Patient satisfaction in ambulatory anesthesia assessed by the Heidelberg Peri-anaesthetic Questionnaire: a cross-sectional study

Abstract Background: Service quality in anesthesiology has been frequently measured by morbidity and mortality. This measure increasingly considers patient satisfaction, which is the result of care from the client's perspective. Therefore, anesthesiologists must be able to build relationships with patients, provide understandable information and involve them in decisions about their anesthesia. This study aimed to evaluate the peri-anesthetic care provided by the anesthesia service in an ambulatory surgery unit using the Heidelberg Peri-anaesthetic Questionnaire. Methods: This cross-sectional study used the Heidelberg Peri-anaesthetic Questionnaire to evaluate 1211 patients undergoing ambulatory surgery. We selected questions that showed a greater degree of dissatisfaction and correlated them with patient characterization data (age, sex, education, and ASA physical status), anesthesia data (type, time, and prior experience), and surgical specialty. Results: Questions in which patients tended to show dissatisfaction involved fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain. Conclusion: The Heidelberg Peri-anaesthetic Questionnaire proved to be a useful tool in identifying points of dissatisfaction, mainly fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain in the population studied. These were correlated with patient, anesthesia, and surgical variables. This allows the establishment of priorities at the different points of care, with the ultimate goal of improving patient satisfaction regarding anesthesia care.

Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

Abstract Background: Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist used for its sedative, analgesic, and anxiolytic effects. Non-Operating Room Anesthesia (NORA) is a modality of anesthesia that can be done under general anesthesia or procedural sedation or/and analgesia. In this particular setting, a level-2 sedation, such as the one provided by DEX, is beneficial. We aimed to study the effects and safety of DEX in the different NORA settings in the adult population. Methods: A systematic review with meta-analysis of randomized controlled trials was conducted. Interventions using DEX only or DEX associated with other sedative agents, in adults (18 years old or more), were included. Procedures outside the NORA setting and/or without a control group without DEX were excluded. MEDLINE, ClinicalTrials.gov, Scopus, LILACS, and SciELO were searched. The primary outcome was time until full recovery. Secondary outcomes included hemodynamic and respiratory complications and other adverse events, among others. Results: A total of 97 studies were included with a total of 6,706 participants. The meta-analysis demonstrated that DEX had a higher time until full recovery (95% CI = [0.34, 3.13] minutes, a higher incidence of hypotension (OR = 1.95 [1.25, 3.05], p = 0.003, I2 = 39%) and bradycardia (OR = 3.60 [2.29, 5.67], p < 0.00001, I2 = 0%), and a lower incidence of desaturation (OR = 0.40 [0.25, 0.66], p = 0.0003, I2 = 60%). Conclusion: DEX in NORA procedures in adults was associated with a lower incidence of amnesia and respiratory effects but had a long time to recovery and more hemodynamic complications..

Informed consent in anesthesiology: An exploratory study / El consentimiento informado en anestesiología: un estudio exploratorio / Consentimento informado em anestesiologia: um estudo exploratório

Abstract: In the literature Informed consent (IC) assumptions is well established. However, the different stages and the conditions under which the IC for anesthetic practices is obtained, is scarce. The aim of the present study is to explore the phases and conditions of IC in anesthesiology. Anonymized clinical records of 325 patients submitted to anesthetic procedures at the Institute of Oncology of Porto were analyzed. A total agreement between the anesthetic techniques established in the IC and those performed, was reach with 270 patients. The importance of IC in clinical practice is discussed and an ideal process for IC is argued.

Resumen: El consentimiento informado (CI) está bien establecido en la literatura. Sin embargo, la información sobre las diferentes fases y condiciones en las que se obtiene el CI para las prácticas anestésicas es escasa. El objetivo del presente estudio es explorar las fases y condiciones de obtención de la CI en anestesiología. Se analizaron las historias clínicas anónimas de 325 pacientes sometidos a procedimientos anestésicos en el Instituto de Oncología de Oporto. Se alcanzó una concordancia total entre las técnicas de anestesia establecidas en el CI y las realizadas con 270 pacientes. Se defiende la importancia del CI en la práctica clínica y se discute un proceso ideal para obtenerlo.

