Adaptación transcultural y validación del cuestionario STOP-bang del inglés al español como herramienta de detección precoz del síndrome de apnea del sueño en el paciente quirúrgico y en la población general / Cross-cultural adaptation and Validation of the STOP-bang Questionnaire from English to Spanish as a tool for the early detection of sleep apnea syndrome in the surgical patient and in the general population

Introduccion: El síndrome de apnea obstructiva del sueño (SAOS) o síndrome de apnea-hipoapnea (SAHS) es uno de los trastornos del sueño más prevalentes en la población general. Está asociado a un aumento en la prevalencia de intubación orotraqueal difícil y de las complicaciones postoperatorias. Se recomienda la aplicación de tests de detección precoz validados como el test en inglés de STOP-bang (STBC); un test de alta calidad metodológica, sensibilidad y especificidad en la detección precoz del SAHS tanto en la población quirúrgica como general. Objetivo: La validación, traducción y adaptación cultural del test STBC a la población española. Material y metodos: Se realizó la adaptación transcultural del STBC al español y un estudio de validación posterior con 77 pacientes consecutivos. El análisis estadístico evaluó la fiabilidad, la validez y la factibilidad de la versión traducida y adaptada culturalmente. Resultados: Se incluyeron el 44% de mujeres y el 56% de varones con una edad media de 53,58±12,88 años. Los resultados en la fiabilidad fueron: un coeficiente alfa de Cronbach de 0,767, una correlación de Pearson r=0,777 (p<0,001) y una correlación de Sperman rho=0,455 (p=0,044). La factibilidad del estudio fue del 100%. La validez de criterio se evaluó mediante el coeficiente Kappa que fué de 0,444. Para una puntuación >3 del cuestionario adaptado al español los resultados de sensibilidad y de especificidad según los distintos niveles de corte del índice apnea hipoapnea (IAH)>5, >15 y >30) fueron: sensibilidad del 87, 91 y 100%, respectivamente, y de especificidad del 50, 31 y 22%, respectivamente.(AU)

Introduction: Obstructive sleep apnea syndrome (OSAS) or apnea-hypoapnea syndrome (SAHS) is one of the most prevalent sleep disorders in the general population. It is associated with an increase in the prevalence of difficult orotracheal intubation and postoperative complications. The application of validated early detection tests,such the STOP-Bang test in English (STBC), is recommended; a test of high methodological quality, sensitivity and specificity in the early detection of SAHS in both surgical and general populations. Objective: The validation, translation, cross-cultural adaptation of the STBC to the Spanish population. Material and methods: The transcultural adaptation of the STBC to Spanish was carried out and a subsequent validation study with 77 consecutive patients was carried out. The statistical analysis evaluated the reliability, validity and feasibility of the translated and culturally adapted version. Results: 44% of women and 56% of men were included,with a mean age of 53.58±12.88 years. The reliability results were: a Cronbach's Alpha Coefficient of 0.767, a Pearson correlation r=.777 (P<.001) and a Sperman correlation rho=.455 (P=.044). The feasibility of the study was 100%. Criterion validity was evaluated using the Kappa coefficient, which was 0.444. For a score >3 of the questionnaire adapted to Spanish, the results of sensitivity, specificity according to the different cut-off levels of the apnea hypopnea index (AHI)>5, >15, >30) were: Sensitivity 87%, 91% and 100% respectively and Specificity of 50%, 31% and 22%. Conclusions: The STBC questionnaire translated, adapted and validated into Spanish, evaluated in the present study, is reliable and valid with respect to the original design of the questionnaire. It is a useful tool that is easy to understand and implement, which can be used rigorously to stratify surgical risk and carry out adequate perioperative planning of those patients at risk of SAHS.(AU)

Cross-cultural adaptation and validation of the STOP-bang Questionnaire from English to Spanish as a tool for the early detection of sleep apnea syndrome in the surgical patient and in the general population.

