Génesis y evolución de la anestesia epidural lumbar en su primer centenario / Genesis and evolution of lumbar epidural anesthesia in its first century

Introducción: La anestesia epidural lumbar es la técnica predilecta para gran número de anestesiólogos. Permite variadas intervenciones quirúrgicas, es útil para el tratamiento del dolor agudo y crónico, a la vez provee al paciente de distintos beneficios. También resalta su versatilidad ya que puede combinarse con otros métodos anestésicos, así como extenderla para el alivio del dolor posoperatorio. Objetivo: Describir los adelantos científicos que propiciaron la aparición de la anestesia epidural lumbar y cuál ha sido la evolución de esta técnica anestésica a lo largo de un siglo. Desarrollo: El acceso por vía lumbar al espacio epidural con fines anestésicos fue publicado por el cirujano español Fidel Pagés en marzo de 1921, luego de una década en el olvido fue introducida por el cirujano italiano Archile Dogliotti en 1931. A partir de entonces, se le han incorporado diversos y valiosos adelantos. Conclusiones: La anestesia epidural lumbar fue descrita hace un siglo por el doctor Pagés. Han sido variados y numerosos los aportes que han recibido, algunos de los cuales han sido objeto de controversias; no obstante, se ha tornado una técnica universal que sigue captando la preferencia de muchos anestesiólogos(AU)

Introduction: Lumbar epidural anesthesia is the technique preferred by a great number of anesthesiologists. It allows performing several surgical interventions and is useful for the treatment of acute and chronic pain; at the same time, it provides the patient with different benefits. It ls also worth highlighting its versatility, since it can be combined with other anesthetic methods, as well as to be extended for postoperative pain relief. Objective: To describe the scientific advances that led to the appearance of lumbar epidural anesthesia and what has been the evolution of this anesthetic technique over a century. Development: the Spanish surgeon Fidel Pagés published lumbar access to the epidural space for anesthetic purposes in March 1921. After a decade in oblivion, the Italian surgeon Archile Dogliotti introduced it, in 1931. From then on, it has been incorporated several valuable advances. Conclusions: Dr. Pagés described lumbar epidural anesthesia a century ago. The contributions achieved have been varied and numerous, some of which have been the subject of controversy; however, it has become a universal technique that continues to capture the preference of many anesthesiologists(AU)

Resección de tumor traqueal / Tracheal tumor resection

Introducción: Los tumores primitivos de la tráquea son infrecuentes. Objetivo: Presentar la evolución de un paciente para resección de un tumor traqueal que ocluía el 95 por ciento de su luz. Caso Clínico: Disnea con tiraje supraesternal. No tolera el decúbito supino, presencia de tos y expectoración. Se le administró anestesia general endotraqueal convencional. Intubación con tubo No. 8. Se colocó en decúbito lateral izquierdo. Se procedió a realizar toracotomía. Con la tráquea abierta, el cirujano intubó el bronquio izquierdo con tubo No. 7. Se aspiraron secreciones, descendió la saturación de oxígeno. Se colocó sonda de levine en el pulmón derecho para oxigenación apneica con lo cual mejoró la saturación. En el pulmón ventilado se aplicó presión positiva al final de la espiración de 3 cm de agua con una fracción inspirada de oxígeno de 1. Luego de cerrada la pared posterior de la tráquea, se pasó una sonda nasogástrica a través del tubo colocado por vía orotraqueal. El cirujano fijó el extremo distal con una pinza. Se retiró el tubo orotraqueal inicial y se colocó un tubo 5.5 para intubar selectivamente el bronquio izquierdo por la boca y terminar la sutura de la tráquea y ambos bronquios. Terminado el procedimiento, se retiró el tubo y se ventilaron ambos pulmones. Conclusiones: La cirugía de tráquea impone un gran reto al anestesiólogo y al cirujano actuante, por lo que resultan imprescindibles las buenas relaciones del equipo de trabajo(AU)

Introduction: Primitive tumors of the trachea are rare. Objective: To present the evolution of a patient for removal of a tracheal tumor that occluded 95 percent of its light. Clinical case: Dyspnea with suprasternal retractions. No tolerance of supine decubitus, presence of cough and expectoration. The patient was administered conventional endotracheal general anesthesia. Intubation with tube number 8. The patient was placed in the left lateral decubitus position. A thoracotomy was performed. With the trachea open, the surgeon intubated the left bronchus with tube number 7. Secretions were aspirated, oxygen saturation decreased. A Levine tube was placed in the right lung for apneic oxygenation, which improved the saturation. In the ventilated lung, positive pressure was applied at the end of the expiration of 3 cm of water with an inspired fraction of oxygen of 1. After closing the posterior wall of the trachea, a nasogastric tube was passed through the tube placed via the orotracheal approach. The surgeon fixed the distal end with a clamp. The initial orotracheal tube was removed and a 5.5 tube was placed to intubate the left bronchus selectively through the mouth and complete the suture of the trachea and both bronchi. After the procedure, the tube was removed and both lungs were ventilated. Conclusions: The trachea surgery represents a great challenge for the anesthesiologist and the surgeon, a reason why good team working relations are essential(AU)