Resumo: Na literatura o Consentimento Informado (CI) é bem estabelecido. Contudo, a informação sobre as diferentes fases e as condições em que o CI para práticas anestésicas é obtido, é escassa. O objetivo do presente estudo é explorar as fases e condições da obtenção do CI em anestesiologia. Foram analisados os registos clínicos anónimos de 325 pacientes submetidos a procedimentos anestésicos no Instituto de Oncologia do Porto. Foi alcançado um acordo total entre as técnicas anestésicas estabelecidas no CI e as realizadas, com 270 pacientes. A importância do CI na prática clínica é defendida e discute-se um processo ideal para a obtenção do CI.

Identifying patient safety competences among anesthesiology residents: systematic review

Abstract Introduction and objective Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and reduces costs. Moreover, while analyzing the area of anesthesiology, one can realize the epidemiological changes, increased complexity and number of procedures, and the adoption of a new matrix of essential skills mandatory for residents of anesthesiology in Brazil. Thus, it is relevant to identify current patient safety competences among anesthesiology residents. Methods A systematic review was elaborated using PubMed, SciELO, BVS, Cochrane Library, LILACS and CAPES databases with the descriptors "anesthesiology", "patient safety", "residency" and "competence". Results and conclusions Thirteen articles published in the past 10 years were analyzed. The articles depicted competences grouped into three categories: knowledge (identification, prevention and management of adverse events; use of correct and up-to-date information; understanding of human factors; and continuous learning), skills (efficient communication; teamwork; leadership; decision-making; and self-confidence), and attitude (management of stress and fatigue; and infection control). All these skills can be developed and assessed through simulation and active learning methods, profiting from a multidisciplinary approach. Studies also reveal that residents perform poorly in certain patient safety domains due to lack of effective in-depth understanding, appreciation of the topic and ineffective teaching. As a result, greater investment in the topic is needed by teaching and health institutions and researchers.

Guía de práctica clínica informada en la evidencia para la el manejo del dolor en el trabajo de parto y parto usando técnica neuroaxial. versión extensa / Evidence-informed clinical practice guideline for pain management in labor and delivery using the neuraxial technique. extended version

Como parte del proceso de priorización de temas en salud materna en el Instituto Nacional Materno Perinatal (INMP), se determinó que el manejo del dolor durante el trabajo de parto es un aspecto fundamental de la actividad del equipo de salud encargado del apoyo y asistencia profesional en la gestante. El Departamento de Anestesiología del INMP asumió el desarrollo de dicha Guía de Práctica Clínica Informada en Evidencia (GPC-IE). En este sentido, se conformó el grupo elaborador de guías de analgesia del INMP, conformado por expertos clínicos en el manejo del tópico de la guía y experiencia en investigación, como parte del grupo metodólogo de la guía participaron tres expertas metodólogas de la UNAGESP/INS, quienes participaron en todas las etapas del desarrollo de la presente GPC ­ IE, además de un panel de expertos clínicos de los diferentes institutos y hospitales de referencia en salud materna del país. El panel de expertos estuvo conformado por un equipo multidisciplinario de médicos anestesiólogos, médicos ginecólogos, Obstetras y enfermeras

Colombian anesthesiology at a crossroad? / ¿La anestesiología en Colombia ante una encrucijada?

The S.C.A.R.E. members assembly held on March 3ist, 2021, was quite revealing: its leitmotiv was the challenging work situation experienced by the colleagues across the country. The similarity with the very first assembly meeting I attended in Pasto in 1990 as a young anesthetist, invited by the tireless of doctor Jorge Osorio, was mystifying. It is rather striking to see how history repeats itself after 31 years, bringing back times that we thought were something of the past.

