíaca e de óbito em pacientes pediátricos durante a anestesia em hospital universitário de atendimento terciário no período de 2005 a 2010. Por meio de um Banco de Dados, o estudo prospectivo identificou a incidência de parada cardíaca e de óbito em 10.649 anestesias pediátricas. As incidências foram calculadas em relação aos atributos: faixa etária, sexo, estado físico segundo a ASA, tipo de atendimento, especialidade cirúrgica, técnica anestésica empregada e fatores desencadeantes (doença/condição do paciente, cirurgia e anestesia como fator principal ou fator contributivo). Foram identificadas 22 paradas cardíacas na sala de operações em crianças sendo que 11 evoluíram ao óbito. Maiores incidências de parada cardíaca ocorreram em pacientes neonatais e lactentes com estado físico ASA IV e V, em cirurgia de emergência durante anestesia geral ou em cuidados de monitorização e suporte e durante cirurgias cardíaca e vascular. A doença/condição do paciente foi o principal fator de parada cardíaca e de óbito. O índice de letalidade foi maior em crianças de 31 dias a um ano de idade, com estado físico ASA V, em cirurgia de emergência e em pacientes ASA V sob cuidados de monitorização e suporte e relacionado ao fator doença/condição do paciente. Ocorreram três paradas cardíacas por fator anestésico contributivo (2,81:10.000) todas em razão de causas respiratórias. Não houve óbito por fator anestésico. Em hospital de ensino de atendimento terciário, a incidência de parada cardíaca (20,65:10.000 anestesias) e de óbito (10,32:10.000 anestesias) em pacientes pediátricos durante a anestesia foi elevada...

Perioperative cardiac arrest and mortality incidences in children are higher than in adults. This study aimed to evaluate the incidence, causes, and outcomes of cardiac arrest and death in a pediatric surgical population during anesthesia in a tertiary care university hospital from 2005 to 2010. Cardiac arrest and death incidences during anesthesia in 10,649 anesthetics performed in children were identified from an anesthesia database. Cardiac arrest and death rates were calculated in relation to age, gender, ASA physical status classification, anesthesia provider information, surgical speciality, type of procedure and triggering factors (totally anesthesia-related; partially anesthesia-related; totally surgery-related; or totally child disease/condition-related). There were 22 cardiac arrests and 11 deaths in children during anesthesia. Major cardiac arrest and death incidences were observed in children under one year age; emergency surgery; ASA physical status IV or V; monitoring care and support in ASA V patients; and in cardiac and vascular procedures. Child disease/condition was the major cause of cardiac arrest or death. Lethality calculated rates were higher in 31 days - 1 year age children; emergency surgery; ASA V physical status; monitoring care and support in ASA V patients; and child disease/condition related. There were three cardiac arrests partially anesthesia-related (2,81:10.000). There were no anesthesia-related deaths. Respiratory classified events were the most common causes of anesthesia-related cardiac arrest. Cardiac arrest (20.65 per 10,000 anesthetics) and mortality (10.32 per 10,000 anesthetics) incidences were increased over a 6-year period in a tertiary teaching hospital. Anesthesia-related cardiac arrest incidence was 2.81 per 10,000 anesthetics...

Controlled mechanical ventilation with lmasureme[TM] Versus I-Gel[TM] in anesthetized adult patients