INTRODUCTION: Obstructive Sleep Apnea Syndrome (OSAS) or Apnea-Hypoapnea Syndrome (SAHS) is one of the most prevalent sleep disorders in the general population. It is associated with an increase in the prevalence of difficult orotracheal intubation and postoperative complications. The application of validated early detection tests, such the STOPbang test in English (STBC), is recommended; a test of high methodological quality, sensitivity and specificity in the early detection of SAHS in both surgical and general populations. OBJECTIVE: The validation, translation, cross-cultural adaptation of the STBC to the Spanish population. MATERIAL AND METHODS: The transcultural adaptation of the STBC to Spanish was carried out and a subsequent validation study with 77 consecutive patients was carried out. The statistical analysis evaluated the reliability, validity and feasibility of the translated and culturally adapted version. RESULTS: 44% of women and 56% of men were included, with a mean age of 53.58 ± 12.88 years. The reliability results were: a Cronbach's Alpha Coefficient of 0.767, a Pearson correlation r = 0.777 (P < .001) and a Sperman correlation rho = 0.455 (P = .044). The feasibility of the study was 100%. Criterion validity was evaluated using the Kappa coefficient, which was 0.444. For a score >3 of the questionnaire adapted to Spanish, the results of sensitivity, specificity according to the different cut-off levels of the apnea hypopnea index (AHI) >5, >15, >30) were: Sensitivity 87%, 91% and 100% respectively and Specificity of 50%, 31% and 22%. CONCLUSIONS: The STBC questionnaire translated, adapted and validated into Spanish, evaluated in the present study, is reliable and valid with respect to the original design of the questionnaire. It is a useful tool that is easy to understand and implement, which can be used rigorously to stratify surgical risk and carry out adequate perioperative planning of those patients at risk of SAHS.

Large retropharyngeal haematoma. Airway management with Airtraq® laryngoscope. / Gran hematoma retrofaríngeo: manejo de la vía aérea con laringoscopio óptico Airtraq®.

Retropharyngeal haematoma is a life-threatening clinical situation that can lead to a potential obstruction of the upper airway and requires rapid diagnosis. Clinicaly, it can be presented in different ways, depending on its size and growing speed. The first measure is to protect and manage the airway: in most cases this is a difficult airway situation. A retropharyngeal haematoma can be formed due to a previous traumatic history, with or without associated cervical fracture. Treatment of the haematoma is conservative in most cases, with close monitoring until it is reabsorbed in 3-4 weeks, although they can sometimes require surgical evacuation. We present the case of a patient who developed a large retropharyngeal haematoma after minor cervical trauma and describe an approach of the airway using the Airtraq® disposable optical laryngoscope.

[Safety and effectiveness of acute postoperative pain treatment in a series of 3670 patients]. / Seguridad y efectividad del tratamiento del dolor agudo postoperatorio: seguimiento de 3.670 pacientes.

OBJECTIVES: To improve the safety and effectiveness of acute postoperative pain treatment in patients under the care of our acute pain clinic, we set 3 objectives: to establish a computerized registry updated daily for all patients treated in the unit, to define categories of quality indicators for assessing the results of acute postoperative pain treatment, and to compare our results with those reported in the literature. PATIENTS AND METHODS: Prospective study of all patients treated by our pain clinic from May 2004 through June 2007. We analyzed 19 previously defined indicators in 4 categories: case characteristics, effectiveness, safety, and patient satisfaction. We then compared the results to those in the literature. RESULTS: A total of 3670 patients were included. Results for the most important indicators were as follows: mean follow-up time, 3.1 days (range 1-12 days); effectiveness, 92%; severe pain (>7 on a numerical scale) at rest, 1%; moderate pain (4-6 on the scale) on movement, 31%; accidental catheter removal, 6%; and medication error, 0.4%. CONCLUSIONS: Daily follow-up and recording of data for patients treated by the acute pain unit facilitates the evaluation of our clinical practice and contributes with improving safety and effectiveness. Comparison with reports in the literature reveals the great heterogeneity of quality assurance indicators that have been defined.

