Comentarios a la carta: Actuación ante un caso de extubación accidental con paciente en posición de decúbito prono / Response to the letter: Anaesthesia management of accidental extubation in the prone position

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Síndrome de encefalopatía posterior reversible en el postoperatorio de neurocirugía. Revisión de la literatura / Posterior reversible encephalopathy syndrome after neurosurgery: a literature review

El síndrome de encefalopatía posterior reversible es una entidad clínico-radiológica que se manifiesta con disminución del nivel de consciencia, convulsiones y alteraciones visuales, y radiológicamente, como edema cerebral predominantemente en la sustancia blanca de regiones parietoccipitales. Son múltiples las situaciones que pueden desencadenar el cuadro, entre ellas, la administración de inmunosupresores, quimioterapia, estados hipertensivos y la sepsis. Se describe el caso de un paciente diagnosticado de adenocarcinoma de próstata en estadio iv que recibió quimioterapia, presentando un síndrome de encefalopatía posterior reversible en el postoperatorio inmediato de una resección de metástasis cerebral (AU)

Posterior reversible encephalopathy syndrome is a clinical-radiological characterized by decreased level of consciousness, seizures, and visual disturbances, as well as radiologically ras brain edema, predominantly in parieto-occipital white matter regions. There are many situations that can trigger the disorder, including the administration of immunosuppressants, chemotherapy agents, hypertensive disorders, and sepsis. The case is described of a patient diagnosed with stage IV prostate adenocarcinoma, receiving chemotherapy, andundergoing a posterior reversible encephalopathy syndrome after surgery for resection of brain metastasis (AU)

Hematoma retroperitoneal en una paciente anticoagulada y portadora de un catéter femoral / Retroperitoneal haematoma in an anticoagulated patient with a femoral catheter

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[Posterior reversible encephalopathy syndrome after neurosurgery: A literature review]. / Síndrome de encefalopatía posterior reversible en el postoperatorio de neurocirugía. Revisión de la literatura.

Posterior reversible encephalopathy syndrome is a clinical-radiological characterized by decreased level of consciousness, seizures, and visual disturbances, as well as radiologically ras brain edema, predominantly in parieto-occipital white matter regions. There are many situations that can trigger the disorder, including the administration of immunosuppressants, chemotherapy agents, hypertensive disorders, and sepsis. The case is described of a patient diagnosed with stage IV prostate adenocarcinoma, receiving chemotherapy, andundergoing a posterior reversible encephalopathy syndrome after surgery for resection of brain metastasis.

Monitorización NIRS en paciente neurocrítico con embolismo aéreo y neumoencéfalo / Near infrared spectroscopy (NIRS) in a neurocritical patient with an air embolisism and pneumocephalus

El neumoencéfalo (NE) es una complicación frecuente asociada a la cirugía intracraneal. La mayoría de las colecciones son pequeñas, de comportamiento benigno y responden a terapia conservadora. No obstante, un porcentaje significativo puede comportarse como una lesión ocupante de espacio, requiriendo alto índice de sospecha e instauración temprana del tratamiento adecuado. La monitorización por niroscopia o espectrometría cercana al infrarrojo (NIRS) puede ayudar a completar el diagnóstico y tratamiento en estos casos. De igual modo, el embolismo aéreo venoso (EAV) es una complicación frecuente en los procedimientos neuroquirúrgicos que se realizan en posición sedente (PS), donde la monitorización NIRS también se ha mostrado de utilidad. En el caso presentado la niroscopia, junto a la clínica y datos gasométricos, sirvieron para el diagnóstico del NE y del EAV respectivamente durante la cirugía de fosa posterior en PS (AU)

The pneumocephalus is commonly encountered after neurosurgical procedures. The collections are usually small with benign behavior, and they respond to a conservative therapy. However, there is a high percentage of cases that may behave like a space-occupying lesion. A high index of suspicion is necessary to make the diagnosis and prompt treatment of these cases. Monitoring Near infra-red spectrometry (NIRS) monitoring could help to complete the diagnosis and treatment in these cases. A venous air embolism is a common complication in neurosurgical procedures that are performed in a sitting position, where this monitoring has also been shown to be useful. In the case presented, NIRS monitoring, along with clinical and analytical data, was used for the diagnosis of the two complications (AU)

[Near infrared spectroscopy (NIRS) in a neurocritical patient with an air embolisism and pneumocephalus]. / Monitorización NIRS en paciente neurocrítico con embolismo aéreo y neumoencéfalo.