The efficacy, safety and ease of insertion of LMA[TM] Supreme and the i-gel™ in adult cases undergoing elective surgical procedures requiring general anesthesia with controlled mechanical ventilation. This study included 60 ASA physical status I-II adult patients of both sexes scheduled for elective surgical procedures under general anesthesia. Patients were randomly allocated into one of two groups; LMA-S[TM] GI [n=30] and i-gel[TM] Gil [n=30]. A size 4 LMA Supreme[TM] and a size 4 i-gel[TM] were used with standard monitoring. Number of insertion attempts, ease of insertion, presence of gastric insufflation, laryn-geal leak, leak pressure, ease of gastric tube insertion, ventilatory parameters, complications as well as hemodynamic variables was recorded. The results showed no clinically significant changes of heart rate, MAP, Sp0[2] or P[ET] CO[2] in GI and GIL The i-gel[TM] showed higher frequency of ease of insertion[p=0.048] and gastric tube [p< 0.001]. First attempt of insertion was successful in 60% of LMA-S[TM] GI and 73.3% of the i-gel[TM]Gil [p=0.460] without failures in both groups. Leak pressure was significantly higher in the i-gel[TM] [25.5 +/- 4.8 cm H[2]O] compared to the LMA-S[TM] [21.1 +/- 7.6 cm H[2]O] [p=0.010] while both peak and plateau pressures were significantly lower in i-gel[TM] GI [19.35 +/- 2.25 cm H[2]O and 17.75 +/- 2.07 cm H[2]O] compared to LMA-S[TM] Gil [30.05 +/- 3.82 cm H[2]O and 28.80 +/- 3.99cm H[2]O][p<0.001] respectively. There was no significant difference between both groups in the frequency of complications encountered during insertion or recovery

Transmisión nosocomial de la hepatitis C asociada a procedimientos anestésicos: un estudio de casos y controles

OBJETIVO: Medir la asociación entre el antecedente de procedimientos anestésicos y el riesgo de infección por el virus de la hepatitis C (VHC) en pacientes con cirugía previa. MATERIAL Y MÉTODOS: Diseño de casos y controles; los casos fueron pacientes con anticuerpo (anti-VHC) positivo confirmado por RIBA y/o RNA VHC y los controles fueron sujetos con el anti-VHC negativo. El riesgo de infección se estimó por razón de momios (RM) y análisis multivariado con regresión logística. RESULTADOS: Se incluyeron 362 sujetos, 211 casos y 151 controles; en 70 casos (33.2 por ciento), con cirugía previa, los procedimientos anestésicos se identificaron como único factor de riesgo significativo para la infección por el VHC (RM ajustada 2.44, IC 95 por ciento 1.44 - 4.11). CONCLUSIONES: Este es el primer estudio en México que demuestra asociación de riesgo significativa con el antecedente de procedimientos anestésicos por cirugía previa, en uno de cada tres enfermos con hepatitis C.

OBJECTIVE: Nosocomial transmission of hepatitis C virus (HCV) infection had been related with anesthesia procedures. The study aim was to measure the association between anesthesia procedures in cases with previous surgery and HCV infection. MATERIAL AND METHODS: In a case-control study were included subjects that attended to the Central Blood Bank of the West Medical National Center, Mexican Institute of the Social Security in Guadalajara, Jalisco between july 2005 and september 2007. Cases were patients with positive hepatitis C antibody (anti-HCV) confirmed by recombinant immunoblot assay (RIBA) and/or nucleic acid test (HCV RNA); the control group was blood donors with negative antibody. An exhaustive questionnaire about risk factors for hepatitis C, was applied. The risk of HCV infection was determined with the Odds Ratio (OR) and multivariate analysis was made by logistic regression. RESULTS: We included 362 subjects, 211 cases and 151 controls; in 70 (33.2 percent) cases were found significant association between the anesthesia procedures and HCV infection in patients with previous surgery (OR adjusted 2.44, CI 95 percent 1.44 - 4.11) CONCLUSION: This is the first study in México that demonstrate association between history of anesthesia procedures and HCV infection in cases with previous surgery.

Cirurgias ambulatoriais realizadas em Hosp. no Sul do Estado de Santa Catarina / Profile of Ambulatorial Surgery in a Hospital in South Brazil