La asamblea de socios de la S.C.A.R.E. celebrada el 3 de marzo de 2021 fue bastante reveladora: su leitmotiv fue la desafiante situación laboral que viven los colegas de todo el país. La similitud con la primera asamblea a la que asistí en Pasto en 1990 como joven anestesista, invitado por el incansable del doctor Jorge Osorio, fue desconcertante. Es bastante llamativo ver cómo la historia se repite después de 31 años, trayendo de vuelta tiempos que creíamos que eran cosa del pasado.

Malignant hyperthermia: what we may need to have at hand / Hipertermia maligna: lo que tendríamos que tener a la mano

Malignant hyperthermia (MH) is often neglected in anesthesia because of its rare incidence (around 1:100,000 general anesthetics). However, when it occurs, it becomes the anesthesiologist's nightmare. In the United States, Canada, and in most European countries, it is mandatory to store dantrolene wherever halogenated agents and/or succinylcholine are used by anesthesia providers (including sites that use only succinylcholine and no volatiles for electroconvulsive therapies). Unfortunately, its availability in Colombia is not mandatory or universal

La hipertermia maligna (HM) es algo a menudo se descuida durante el acto anestésico debido a su muy baja incidencia (aproximadamente 1:100.000 anestesias generales). Sin embargo, cuando se presenta, se convierte en una pesadilla para el anestesiólogo. En los Estados Unidos, Canadá y la mayoría de los países de Europa es obligatorio contar con dantroleno siempre que los anestesiólogos administran agentes halogenados y/o succinilcolina (incluidos los centros que utilizan succinilcolina sola sin agentes volátiles para terapias electroconvulsivas). En Colombia, infortunadamente, su disponibilidad no es obligatoria ni universal

Questions and answers / Preguntas y respuestas

According to Professor Alejandro Jadad in his article "Toward the 'next normal': An opportunity to unlearn and reflect about life, death, and our mental health during the pandemic," 1 Which of the following feelings is perhaps the most important source of unhappiness at the end of life?

Según el profesor Alejandro Jadad en su artículo "Hacia la 'próxima normalidad': una oportunidad para desaprender y reflexionar sobre la vida, la muerte y nuestra salud mental durante la pandemia" 1 ¿Cuál de los siguientes sentimientos es quizás la fuente más importante? de la infelicidad al final de la vida?

Inducción e intubación en secuencia rápida en pacientes portadores de COVID-19 / Rapid sequence induction and intubation in Covid 19 carrier patients

Introducción: La inducción e intubación en secuencia rápida es un procedimiento en anestesiología de emergencia para controlar la vía aérea en pacientes graves e insertar un tubo en la tráquea en el menor tiempo posible. Originalmente, este proceder se indicaba en los casos de regurgitación y/o reflujo para atenuar y prevenir la aspiración del contenido gástrico. La técnica descrita y usada por primera vez en los años 1970 retomó su uso en el contexto de la pandemia Covid-19. Sin embargo, una técnica convencional de intubación de secuencia rápida no sería adecuada pues no evitaría la dispersión del virus desde la vía aérea del paciente hacia el entorno, con la posibilidad de contaminación del personal que la realice. Objetivo: Describir una técnica modificada de intubación de secuencia rápida en tiempos de Covid-19. Métodos: Se realizó una revisión de las primeras publicaciones con protocolos de esta técnica modificada. La búsqueda se realizó en base de datos como PubMed, Google Académico y Elsevier. Desarrollo: El aspecto más importante para el profesional que realice la técnica es lograr con éxito la maniobra y conservar la vida del paciente. En este sentido, debe ser el más experimentado y preparado para controlar el tiempo de cada una de las etapas en las que se divide. Conclusiones: En la enfermedad Covid-19 las situaciones clínicas son muy variantes por lo que los protocolos en la atención perioperatoria de los enfermos puede modificarse según exista nueva evidencia(AU)