The pneumocephalus is commonly encountered after neurosurgical procedures. The collections are usually small with benign behavior, and they respond to a conservative therapy. However, there is a high percentage of cases that may behave like a space-occupying lesion. A high index of suspicion is necessary to make the diagnosis and prompt treatment of these cases. Monitoring Near infra-red spectrometry (NIRS) monitoring could help to complete the diagnosis and treatment in these cases. A venous air embolism is a common complication in neurosurgical procedures that are performed in a sitting position, where this monitoring has also been shown to be useful. In the case presented, NIRS monitoring, along with clinical and analytical data, was used for the diagnosis of the two complications.

Utilidad del score predictivo de Cameron para la realización de traqueostomía electiva después de cirugía tumoral oral / Usefulness of the Cameron tracheostomy scoring system after oral tumor surgery

Objetivos. Analizar la aplicación del score predictivo (SP) de Cameron para la traqueostomía reglada (TR) en cirugía tumoral oral. Material y métodos. Estudio retrospectivo y descriptivo de pacientes intervenidos de cirugía tumoral oral consecutivamente entre enero de 2010 y diciembre de 2012. Se recogieron los ítems del SP: la reconstrucción y el tipo de injerto, la maxilectomía inferior, la disección bilateral cervical y la localización tumoral. Se agruparon los pacientes según el manejo de la vía aérea al final de la cirugía en 4 grupos: extubados, intubados, TR y traqueostomía urgente. Se consideró un punto de corte ≥ 5 puntos del SP para la realización de TR. Resultados. Se registraron un total de 90 pacientes. La distribución por grupos fue: extubados = 27,8% de los casos, intubados = 17,8%, TR = 53,3% y un caso (1,1%) de traqueostomía urgente. Los 3 pacientes en los que se efectuó una traqueostomía no reglada tenían un SP ≥ 5 puntos. Usando el valor del SP ≥ 5 puntos se obtuvo un valor de sensibilidad diagnóstica de 0,7 para un intervalo de confianza (IC) del 95% de 0,57-0,82 y un valor de especificidad diagnóstica de 0,9 (IC del 95% 0,79-0,99). El VPP fue de 0,9 (IC del 95% 0,81-0,99) y el VPN de 0,67 (IC del 95% 0,54-0,8). El ABC dio un valor de 0,87 (error estándar 0,36). El cociente de probabilidad positivo fue 6,48. Conclusión. La decisión de realizar una TR durante la cirugía tumoral oral puede reforzarse utilizando el SP de Cameron basándose en datos objetivos (AU)

Objectives. The aim of this study was to analyze the results of applying the predictive score (PS) of Cameron to perform elective tracheostomy (ET) in oral tumor surgery. Material and methods. A retrospective and descriptive study was conducted on consecutive patients undergoing oral tumor surgery between January 2010 and December 2012. Items of the PS were collected: reconstruction and type of graft, mandibulectomy, bilateral neck dissection, and tumor location. Patients were grouped according to the management of the airway at the end of surgery into 4 groups: extubated, intubated, ET, and urgent tracheostomy. A cutoff of ≥ 5 points PS was considered for conducting ET. Results. A total of 90 patients were included. Group distribution was: extubated = 27.8%, intubated = 17.8%, ET = 53.3%, and one case (1.1%) of urgent tracheostomy. Using the cutoff value of PS ≥ 5 points yielded a diagnostic sensitivity value of 0.7 for a 95% confidence interval (CI) (0.57 to 0.82), and a diagnostic specificity value of 0.9 (95% CI 0.79 to 0.99). The PPV was 0.9 (95% CI 0.81 to 0.99) and the NPV was 0.67 (95% CI 0.54 to 0.8). The AUC gave a value of 0.87 (standard error 0.36). The likelihood ratio was 6.48. Conclusion. The decision to perform an ET for oral tumor surgery can be enhanced using the PS of Cameron based on objective data (AU)

