Perioperative factors that contribute to postoperative pain and/or nausea and vomiting in ambulatory laparoscopic surgery. / Factores perioperatorios que contribuyen a la aparición de dolor o náuseas y vómitos postoperatorios en cirugía laparoscópica ambulatoria.

INTRODUCTION: Both postoperative pain and postoperative nausea and vomiting are major factors that determine the time and quality of recovery in laparoscopic surgery. OBJECTIVE: To determine the perioperative factors that contribute to the appearance of postoperative pain and postoperative nausea and vomiting in outpatient laparoscopic surgery. MATERIAL AND METHODS: A prospective study was conducted on a cohort of 297 patients undergoing laparoscopic ambulatory surgery. A record was made of preoperative factors (usual medication, anaesthetic risk, etc.), intraoperative (surgical and anaesthetic times, drugs, CO2 pressure, etc.), and postoperative factors (major and minor complications, recovery times, etc.). As dependent variables, the postoperative symptoms considered were, nausea, vomiting, and/or postoperative pain. RESULTS: Considering as a combined variable the occurrence of níusea, vomiting or moderate/severe pain (4 or more points on a visual analogue scale), one or more of these symptoms occurred in 58.7% of the patients (95% CI: 52.8-64.4). Using a logistic regression, the variables associated with the appearance of symptoms were: female gender (OR: 3.4), waiting time over 45minutes prior to surgery (OR: 4.9) and no anti-emetic prophylaxis (OR: 12.2). CONCLUSIONS: In patients undergoing ambulatory laparoscopic surgery, one in 4had postoperative nausea and vomiting, and approximately half of moderate-intensity pain before discharge. Considering the overall the occurrence of pain and/or postoperative níusea and vomiting, these symptoms affect more than half of the patients being operated on, and are more frequent in women and in those who have to wait to access the operating room.

Sistema automático de autoevaluación telefónica en cirugía ambulatoria / Automatic self-assessment system in ambulatory surgery

Introducción: las tecnologías de la información y comunicación, aplicadas al control domiciliario, pueden permitir una mejora en el control y seguimiento de los pacientes en el área de la cirugía ambulatoria. En el presente estudio se valora la aplicación de un sistema de auto-chequeo por parte de pacientes sometidos a intervenciones de cirugía ambulatoria en el postoperatorio inmediato domiciliario. También se pretende analizar la utilidad y rendimiento según el nivel ASI (incapacidad postoperatoria esperada según intervención).Material y métodos: se realiza un estudio randomizado, prospectivo y multicéntrico en el que se incluyen 2.037 pacientes, la mitad en el grupo control y la otra mitad en el grupo piloto. Estos últimos realizan un auto-chequeo vía telefónica: son atendidos por un programa virtual que, según las respuestas obtenidas, los clasifica seleccionando a aquellos que necesitan ponerse en contacto directo con un profesional sanitario. Todos los pacientes del grupo control reciben las llamadas telefónicas convencionales del personal de las unidades correspondientes. Resultados: los resultados de los 2 grupos son similares, lo que demuestra la validez del sistema analizado. Numerosos pacientes del grupo piloto no realizan el auto-chequeo a pesar de haberse comprometido con el estudio. Asimismo, a mayor nivel ASI, mayor número de alertas y llamadas fuera de protocolo. Las llamadas evitan en muchos casos la visita a urgencias, con el considerable ahorro social y económico que ello implica. Discusión: el sistema de auto-chequeo puede ser una alternativa válida al control telefónico en los parámetros analizados. Aunque en el grupo piloto se observa un seguimiento del protocolo menor y genera una mayor actividad telefónica, evita más visitas a urgencias en pacientes con menor ASI. El sistema de auto-chequeo no aumenta el número de visitas a urgencias ni reingresos ni reintervenciones (AU)

Introduction: Information and communication technologies permit a better patient monitoring. Ambulatory surgery is a field where they can be relevant, mainly at the domiciliary control. The aim of our study is to validate the applications of an auto-check system in ambulatory surgery patients at home. We also want to analyze the usefulness and output depending on the ASI level (Ambulatory Surgery Incapacity level). Patients and methods: 2037 patients were included in a randomized, prospective and metacentric study: half in the control group and the other half in the study group. This group is attended by a virtual program that classifies them in base of their answers and selects those who may get in contact with medical staff. The control group receives the habitual phone control made by the respective units. Results: Results of both groups are similar, demonstrating the system validity. Many patients in the pilot group did not make the self-checkup despite their compromise. Likewise, the higher the ASI, the greater alerts and off protocol calls. In many cases, telephone calls avoided emergency department visits, with the social and economic saving it implies. Discussion: Auto-check may be a valid and safe alternative to the telephone control in the analyzed parameters. Although the protocol accomplishment is diminished and it generates more telephonic activity, it avoids more emergency visits in patients with lower postoperative disability. The auto-check system does not increase the number of visits to the emergency room or readmissions or reoperations (AU)

[Obstetric bleeding: an update]. / La hemorragia obstétrica. Actualización.

Massive bleeding in obstetrics still ranks among the most frequent causes of maternal morbidity and mortality worldwide. The most frequent type is primary postpartum hemorrhage, which is usually the result of an atonic uterus. The clinical priorities are to assure hemodynamic stability and to correct coagulation abnormalities. If pharmacologic treatment cannot achieve these goals, invasive methods such as interventional vascular radiology or artery ligation must be used. Hysterectomy is the last resort when the previous methods fail. For the best prognosis, in terms of preventing death, maintaining maternal fertility and minimizing morbidity, every maternity ward should have a well-defined multidisciplinary protocol that facilitates diagnosis and immediate treatment.

La hemorragia obstétrica. Actualización / Obstetric bleeding: an update

La hemorragia obstétrica masiva sigue siendo una delas causas más frecuentes de morbi-mortalidad maternaen todo el mundo. La hemorragia postparto primaria esla más frecuente siendo la atonía uterina su etiologíamás común. Es prioritario garantizar la estabilidadhemodinámica de la paciente y corregir las alteracionesde la coagulación. Si el tratamiento farmacológico resultainsuficiente se deben emplear métodos invasivos comola radiología vascular intervensionista o la ligadura delos vasos arteriales. La histerectomía es la última opcióncuando fracasan las medidas anteriores. Para que el pronósticosea favorable, ya no sólo en términos de mortalidadsino en mantener la fertilidad de la madre y minimizarla morbilidad, es fundamental que cada unidadmaternal cuente con un protocolo de actuación bien definidoy multidisciplinar que facilite el diagnóstico y eltratamiento inmediato(AU)

Massive bleeding in obstetrics still ranks among themost frequent causes of maternal morbidity andmortality worldwide. The most frequent type isprimary postpartum hemorrhage, which is usually theresult of an atonic uterus. The clinical priorities are toassure hemodynamic stability and to correctcoagulation abnormalities. If pharmacologictreatment cannot achieve these goals, invasivemethods such as interventional vascular radiology orartery ligation must be used. Hysterectomy is the lastresort when the previous methods fail. For the bestprognosis, in terms of preventing death, maintainingmaternal fertility and minimizing morbidity, everymaternity ward should have a well-definedmultidisciplinary protocol that facilitates diagnosisand immediate treatment(AU)