Introduction: Rapid-sequence induction and intubation is an emergency anesthesiology procedure for airway control in critically ill patients and for inserting a tube into the trachea in the shortest possible time. Originally, this procedure was indicated in cases of regurgitation and/or reflux in order to attenuate and prevent aspiration of gastric contents. The technique, described and used for the first time in the 1970s, resumed its use in the context of the COVID-19 pandemic. However, a conventional rapid-sequence intubation technique would not be adequate as it would not prevent the virus spread from the patient's airway to the environment, with the possibility of contamination of the personnel performing it. Objective: To describe a modified rapid-sequence intubation technique in times of COVID-19. Methods: A review of the first publications with protocols of this modified technique was carried out. The search was carried out in databases such as PubMed, Google Scholar and Elsevier. Development: The most important aspect for the professional performing the technique is to achieve the maneuver successfully and preserve the life of the patient. In this respect, the physician must be the most experienced and prepared to control the time of each of the stages into which it is divided. Conclusions: In COVID-19, clinical situations are highly variable, a reason why protocols in the perioperative care of patients can be modified according to new evidence(AU)

Infusiones controladas por objetivo y sistemas de circuito cerrado. Límites en expansión / Target-controlled infusions and closed-loop systems: expansion limits

Introducción: La administración manual en bolo ha evolucionado desde la infusión volumétrica basada en regímenes farmacológicos estandarizados, hasta los sistemas de infusión controlada por objetivo y los más sofisticados sistemas de circuito cerrado. Objetivo: Describir los principios tecnológicos y aplicaciones clínicas extendidas de la infusión controlada por objetivo y los sistemas de circuito cerrado. Métodos: Se realizó una revisión no sistemática de la literatura, en bases de datos científicas como Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, Science Direct, OVID y el buscador académico Google Scholar, en el mes de septiembre del año 2020. Desarrollo: La disponibilidad y portabilidad de dispositivos electrónicos con capacidad de procesamiento avanzado a precios relativamente accesibles, el perfeccionamiento del aprendizaje automático e inteligencia artificial aplicado a las decisiones médicas, y las iteraciones tecnológicas complejas incorporadas en los sistemas de circuito abierto y cerrado, desarrollados originalmente en el campo de la Anestesiología, han posibilitado su expansión a otras especialidades y entornos clínicos tan disímiles como el tratamiento de la diabetes mellitus, administración de fármacos antineoplásicos, ventilación mecánica, control de las variables hemodinámicas y la terapia antimicrobiana en pacientes críticos. Conclusiones: La infusión controlada por objetivo y los sistemas de circuito cerrado se han convertido en tecnologías maduras, seguras y viables, aplicadas clínicamente en múltiples naciones y escenarios, con un desempeño superior a los sistemas manuales tradicionales(AU)

Introduction: Manual bolus administration has evolved from volumetric infusion based on standardized pharmacological regimens to target-controlled infusion systems and the most sophisticated closed-loop systems. Objective: To describe the technological principles and extended clinical applications of target-controlled infusion and closed-loop systems. Methods: A nonsystematic review of the literature was carried out, during September 2020, in scientific databases such as Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, Science Direct, OVID and the academic search engine Google Scholar. Development: The availability and portability of electronic devices with advanced processing capacity at relatively affordable prices, the refinement of machine learning and artificial intelligence applied to medical decisions, as well as the complex technological iterations incorporated into open and closed-loop systems, originally developed in the field of anesthesiology, have enabled their expansion to other specialties and clinical settings so diverse as treatment of diabetes mellitus, administration of antineoplastic drugs, mechanical ventilation, control of hemodynamic variables and antimicrobial therapy in critical patients. Conclusions: Target-controlled infusion and closed-loop systems have become mature, safe and viable technologies, applied clinically in multiple nations and settings, with superior performance compared to traditional manual systems(AU)