Factores meteorológicos y urgencias psiquiátricas / Meteorological factors and psychiatric emergencies

Introducción. En el ámbito psiquiátrico los trabajos relacionados con la biometeorología suelen coincidir al reconocer un ritmo estacional en la presentación de los trastornos depresivos, suicidios violentos y episodios maníacos, existiendo discrepancias respecto a la correlación con otros cuadros. El objetivo de este trabajo es revisar una amplia muestra de población residente en las comarcas del Baix Camp/Tarragona, atendida en el Servicio de Urgencias de nuestro hospital, con el fin de valorar si existen variables meteorológicas que se correlacionen con el número total de urgencias diarias. Metodología. Se recopilan los datos de 3.048 visitas atendidas en el Servicio de Urgencias del Institut Pere Mata de Reus (Tarragona) desde el 1 de enero de 2003 hasta el 31 de diciembre de 2005. Se analiza estadísticamente la posible relación entre el número de visitas diarias y las distintas variables meteorológicas (dirección y velocidad del viento, temperatura, humedad, presión atmosférica y radiación solar). Resultados. Los resultados fueron estadísticamente significativos para las variables de temperatura media (TMED), temperatura máxima (TMAX) y temperatura mínima (TMIN). La relación entre la humedad y el número de visitas diarias también fue estadísticamente significativa (distribución no lineal). El resto de comparaciones no alcanzaron significación estadística. Conclusiones. Se constata la existencia de una relación directa entre el incremento de la temperatura ambiental y el aumento en el número de pacientes atendidos de urgencia. Respecto a la humedad también se pudo evidenciar una relación. Este hecho puede sugerir la necesidad de una adecuada planificación asistencial durante los períodos más cálidos y húmedos (AU)

Introduction. Studies conducted in the psychiatric setting and related with biometeorology generally coincide that there is a seasonal rhythm between seasons and depressive disorders, violent suicides and manic episodes. However, there are many discrepancies about the correlation of specific meteorological variables with the remaining clinical pictures. This work has aimed to study a wide sample of psychiatric cases in this area (Baix Camp/Tarragona) to see whether there is a relationship between meteorological variables and the total number of daily emergencies. Method. We recorded the data of 3,048 cases attended in the Emergency Department of the Hospital Pere Mata de Reus (Tarragona) from January 1, 2003 to December 31, 2005. The possible relationship between the number of daily visits and different meteorological endpoints (such as wind direction and speed, temperature, humidity, atmospheric pressure and solar radiation) were analyzed statistically. Results. The results were statistically significant for the meteorological endpoints of medium temperature (TMED), maximum temperature (TMAX) and minimum temperature (TMIN). The relationship between humidity and number of daily visits was also statistically significant (non-linear form). The remaining comparisons did not reach statistical significance. Conclusions. The main conclusion of our study is that there is a direct relationship between environmental temperature increase and the number of patients attended in the hospital emergency department. A relationship could also be observed in regards to humidity. This fact may suggest the need to have suitable medical attendance planning for the hottest and most humid periods (AU)

[Meteorological factors and psychiatric emergencies]. / Factores meteorológicos y urgencias psiquiátricas.

INTRODUCTION: Studies conducted in the psychiatric setting and related with biometeorology generally coincide that there is a seasonal rhythm between seasons and depressive disorders, violent suicides and manic episodes. However, there are many discrepancies about the correlation of specific meteorological variables with the remaining clinical pictures. This work has aimed to study a wide sample of psychiatric cases in this area (Baix Camp/Tarragona) to see whether there is a relationship between meteorological variables and the total number of daily emergencies. METHOD: We recorded the data of 3,048 cases attended in the Emergency Department of the Hospital Pere Mata de Reus (Tarragona) from January 1, 2003 to December 31, 2005. The possible relationship between the number of daily visits and different meteorological endpoints (such as wind direction and speed, temperature, humidity, atmospheric pressure and solar radiation) were analyzed statistically. RESULTS: The results were statistically significant for the meteorological endpoints of medium temperature (TMED), maximum temperature (TMAX) and minimum temperature (TMIN). The relationship between humidity and number of daily visits was also statistically significant (non-linear form). The remaining comparisons did not reach statistical significance. CONCLUSIONS: The main conclusion of our study is that there is a direct relationship between environmental temperature increase and the number of patients attended in the hospital emergency department. A relationship could also be observed in regards to humidity. This fact may suggest the need to have suitable medical attendance planning for the hottest and most humid periods.