Sensibilidad y especificidad de las pruebas para evaluar la vía respiratoria / Sensitivity and specificity of the airway assessment tests

Introducción: una de las responsabilidades del anestesiólogo es controlar la vía respiratoria del paciente. El 34 por ciento de las demandas realizadas a anestesiólogos se encuentran en relación con eventos de la vía respiratoria y a la dificultad para la intubación. Objetivos: identificar cuál de las pruebas pronósticas es la de mayor sensibilidad y especificidad en los pacientes operados de colecistectomía laparoscópica. Método: se realizó un estudio analítico longitudinal retrospectivo con un universo de 300 pacientes intervenidos por colecistectomía laparoscópica en el período comprendido entre enero 2011 y enero 2016. Se trabajó con una muestra no probabilística de 199 de pacientes. Resultados: el índice de masa corporal fue de 24,6 ± 3,9. La edad de 42,28 ± 14,6 años. El 39 por ciento fueron hombres. La prueba de la mordida del labio superior fue positiva en 6 por ciento, pacientes con sensibilidad 94 por ciento y especificidad en 91 por ciento. El 24,1 por ciento presentó Mallampati entre 3-4, con sensibilidad 86 por ciento y especificidad 43 por ciento. La apertura bucal tuvo una sensibilidad de 89 por ciento, especificidad 31 por ciento y positiva en 24,6 por ciento. La distancia tiromentoniana arrojó una sensibilidad de 90 por ciento y especificidad de 72 por ciento. Fue positiva en 14 por ciento. Por último la extensión atlantoaxial fue positiva en solo 10 pacientes para un 5 por ciento con una sensibilidad de 3 por ciento y especificidad de 10 por ciento. Conclusiones: en la serie estudiada, la prueba predictiva de intubación difícil con mejor sensibilidad y especificidad fue la de la mordida del labio superior(AU)

Introduction: One of the anesthesiologist responsibilities is to control the patient's airway. 34 percent of the lawsuits against anesthesiologists are due to airway events and intubation difficulty. Objectives: To identify which one of the prognostic tests has the highest sensitivity and specificity in patients performed laparoscopic cholecystectomy. Method: A retrospective longitudinal analysis was carried out with a sample group of 300 patients who were performed laparoscopic cholecystectomy, in the period from January 2011 to January 2016. We worked with a nonprobabilistic sample of 199 patients. Results: Body mass index was 24.6 ± 3.9. Age was 42.28 ± 14.6 years. 39 percent were men. The upper lip bite test was positive in 6 percent pf the patients, with sensitivity being 94 percent , and specificity of 91 percent . 24.1 percent showed Mallampati between 3 and 4, with 86 percent of sensitivity and 43 % of specificity. The mouth opening had a sensitivity of 89 percent and a specificity of 31 percent was positive in 24.6 percent . Thyromental distance yielded a sensitivity of 90 percent and a specificity of 72 percent . It was positive in 14 percent . Finally, the atlantoaxial extension was positive in 10 patients, for a 5 percent with a sensitivity of 3 percent and specificity of 10 percent . Conclusions: In the studied series, the difficult intubation predictive test with better sensitivity and specificity was the upper lip bite test(AU)

Profile of drug administration errors in anesthesia among anesthesiologists from Santa Catarina / Perfil de erros de administração de medicamentos em anestesia entre anestesiologistas catarinenses

INTRODUCTION: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. OBJECTIVE: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. MATERIALS AND METHODS: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors. RESULTS: Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%). CONCLUSION: Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity.

INTRODUÇÃO: A anestesiologia é a única especialidade médica que prescreve, dilui e administra os fármacos sem conferência de outro profissional. Somando-se a alta frequência de administração de fármacos, cria-se o cenário propício aos erros. OBJETIVO: Verificar a prevalência dos erros de administração de medicamentos durante anestesia, entre anestesiologistas catarinenses, as circunstâncias em que ocorreram e possíveis fatores associados. MATERIAIS E MÉTODOS: Um questionário eletrônico foi enviado a todos os anestesiologistas da Sociedade de Anestesiologia do Estado de Santa Catarina contendo respostas diretas ou de múltipla escolha sobre dados demográficos e perfil da prática anestésica do entrevistado; prevalência de erros, tipo e consequência do erro; e fatores que possivelmente contribuíram para os erros. RESULTADOS: Dos entrevistados, 91,8% afirmaram ter cometido erro de administração, somando total de erros de 274 e média de 4,7 (6,9) erros por entrevistado. O erro mais comum foi substituição (68,4%), seguido por erro de dose (49,1%) e omissão (35%). Apenas 7% dos entrevistados referiram erros de administração no neuroeixo. Quanto às circunstâncias dos erros, ocorreram principalmente no período matutino (32,7%), na manutenção da anestesia (49%), com 47,8% sem danos ao paciente e 1,75% com maior morbidade com dano irreversível e em 87,3% dos casos a identificação imediata. Quanto aos possíveis fatores contribuintes, os mais frequentes foram: distração e fadiga (64,9%) e leitura errada dos rótulos de ampolas ou seringas (54,4%). CONCLUSÃO: A maioria dos anestesiologistas entrevistados cometeu mais de um erro de administração em anestesia, principalmente justificado como distração ou fadiga, de baixa gravidade.