[Usefulness of the Cameron tracheostomy scoring system after oral tumor surgery]. / Utilidad del score predictivo de Cameron para la realización de traqueostomía electiva después de cirugía tumoral oral.

OBJECTIVES: The aim of this study was to analyze the results of applying the predictive score (PS) of Cameron to perform elective tracheostomy (ET) in oral tumor surgery. MATERIAL AND METHODS: A retrospective and descriptive study was conducted on consecutive patients undergoing oral tumor surgery between January 2010 and December 2012. Items of the PS were collected: reconstruction and type of graft, mandibulectomy, bilateral neck dissection, and tumor location. Patients were grouped according to the management of the airway at the end of surgery into 4 groups: extubated, intubated, ET, and urgent tracheostomy. A cutoff of≥5 points PS was considered for conducting ET. RESULTS: A total of 90 patients were included. Group distribution was: extubated=27.8%, intubated=17.8%, ET=53.3%, and one case (1.1%) of urgent tracheostomy. Using the cutoff value of PS≥5 points yielded a diagnostic sensitivity value of 0.7 for a 95% confidence interval (CI) (0.57 to 0.82), and a diagnostic specificity value of 0.9 (95% CI 0.79 to 0.99). The PPV was 0.9 (95% CI 0.81 to 0.99) and the NPV was 0.67 (95% CI 0.54 to 0.8). The AUC gave a value of 0.87 (standard error 0.36). The likelihood ratio was 6.48. CONCLUSION: The decision to perform an ET for oral tumor surgery can be enhanced using the PS of Cameron based on objective data.

Anestesia para la craneotomía en el paciente consciente / Anesthesia for craniotomy in the conscious patient

La craneotomía en el paciente consciente (CPC) permite valorar los cambios neurológicos durante la obtención de mapas neurológicos en la cirugía de la epilepsia, la localización de los electrodos durante la cirugía de estimulación cerebral profunda y la extirpación tumoral en áreas elocuentes del cerebro. La CPC consciente es útil para realizar cirugía radical, minimizando el daño en las zonas funcionales del cerebro. El anestesiólogo debe asegurar un adecuado bienestar al paciente, una óptima analgesia y garantizar su colaboración. Se debe realizar una adecuada selección conjunta de los posibles candidatos con todos los profesionales implicados en el caso. El conocimiento de las distintas fases de esta forma de craneotomía, la coordinación y comunicación entre los especialistas, el dominio de la farmacología y de las técnicas anestésicas específicas, junto con la capacidad de comunicación psicoemocional con el paciente, son los determinantes del éxito del procedimiento, que debe someterse, además, a la cultura de seguridad. El objetivo de esta revisión es describir el tratamiento anestésico integral, las consideraciones neurofisiológicas y las complicaciones intraoperatorias de la CPC(AU)

Craniotomy in the conscious patient (CPC) enables the neurological changes to be assessed during the mapping in epilepsy surgery, the location of the electrodes during deep brain stimulation surgery, and tumor resection in eloquent areas of the brain. CPC is a useful technique for radical surgery in order to minimize the damage to the functional areas of the brain. The anesthesiologist must ensure, adequate patient comfort, analgesia and ensure optimal collaboration. The appropriate selection of potential candidates for CPC should be made jointly with all professionals involved in the case. Knowledge of the different phases of CPC, coordination and communication among specialists, the right management of the pharmacology, and anesthetic techniques specific to CPC, along with the ability of psycho-emotional communication with the patient, determine the success of the procedure to be performed in the culture of patient safety. The aim of this review was to describe the anesthetic management, comprehensive considerations, and intraoperative neurophysiological tests for CPC(AU)

[Anesthesia for craniotomy in the conscious patient]. / Anestesia para la craneotomía en el paciente consciente.

