Strengths-Weaknesses-Opportunities-Threats Analysis for a Pediatric Anesthesia Program.

Risk management in healthcare institutions begins by first identifying the potential risks within a certain organization or specific area and then goes on to develop further strategies to reduce harm. The most common tool for this type of analysis is Strengths-Weaknesses-Opportunities-Threats (SWOT). METHODS: We conducted a SWOT analysis in our pediatric anesthesia program: key factors were identified in a matrix, prioritized in a score table, represented in a graph, and finally analyzed. RESULTS: Items obtained partial scores from 20 to 120. The item "lack of clinical protocols" was given greater weight (60) and received a lower value (1), resulting in the highest partial score (60) among the negative key factors and indicating a need for greater efforts to improve this specific aspect. CONCLUSION: The SWOT tool proved effective in identifying safety and quality key factors, and it provided information for initiating an improvement program.

Impacto del manejo perioperatorio en el pronóstico oncológico del cáncer de mama no metastásico. Un paradigma de futuro / Impact of perioperative management on the oncologic prognosis of non-metastatic breast cancer. A future paradigm

Introducción: La aparición de recidivas locales o metástasis a distancia suele ser la principal causa de muerte en el cáncer de mama. Objetivos: Valorar y revisar la implicación de la técnica anestésica y/o la analgesia perioperatoria y postoperatoria en la aparición de recurrencias y el pronóstico del cáncer de mama. Material y métodos: Se realiza una revisión de la literatura con el objetivo de obtener los estudios que relacionen la anestesia y la analgesia peri y postoperatoria con el pronóstico oncológico del cáncer de mama. Resultados: Tras la búsqueda se obtuvo un total de 146 estudios, de los cuales se seleccionaron 9 para su análisis exhaustivo. Discusión: La capacidad de las células tumorales para evadir la inmunidad del paciente es la clave del desarrollo de las metástasis. La inmunosupresión y la activación de mediadores de la inflamación durante el periodo perioperatorio pueden estar implicadas en la recurrencia de la enfermedad. Conclusión: El uso de opiáceos, los anestésicos inhalatorios y la técnica anestésica parecen tener una influencia negativa en el pronóstico oncológico, aunque hoy en día solo existen estudios en animales o in vitro

Introduction: Recurrent disease or metastases are the main cause of death from breast cancer. Objectives: To assess the influence of perioperative and postoperative anaesthetic and analgesic techniques on the appearance of recurrences and breast cancer prognosis. Material and methods: A literature search was conducted for studies that assessed perioperative and postoperative anaesthetic technique and analgesia in relation to the oncological prognosis of breast cancer. Results: We identified 146 studies and selected 9 studies for a full text reading. Discussion: The ability of tumour cells to escape patient immunity is the key to the development of metastases. Patient immunosuppression and perioperative inflammatory mediators could be involved in recurrence. Conclusion: The use of opioids, inhalational anaesthesia and the anaesthetic technique seem to have a negative influence on prognosis. However, there are currently only animal on in vitro studies on this topic