Control del dolor postoperatorio en hemorroidectomía ambulatoria mediante infusión endovenosa continua domiciliaria / Management of postoperative pain in outpatient hemorrhoidectomy with home continuous endovenous infusion

Introducción:El dolor postoperatorio moderado-severo sigue siendoun problema en cirugía ambulatoria, ya que provoca problemasde flujo de pacientes, retrasando el alta de los pacientes,siendo uno de los principales motivos de reingresoen los hospitales, y por tanto un importante indicadorde calidad de estas Unidades. El empleo de técnicas analgésicasinvasivas domiciliarias, en todos sus regímenes,puede controlar el dolor postoperatorio en estas intervencionesy permitir incluirlas en los programas de cirugíaambulatoria.Objetivos:El objetivo de nuestro estudio es valorar la viabilidad y laseguridad de la utilización de bombas de perfusión continuaelastoméricas para la administración de analgesia endovenosacontinua domiciliaria, a la vez que valorar la eficaciaanalgésica y el grado de satisfacción de los pacientesintervenidos de hemorroidectomía en régimen ambulatorio.Material y métodos:Estudio prospectivo simple en 61 pacientes. Una vez intervenidosbajo estrategia de analgesia multimodal, se lescoloca una bomba elastomérica endovenosa a 5 ml.h-1 con16.000 mg de metamizol, 500 mg de tramadol y 16 mg deondansetrón en un reservorio de 275 ml. En el domicilio,la Unidad de Atención Domiciliaria realiza revisiones de laintegridad del sistema infusor y de la vía endovenosa, detecciónde efectos secundarios e incidentes atribuibles alsistema y retiradas precoces durante las 48 horas delpostoperatorio.Resultados:De los 61 pacientes, sólo se registra un caso (1,63%) dedolor severo durante el primer día del postoperatorio. Un81,96% de los pacientes no tienen dolor durante el primerdía, 95% el segundo y 98,35% el tercer día. Un 9,83% delos pacientes precisan rescate con tramadol. Veinte pacientespresentan efectos secundarios atribuibles a los analgésicos.Dos casos de retirada precoz del sistema infusor porintolerancia al tramadol. En un 91,8% de los pacientes semostró un alto grado de satisfacción con el sistema infusory el procedimiento.Conclusión:Nuestro estudio demuestra la viabilidad y seguridad de lautilización de infusores elastoméricos endovenosos comométodo de analgesia postoperatoria, que permiten controlarlos casos de dolor moderado a severo en procedimientosaplicados a la cirugía ambulatoria. Sin embargo se necesitanmás estudios comparativos con técnicas analgésicasconvencionales, así como con diferentes regímenes de infusión