Craniotomy in the conscious patient (CPC) enables the neurological changes to be assessed during the mapping in epilepsy surgery, the location of the electrodes during deep brain stimulation surgery, and tumor resection in eloquent areas of the brain. CPC is a useful technique for radical surgery in order to minimize the damage to the functional areas of the brain. The anesthesiologist must ensure, adequate patient comfort, analgesia and ensure optimal collaboration. The appropriate selection of potential candidates for CPC should be made jointly with all professionals involved in the case. Knowledge of the different phases of CPC, coordination and communication among specialists, the right management of the pharmacology, and anesthetic techniques specific to CPC, along with the ability of psycho-emotional communication with the patient, determine the success of the procedure to be performed in the culture of patient safety. The aim of this review was to describe the anesthetic management, comprehensive considerations, and intraoperative neurophysiological tests for CPC.

El cuidado anestésico en Oftalmología / Anaesthetic care in Ophthalmology

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[Pharmacologic treatment for 2 thrombocytopenic patients prior to neurosurgery]. / Tratamiento farmacológico preoperatorio de dos pacientes trombopénicos para intervención neuroquirúrgica.

Preoperative prophylaxis of hemorrhage for patients with thrombocytopenia or a platelet disorder is controversial. Platelet count correlates to a certain degree with risk of hemorrhage, and risk factors for hemorrhage should be assessed and treated before deciding on perioperative treatments. Thirteen percent of cirrhotic patients have a platelet count between 50,000 and 75,000/microL and thrombocytopenia is multifactorial in origin. Idiopathic thrombocytopenic purpura is an acquired disease; since it may be either primary or secondary to other conditions, treatment may vary considerably. No clinical method has been established for predicting risk of perioperative bleeding in patients with thrombocytopenia. We describe 2 thrombocytopenic patients scheduled for intracranial surgery who were treated with thrombopoietic growth factors; in both cases, platelet counts increased sufficiently for this type of surgery. Controlled clinical trials are needed to ascertain the safety and prophylactic utility of platelet transfusion and thrombopoietin analogs in certain situations of refractory thrombocytopenia.

Tratamiento farmacol¨®gico preoperatorio de dos pacientes trombop¨¦nicos para intervenci¨®n neuroquir¨²rgica / Pharmacologic treatment for 2 thrombocytopenic patients prior to neurosurgery

El tratamiento y la profilaxis de la hemorragia del paciente con trombopenia o con alteraciones de la funci¨®n plaquetaria son controvertidos. El recuento plaquetario se correlaciona parcialmente con el riesgo hemorr¨¢gico. Existen factores de riesgo hemorr¨¢gico que deben ser evaluados y tratados antes de decidir el tratamiento perioperatorio. El 13% de los pacientes cirr¨®ticos tienen un recuento de plaquertas entre 50.000-75.000/¦ÌL, siendo la trombopenia de origen multifactorial. La p¨²rpura trombop¨¦nica idiop¨¢tica, PTI, es una enfermedad adquirida bien de forma primaria o secundaria a otras enfermedades, siendo la evoluci¨®n y el tratamiento de ambas formas bastante diferente. No hay m¨¦todos cl¨ªnicos que predigan el riesgo de hemorragia perioperatoria en pacientes con trombopenia. Se presentan dos casos de pacientes con trombopenia programados para cirug¨ªa intracraneal, tratados con factores de crecimiento de la trombopoyesis. En ambos casos se consigui¨® un recuento plaquetar acorde al tipo de intervenci¨®n. Se necesitan ensayos cl¨ªnicos controlados que determinen la seguridad, la utilidad profil¨¢ctica de la transfusi¨®n de plaquetas y de los an¨¢logos de la trombopoyetina en algunas situaciones refractarias de trombopenia(AU)