Introdução: A cirurgia ambulatorial é caracterizada por hospitalização desnecessária e o retorno para casaocorre em menos de 24 horas após o procedimento cirúrgico. Objetivo: Determinar o perfil epidemiológico das cirurgias ambulatoriais realizadas no Hospital Nossa Senhora da Conceição (HNSC), na cidade de Tubarão,Santa Catarina. Metodologia: Estudo transversal, constituído pelospacientes submetidos às cirurgias ambulatoriais realizadas no centro cirúrgico do HNSC, no período de junho asetembro de 2007. Resultados: A prevalência de cirurgias ambulatoriaisrealizadas no período de estudo foi de 18,84% com predominância do sexo feminino (50,9%,). A maior proporçãode pacientes pertencia ao grupo até 13 anos de idade (27,8%). A especialidade cirúrgica mais freqüente foi a otorrinolaringologia (36,2%). Quanto ao tipo de cirurgia, o maior número de pacientes submeteu-se a amigdalectomiacom adenoidectomia (21,6%). A anestesia geral foi a técnica anestésica mais utilizada na realizaçãodas cirurgias ambulatoriais (44,2%).Conclusão: A prevalência de cirurgias ambulatoriais foi baixa. Porém é uma instituição que apresenta condiçõespara a viabilização de tais procedimentos, considerando-se as inúmeras vantagens proporcionadas por este método, pois não depende de novas tecnologias para sua implantação, mas de transformações e adaptações dos profissionais e do serviço de saúde local para garantir qualidade e segurança aos pacientes. E, apesar da anestesiageral ter sido a técnica anestésica mais prevalente na realização das cirurgias ambulatoriais no período de estudo, deve-se dar preferência, quando possível, a anestesia regional para realização de tais procedimentos.

Introduction - The ambulatory surgery is characterized by the unnecessary hospitalization and with home return of the patient in less than twenty-four hours after the surgical procedure.Aim: To determine the epidemiological profile of ambulatory surgeries performed at Nossa Senhora daConceição Hospital (HNSC), in Tubarão city, Santa Catarina. Methods: Cross-sectional study, constituted by patientssubmitted to ambulatory surgery performed in HNSC surgical center, from June to September of 2007. Results: The prevalence of ambulatory surgery performed in the study period was 18.84%. There was female predominance (50.9%) and the largest proportion of patients belonged to the group of less than 13 years old (27.8%). The most frequent surgical specialty in ambulatory surgery was otorhinolaryngology (36.2%). As to the type of surgery, the highest number of patients submitted to amygdalectomy with adenoidectomy (21.6%). General anesthesia was the most anesthetictechnique used in the ambulatory surgery (44.2%). Conclusion - The prevalence of ambulatory surgerieswas low. But it is an institution which has conditions for the viability of these procedures, considering manyadvantages offered by this method, because it does not depend on new technology for its implementation, but onchanges and adjustments of the professionals and the local health department to secure quality and safety to the patients. And, in despite of general anesthesia has been the most prevalent anesthetic technique performed in ambulatory surgery during this study, it is better, when it is possible, regional anesthesia for these procedures.

The Thai Anesthesia Incidents Study (THAI Study) of ambulatory anesthesia: Part I: Method, geographic distribution and population.

BACKGROUND: There is a continuing trend to have more elective surgical operations performed on an outpatient basis. OBJECTIVE: To determine the proportional distribution of anesthetic procedures performed in ambulatory elective surgery at different levels of hospitals across Thailand. MATERIAL AND METHOD: A prospective and descriptive study was conducted at 20 hospitals comprising seven universities, five regional, four general and four district hospitals across Thailand Consecutive outpatients who were undergoing elective surgical operation were included and their relevant data were selected and extracted for summary by using descriptive statistics. RESULTS: From the database of 118,027 anesthetics performed for elective surgical operation, 7,786 (6.6%) were outpatients. According to this, 7,016 (90.1%) were practiced in university hospitals, 656 (8.4%) in regional or tertiary hospitals, 71 (9%) in general or provincial hospitals, and 43 (0.6%) in district hospitals. The frequency of the ambulatory anesthesia was higher in hospitals in the central region, especially in university hospitals in Bangkok than in other regions. The majority of cases (86%) received their initial pre-anesthetic evaluation in the operating room while 12% were evaluated at the outpatient office. About 28% of the cases presented with pre-anesthetic abnormal conditions. The relatively common pre-anesthetic diseases were hypertension, diabetes mellitus, anemia, arrhythmia, and asthma. CONCLUSION: From the results of the present study, the authors have concluded that the rate of expansion of ambulatory anesthesia in Thailand is relatively slow, and varies according to the type of hospital and its geographic region. This indicates further studies should be formally conducted to determine factors affecting the practice of ambulatory surgery in Thailand. A large proportion of patients receive initial pre-anesthetic evaluation in the operating room on the day of surgery. This indicates that a system of pre-anesthetic evaluation should be set up for outpatients such as a pre-anesthetic care clinic should be set up for outpatients.