Seguridad y efectividad del tratamiento del dolor agudopostoperatorio: seguimiento de 3.670 pacientes / Safety and effectiveness of acute postoperative pain treatment in a series of 3670 patients

OBJETIVOS: Con el fin de mejorar la seguridad y la efectividaddel tratamiento del dolor postoperatorio en lospacientes controlados por la Unidad de Dolor Agudo(UDA), nos propusimos tres objetivos: implantar un sistemade seguimiento y registro informatizado diario de lospacientes tratados en la UDA, definir categorías de indicadoresde resultado del tratamiento del dolor agudo postoperatorio(DAP) y evaluar nuestros resultados y compararloscon los datos extraídos de la revisión bibliográfica.PACIENTES Y MÉTODOS: Estudio prospectivo de todos lospacientes atendidos en la UDA desde mayo de 2004 hastajunio de 2007. Analizamos 19 indicadores definidos previamenteen la unidad y agrupados en cuatro categorías,(casuística, efectividad, seguridad y satisfacción delpaciente). Se compararon nuestros resultados con loshallados en la revisión bibliográfica.RESULTADOS: Incluimos 3.670 pacientes. Los indicadoresmás relevantes fueron: tiempo medio de seguimiento3,1 días (rango 1-12 días), efectividad 92%, dolor grave(escala numérica EN > 7) en reposo 1%, dolor moderado(EN: 4-6) en movimiento 31%, salida accidental de catéterepidural 6% y errores de medicación 0,4%.CONCLUSIONES: El seguimiento y registro diario de lospacientes tratados en la UDA posibilita la evaluación delos resultados de nuestra práctica clínica y contribuye a lamejora de la seguridad y efectividad de los tratamientos.La comparación con los datos de la bibliografía revelauna gran heterogeneidad en las definiciones de los indicadores (AU)

OBJECTIVES: To improve the safety and effectivenessof acute postoperative pain treatment in patients underthe care of our acute pain clinic, we set 3 objectives: toestablish a computerized registry updated daily for allpatients treated in the unit, to define categories ofquality indicators for assessing the results of acutepostoperative pain treatment, and to compare ourresults with those reported in the literature.PATIENTS AND METHODS: Prospective study of allpatients treated by our pain clinic from May 2004through June 2007. We analyzed 19 previously definedindicators in 4 categories: case characteristics,effectiveness, safety, and patient satisfaction. We thencompared the results to those in the literature.RESULTS: A total of 3670 patients were included.Results for the most important indicators were asfollows: mean follow-up time, 3.1 days (range 1-12days); effectiveness, 92%; severe pain (>7 on anumerical scale) at rest, 1%; moderate pain (4-6 on thescale) on movement, 31%; accidental catheter removal,6%; and medication error, 0.4%.CONCLUSIONS: Daily follow-up and recording of datafor patients treated by the acute pain unit facilitates theevaluation of our clinical practice and contributes withimproving safety and effectiveness. Comparison withreports in the literature reveals the great heterogeneityof quality assurance indicators that have been defined (AU)

[Asystole after combination anesthesia]. / Asistolia después de anestesia combinada.

A 55-year-old man with liver cancer underwent partial hepatectomy under combined lumbar epidural and general anesthesia. Asystole during postoperative recovery was followed by ventricular fibrillation. After unsuccessful cardiopulmonary resuscitation efforts, brain death was diagnosed. In the absence of anemia, acidosis, electrolytic alterations or hypothermia, and after ruling out hemoperitoneum, acute myocardial infarction and stroke, we conclude that the clinical picture described was the result of autonomic imbalance due to spreading of the sympathetic block.

Asistolia después de anestesia combinada / Asystole after combined anesthesia

Un paciente de 55 años diagnosticado de hepatocarcinoma fue sometido a hepatectomía parcial bajo anestesia combinada epidural lumbar y general. En el postoperatorio inmediato presentó asistolia seguida de fibrilación ventricular. Tras una reanimación cardiopulmonar ineficaz, se produjo el fallecimiento por muerte cerebral. En ausencia de anemia, acidosis, alteraciones electrolíticas e hipotermia y descartados el hemoperitoneo, el infarto agudo de miocardio y el accidente vásculo-cerebral, este cuadro clínico podría obedecer a un desequilibrio del sistema nervioso autónomo por bloqueo simpático extenso (AU)

Percutaneous anterior approach to the coeliac plexus using ultrasound.

A new approach is described to the neurolytic block of the coeliac plexus through the anterior abdominal wall using ultrasonic guidance. In nine patients, ultrasound was used for needle placement and examination of the spread of injection. Total pain relief was obtained in seven of the patients after 2 weeks and in five patients after 6 months. No serious complications were observed. The anterior approach is simple and useful in those patients with chronic pancreatic pain undergoing biopsy of the pancreas, and in those terminally ill or heavily sedated patients who have difficulty in tolerating the prone flexed position.