Preoperative prophylaxis of hemorrhage for patients with thrombocytopenia or a platelet disorder is controversial. Platelet count correlates to a certain degree with risk of hemorrhage, and risk factors for hemorrhage should be assessed and treated before deciding on perioperative treatments. Thirteen percent of cirrhotic patients have a platelet count between 50 000 and 75 000/¦ÌL and thrombocytopenia is multifactorial in origin. Idiopathic thrombocytopenic purpura is an acquired disease; since it may be either primary or secondary to other conditions, treatment may vary considerably. No clinical method has been established for predicting risk of perioperative bleeding in patients with thrombocytopenia. We describe 2 thrombocytopenic patients scheduled for intracranial surgery who were treated with thrombopoietic growth factors; in both cases, platelet counts increased sufficiently for this type of surgery. Controlled clinical trials are needed to ascertain the safety and prophylactic utility of platelet transfusion and thrombopoietin analogs in certain situations of refractory thrombocytopenia(AU)

[Respiratory failure from upper airway collapse following anterior cervical spine surgery]. / Insuficiencia respiratoria por obstrucción de la vía aérea superior en el postoperatorio de la cirugía de columna cervical por vía anterior.

OBJECTIVES: To determine the frequencies of variables that might predispose to upper airway collapse in a series of patients undergoing anterior cervical spine surgery. PATIENTS AND METHODS: Retrospective review of the medical records of 204 patients who underwent anterior cervical spine neurosurgery between 2003 and 2009. We gathered information on perioperative variables that might be related to upper airway collapse, on whether intensive care unit admission was planned or not, and on the moment when obstruction developed. RESULTS: Partial obstruction occurred in 7 cases (3.4%); 4 (1.9%) resolved with tracheal intubation and 3 (1.5%) required emergency tracheostomy. None of the variables were significantly associated with the development of postoperative upper airway obstruction in these patients. CONCLUSIONS: Upper airway obstruction after anterior cervical spine surgery is an unforeseen event and the emergency assessment of the airway may not coincide with the assessment of the anesthetist during the preanesthetic visit. This event may constitute an emergency for which preparation times and resources may differ from those available when this complication is foreseen. The problem for the anesthetist is not the impossibility of tracheal intubation but rather the difficulty of ventilating through a facial mask or supraglottic device, possibly with life-threatening consequences.

Insuficiencia respiratoria por obstrucción de la vía aérea superior en el postoperatorio de la cirugía de columna cervical por vía anterior / Respiratory failure from upper airway collapse following anterior cervical spine surgery

OBJETIVOS: Determinar la frecuencia y las variables que predisponen a una obstrucción de la vía aérea superior en una serie de procedimientos quirúrgicos por vía anterior en la columna cervical. PACIENTES Y MÉTODOS: Revisión retrospectiva de 204 historias clínicas de pacientes operados de cirugía de columna cervical por vía anterior, por el servicio de neurocirugía, entre 2003 y 2009. Se recogieron las variables perioperatorias que pudieran influir en la aparición de obstrucción respiratoria de la vía aérea superior, el ingreso programado o no en la unidad de cuidados intensivos y el momento de aparición de la complicación. RESULTADOS: En 7 casos (3,4%) se produjo obstrucción parcial de la vía aérea superior, de los cuales 4 (1,9%) se resolvieron mediante intubación traqueal mientras que 3 (1,5%) requirieron una traqueostomía urgente. No hubo diferencias estadísticamente significativas entre las variables estudiadas y la aparición de obstrucción de la vía aérea superior en el postoperatorio. CONCLUSIONES: La obstrucción de la vía aérea superior asociada a la cirugía de columna cervical por vía anterior es una circunstancia inesperada, en la que además la valoración urgente de la vía aérea superior puede no coincidir con la realizada en la consulta preanestésica. En algunas ocasiones constituye una emergencia quirúrgica, por lo que los tiempos de preparación y los recursos difieren de una situación prevista. El problema anestésico no es la imposibilidad para la intubación traqueal, sino la dificultad para la ventilación con mascarilla facial o dispositivos supraglóticos, que cuando se ve comprometida supone un peligro para la vida del paciente(AU)