Introduction:Moderate to severe postoperative pain is still a problemin outpatient surgery, since it causes patient flow problemsand delays the discharge of patients, being one of the majorcauses of re-hospitalization and hence a relevant qualityindicator of these Units. The use of home invasive analgesictechniques, in all their regimes, can be effective for themanagement of postoperative pain in these surgical proceduresand allow them to be included in outpatient surgeryprograms.Objectives:The aim of our study was to determine the feasibilityand safety of the use of elastomeric continuous perfusionpumps for the administration of home continuous endovenousanalgesia, as well as to assess analgesic effectivenessand degree of satisfaction of patients undergoing outpatienthemorrhoidectomy. Material and methods:We conducted a simple prospective study in 61 patients.After the surgical procedure was performed under multimodalanalgesia, an elastomeric endovenous pump operatingat 5 ml.h-1 with 16,000 mg of metamizol, 500 mg oftramadol and 16 mg of ondansetron in a 275 ml reservoirwas used. At home, the Home Care Unit checked the perfusionsystem and the endovenous access, detected side effectsand events attributable to the system and withdrewthe system prematurely during the first 48 hours of postoperative.Results:Just 1 out of 61 patients of the study (1.63%) had severepain during the first day of postoperative, compared to81.96% of patients that did not have pain at day 1, 95% atday 2 and 98.35% at day 3. The 9,83% of patients requiredrescue therapy with tramadol and 20 patients reportedside effects attributable to analgesics. There were two casesof early withdrawal of the infusion system because ofintolerance to tramadol. A 91.8% of patients reported ahigh degree of satisfaction with the infusion system and theprocedure.Conclusion:Our study has shown the feasibility and safety of the useof endovenous elastomeric infusion pumps as a method ofpostoperative analgesia that allow to manage cases of moderateor severe pain after outpatient surgical procedures.However, further studies are required to compare this techniquewith conventional analgesic techniques, as well aswith different infusion regimes

Analgesic effect of intra-articular ketorolac in knee arthroscopy: comparison of morphine and bupivacaine.

This prospective study assessed the postoperative analgesic effect of intra-articular ketorolac, morphine, and bupivacaine during arthroscopic outpatient partial meniscectomy. Group 1 patients (n=20) received postoperative injection of 60 mg intra-articular ketorolac, group 2 patients (n=20) 10 cc intra-articular bupivacaine 0.25%, group 3 patients (n=20) 1 mg intra-articular morphine diluted in 10 cc saline, and group 4 patients (n=20, controls) only 10 cc saline. We evaluated the postoperative analgesic effect (period measured from the end of the surgery until further analgesia was demanded), the level of postoperative pain (by visual analog scale 1, 2, 3, 12, and 24 h after surgery), and the need for additional pain medication (during the first 24 h after surgery). The best analgesic effect was in patients treated with intra-articular ketorolac, and this was statistically significant in: postoperative analgesic effect and the need for additional pain medication immediately after surgery, and after 24 h. No complications were found related to the intra-articular treatment. We conclude that 60 mg intra-articular ketorolac provides better analgesic effect than 10 cc intra-articular bupivacaine 0.25% or 1 mg intra-articular morphine.

Analgesia postoperatoria en cirugía mayor ambulatoria / Postoperative analgesia in outpatient major surgery

La aplicación de nuevas técnicas analgésicas en el ámbito de la cirugía ambulatoria puede ser un factor importante para aumentar el número de procedimientos tributarios de realizarse sin ingreso hospitalario. La utilización de regímenes analgésicos multimodales mediante la utilización de nuevos fármacos no opioides y anestésicos locales se ha demostrado eficaz en la disminución de los marcadores del dolor postoperatorio y en la disminución de los requerimientos analgésicos. La analgesia preventiva, aunque discutida, parece tener un lugar en los protocolos de analgesia para cirugía ambulatoria. En casos de dolor postoperatorio severo puede ser útil el empleo de técnicas analgésicas invasivas mediante el mantenimiento de vías endovenosas o subcutáneas para la administración de analgésicos, o la utilización de técnicas regionales continuas para la infusión de anestésicos locales, contando siempre con la supervisión y el apoyo del personal de Unidades de Atención Domiciliaria (AU)

[Hypotension refractory to ephedrine after sympathetic blockade in a patient on long-term therapy with tricyclic antidepressants]. / Hipotensión por bloqueo simpático refractaria a efedrina en una paciente en tratamiento crónico con antidepresivos tricíclicos.

A 61-year-old woman in chronic treatment with 25 mg of amitriptyline underwent ovarian cancer resection under combined general and epidural lumbar anesthesia. After administration of local anesthetic she presented signs of severe arterial hypotension that was refractory to high doses of ephedrine and administration of dopamine alpha-adrenergic substances. Control was achieved with 200 micrograms of noradrenaline. We review the anesthetic implications of chronic use of tricyclic antidepressives as they affect choice of vasopressin for treating hypotensive events during anesthesia.