Eficacia en la prevención del temblor postoperatorio en pacientes mayores de 16 años sometidos a cirugías electivas en el HEODRA, de enero 2004 a noviembre del 2005 / Effectiveness in the prevention of the postoperative tremor in patient bigger than 16 subjected years to elective surgeries in the HEODRA, of January 2004 to November of the 2005

Se realizó un estudio de tipo cuasi experimental, el que se desarrollo en dos fases y en tiempos diferentes, a pacientes sometidos a cirugías electivas, en el Servicio de Cirugía del Hospital Escuela Oscar Danilo Rosales (HEODRA). La primera fase se desarrolló en el añoi 2004. En la preanestesia se le explicó a cada paciente los objetivos del estudio, el compromiso de velar por su estado de salud y la importancia de registrar algunos datos del proceso. En el proceso quirúrgico se registraron los datos generales, fármacos aplicados, tiempo quirúrgico, temperatura de ingreso y egreso, así como la del quirófano y el uso de métodos para protección del paciente. En el postoperatorio se registró la presencia o no del temblor. La segunda fase se desarrollo en el año 2005. EN la preanestesia se le explicó a cada paciente los objetivos del estudio, el compromiso de velar por su estado de salud y la importancia de registrar algunos datos del proceso. Se solicitó su consentimiento el cual fue firmado por el propio paciente. En el proceso quirúrgico se registraron los datos generales, fármacos aplicados, tiempo quirúrgico, temperatura ótica de ingreso y egreso, así como del quirófano. Se aplicaro métodos para protección del paciente., que fue envolver al paciente (de distal a próximal) en 2 capas de guata y posteriormente en las frazadas habituales del quirófano, haciendo tres capas con estas

A Korean Predictive Model for Postoperative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) is one of the most common and distressing complications after surgery. An identification of risk factors associated with PONV would make it easier to select specific patients for effective antiemetic therapy. We designed a case-controlled study to identify the risk factors for PONV in 5,272 surgical patients. At postoperative 2 and 24 hr, patients were visited and interviewed on the presence and severity of PONV. Thirty nine percent of patients experienced one or more episodes of nausea or vomiting. Five risk factors were highly predictive of PONV: 1) female, 2) history of previous PONV or motion sickness, 3) duration of anesthesia more than 1 hour, 4) non-smoking status, and 5) use of opioid in the form of patient controlled analgesia (PCA), in the order of relevance. The formula to calculate the probability of PONV using the multiple regression analysis was as follows: P (probability of PONV)=1/1+e(-Z), Z=-1.885+0.894 (gender)+0.661 (history)+0.584 (duration of anesthesia)+0.196 (smoking status) +0.186 (use of PCA-based opioid) where gender: female=1, male=0; history of previous PONV or motion sickness: yes=1, no=0; duration of anesthesia: more than 1 hr=1, less than or 1 hr=0; smoking status: no=1, yes=0; use of PCA-based opioid: yes=1, no=0.

Anestesia y sedación en endoscopia del tubo digestivo con presión positiva contínua en vías aéreas por vía nasal y Cánula de Guedel modificada, para asegurar la oxigenación en los pacientes / Continous positive air pressure in endoscopy sedation

El objetivo de este trabajo fue evaluar la efectividad y seguridad del procedimiento de presión positiva continua en vías aéreas (CPAP) y verificar la facilidad de su implementación en diferentes diagnósticos terapéuticos tales como gastroesofágicos, colonoscópicos y pancreatobiliares. El estudio fue prospectivo de 150 pacientes en el Depto. de Endoscopia. Se concluyo que al asegurar la oxigenanción por este metodo, el endoscopista puede realizar su trabajo con facilidad y confianza