OBJETIVES: To determine the frequencies of variables that might predispose to upper airway collapse in a series of patients undergoing anterior cervical spine surgery. PATIENTS AND METHODS: Retrospective review of the medical records of 204 patients who underwent anterior cervical spine neurosurgery between 2003 and 2009. We gathered information on perioperative variables that might be related to upper airway collapse, on whether intensive care unit admission was planned or not, and on the moment when obstruction developed. RESULTS: Partial obstruction occurred in 7 cases (3.4%); 4 (1.9%) resolved with tracheal intubation and 3 (1.5%) required emergency tracheostomy. None of the variables were significantly associated with the development of postoperative upper airway obstruction in these patients. CONCLUSIONS: Upper airway obstruction after anterior cervical spine surgery is an unforeseen event and the emergency assessment of the airway may not coincide with the assessment of the anesthetist during the preanesthetic visit. This event may constitute an emergency for which preparation times and resources may differ from those available when this complication is foreseen. The problem for the anesthetist is not the impossibility of tracheal intubation but rather the difficulty of ventilating through a facial mask or supraglottic device, possibly with lifethreatening consequences(AU)

[Patient satisfaction with anesthetic care monitored during phacoemulsification]. / Satisfacción del paciente con el cuidado anestésico monitorizado durante la facoemulsificación.

OBJECTIVES: To assess satisfaction with anesthesia during cataract surgery, as a quality indicator for such surgery. MATERIAL AND METHODS: Patients undergoing cataract surgery with topical and intracameral anesthesia were studied prospectively. We analyzed patient characteristics, physical status, postoperative pain, duration of surgery, administration of an intraoperative sedative, systemic complications, and satisfaction on the Iowa Satisfaction with Anesthesia Scale (ISAS). For patients operated on both eyes, the ISAS score in the first (ISAS1) and second (ISAS2) interventions were compared. RESULTS: A total of 233 patients were included in the study; 36 of them (15.5%) had ISAS scores of less than 5.4. The median ISAS score was 6.0 (interquartile range [IQR], 5.6-6.0). In the 71 patients operated on both eyes, the ISAS1 score was significantly lower than the ISAS2 score. Ten patients (4.3%) had visual analog scores of 3 or more in the postoperative period. Complications developed in 2.9% of the procedures (9/304). The median duration of surgery was 9 minutes (IQR, 8-10 minutes). Postoperative pain was the only factor that predicted a lower level of satisfaction. CONCLUSIONS: Pain is common during phacoemulsification and is the main cause of patient dissatisfaction with anesthetic care.

Satisfacción del paciente con el cuidado anestésico monitorizado durante la facoemulsificación / Patient satisfaction with anesthetic care monitored during phacoemulsification

OBJETIVOS: Evaluar la satisfacción con el cuidadoanestésico monitorizado como indicador de calidad en lacirugía de cataratas.MATERIALES Y MÉTODOS: Se realizó un estudio prospectivoen pacientes intervenidos de cataratas con anestesiatópica e intracamerular. Se analizaron las variablesdemográficas, el estado físico del paciente, dolorpostoperatorio, el tiempo quirúrgico, la administraciónde sedación intraoperatoria, las complicaciones sistémicasy la satisfacción según la escala de Iowa de satisfaccióncon la anestesia (EISA). Se comparó la EISA en laprimera y segunda intervención (EISA1 y EISA2 respectivamente)en los pacientes que se operaron de los dosojos durante el estudio.RESULTADOS: 233 pacientes fueron incluidos en el estudio,de los que un 15,5% (n = 36) tuvo un bajo grado desatisfacción (EISA < 5,4). La mediana muestral de laEISA fue de 6,0 (recorrido intercuartílico 5,6-6,0). En lospacientes operados de los 2 ojos (n = 71) la EISA1 fuesignificativamente menor que la EISA2. El 4,3% (n = 10)de los pacientes tuvo una escala visual analógica (EVA)≥ 3 en el postoperatorio. La frecuencia de complicacionesfue del 2,9 % (n = 9/304). La mediana del tiempoquirúrgico fue de 9 (recorrido intercuartílico 8-10) min.El dolor postoperatorio fue el único factor predictivo delos estudiados de un menor grado de satisfacción.CONCLUSIONES: El dolor perioperatorio es frecuente yes la causa principal de insatisfacción del paciente con elcuidado anestésico durante la facoemulsificaciónOBJETIVOS: Evaluar la satisfacción con el cuidadoanestésico monitorizado como indicador de calidad en lacirugía de cataratas.MATERIALES Y MÉTODOS: Se realizó un estudio prospectivoen pacientes intervenidos de cataratas con anestesiatópica e intracamerular. Se analizaron las variablesdemográficas, el estado físico del paciente, dolorpostoperatorio, el tiempo quirúrgico, la administraciónde sedación intraoperatoria, las complicaciones sistémicasy la satisfacción según la escala de Iowa de satisfaccióncon la anestesia (EISA). Se comparó la EISA en laprimera y segunda intervención (EISA1 y EISA2 respectivamente)en los pacientes que se operaron de los dosojos durante el estudio.RESULTADOS: 233 pacientes fueron incluidos en el estudio,de los que un 15,5% (n = 36) tuvo un bajo grado desatisfacción (EISA < 5,4). La mediana muestral de laEISA fue de 6,0 (recorrido intercuartílico 5,6-6,0). En lospacientes operados de los 2 ojos (n = 71) la EISA1 fuesignificativamente menor que la EISA2. El 4,3% (n = 10)de los pacientes tuvo una escala visual analógica (EVA)≥ 3 en el postoperatorio. La frecuencia de complicacionesfue del 2,9 % (n = 9/304). La mediana del tiempoquirúrgico fue de 9 (recorrido intercuartílico 8-10) min.El dolor postoperatorio fue el único factor predictivo delos estudiados de un menor grado de satisfacción.CONCLUSIONES: El dolor perioperatorio es frecuente yes la causa principal de insatisfacción del paciente con el cuidado anestésico durante la facoemulsificación

OBJECTIVES: To assess satisfaction with anesthesia during cataract surgery, as a quality indicator for such surgery. MATERIAL AND METHODS: Patients undergoing cataract surgery with topical and intracameral anesthesia were studied prospectively. We analyzed patient characteristics, physical status, postoperative pain, duration of surgery, administration of an intraoperative sedative, systemic complications, and satisfaction on the Iowa Satisfaction with Anesthesia Scale (ISAS). For patients operated on both eyes, the ISAS score in the first (ISAS1) and second (ISAS2) interventions were compared. RESULTS: A total of 233 patients were included in the study; 36 of them (15.5%) had ISAS scores of less than 5.4. The median ISAS score was 6.0 (interquartile range [IQR], 5.6-6.0). In the 71 patients operated on both eyes, the ISAS1 score was significantly lower than the ISAS2 score. Ten patients (4.3%) had visual analog scores of 3 or more in the postoperative period. Complications developed in 2.9% of the procedures (9/304). The median duration of surgery was 9 minutes (IQR, 8-10 minutes). Postoperative pain was the only factor that predicted a lower level of satisfaction. CONCLUSIONS: Pain is common during phacoemulsification and is the main cause of patient dissatisfaction with anesthetic care