[First-year medical residents' self-assessment of skill in basic life support and automatic external defibrillation]. / Percepción de los residentes de primer año de sus competencias en soporte vital básico y desfibrilación automática externa.

OBJECTIVE: To determine first-year medical residents' perception of their competence in basic life support (BLS) and the use of automatic external defibrillation (AED). MATERIAL AND METHODS: Course in BLS and AED accredited by the European Resuscitation Council with pre- and post-course self-assessment. The post-training questionnaire was administered immediately after the course and 8 months later. The data recorded covered (a) prior training and experience, (b) self-assessment of BLS and AED skills (9 items, scored 1-5), (c) the skill considered most difficult, and (d) satisfaction (13 items, scored 0-10). RESULTS: The questionnaire was initially completed by 71 residents; 31 also responded 8 months later. Self-assessment scores improved immediately after the course (P = .0001). Scores had fallen 8 months later (P = .0001) but were still significantly higher than pre-course perception of skill (P = .017). More than 95% of the residents considered themselves to be competent after the course and more than 80% felt competent 8 months later, with the exception of skills in bag-mask ventilation (74.2%) and removal of a foreign body (61.3%). The skill considered most difficult was bag-mask ventilation. Mean (SD) BLS and AED scores for real-life situations were 8.48 (1.33) and 9.19 (0.94), respectively, after the course and 7.32 (1.4) and 7.29 (1.32) at 8 months (P = .0001). Overall satisfaction was high. CONCLUSIONS: The residents perceived themselves as competent to give BLS and AED immediately after the course and 8 months after training, although fewer felt as competent at the second assessment. Bag-mask ventilation was considered the most difficult skill.

Percepción de los residentes de primer año de sus competencias en soporte vital básico y desfibrilación automática externa / First-year medical residents’ self-assessment of skill in basic life support and automatic external defibrillation

OBJETIVOS: Evaluar la opinión de residentes de primeraño sobre sus competencias en soporte vital básico(SVB) y desfibrilación automática externa (DAE).MATERIAL Y MÉTODOS: Curso acreditado de SVB yDAE según el European Resuscitation Council. Encuestaantes, inmediatamente después del curso y a los 8 meses.Datos registrados: a) formación y experiencia previas; b)autoevaluación de habilidades para SVB y DAE (9ítems; puntuación: 1-5); c) habilidad considerada másdifícil; d) encuesta de satisfacción (13 ítems; puntuación:0-10).RESULTADOS: El estudio inicial incluyó 71 residentesde los cuales 31 cumplimentaron también la encuesta alos 8 meses. La autoevaluación mejoró después del curso(p = 0,0001). A los 8 meses las puntuaciones empeoraron(p = 0,0001) pero se mantuvieron significativamentesuperiores a las iniciales (p < 0,017). Más del 95% de losresidentes se consideraron competentes después del cursoy más del 80% a los 8 meses, excepto para la ventilacióncon bolsa-mascarilla (74,2%) y la liberación decuerpo extraño (61,3%). La habilidad considerada másdifícil fue la ventilación con bolsa-mascarilla. La valoraciónde las competencias para SVB y DAE en situaciónreal fue 8,48 (±1,33) y 9,19 (±0,94) después del curso y7,32 (±1,4) y 7,29 (±1,32) a los 8 meses (p = 0,0001). Lasatisfacción global fue alta.CONCLUSIONES: Los residentes consideraron que erancompetentes para aplicar SVB y DAE inmediatamentedespués del curso y a los 8 meses de su formación, aunqueen menor grado. La habilidad considerada más difícilfue la ventilación con bolsa-mascarilla(AU)

OBJECTIVE: To determine first-year medical residents’perception of their competence in basic life support (BLS)and the use of automatic external defibrillation (AED).MATERIAL AND METHODS: Course in BLS and AEDaccredited by the European Resuscitation Council withpre- and post-course self-assessment. The post-trainingquestionnaire was administered immediately after thecourse and 8 months later. The data recorded covered a)prior training and experience, b) self-assessment of BLSand AED skills (9 items, scored 1-5), c) the skill consideredmost difficult, and d) satisfaction (13 items, scored 0-10).RESULTS: The questionnaire was initially completed by71 residents;, 31 also responded 8 months later. Selfassessmentscores improved immediately after the course(P=.0001). Scores had fallen 8 months later (P=.0001) butwere still significantly higher than pre-course perceptionof skill (P=.017). More than 95% of the residentsconsidered themselves to be competent after the courseand more than 80% felt competent 8 months later, withthe exception of skills in bag-mask ventilation (74.2%)and removal of a foreign body (61.3%). The skillconsidered most difficult was bag-mask ventilation.Mean (SD) BLS and AED scores for real-life situationswere 8.48 (1.33) and 9.19 (0.94), respectively, after thecourse and 7.32 (1.4) and 7.29 (1.32) at 8 months(P=.0001). Overall satisfaction was high.CONCLUSIONS: The residents perceived themselves ascompetent to give BLS and AED immediately after thecourse and 8 months after training, although fewer feltas competent at the second assessment. Bag-maskventilation was considered the most difficult skill(AU)

Reflexiones sobre las interconsultas en Anestesiología / Considerations about preoperative medical consultations in Anestesiology

No disponible

[Postoperative respiratory alkalosis as a complication of neuroendoscopy]. / Alcalosis respiratoria postoperatoria como complicación de la neuroendoscopia.

Endoscopic neurosurgery is a minimally invasive technique that has been developing rapidly. It is mainly indicated for the treatment of hydrocephaly due to ventriculocisternostomy, biopsies of cerebral ventricular lesions, evacuation of cerebral hematomas and spinal surgery. Hemorrhage, infection and spinal fluid fistula are known complications. We report the appearance of symptomatic postoperative respiratory alkalosis in a patient who underwent ventriculocisternostomy by endoscopic neurosurgery. The underlying disease was obstructive hydrocephaly secondary to partial stenosis of the Silvius aqueduct.

[Fluid therapy without glucose in neurosurgery. Effect on glycemia]. / Fluidoterapia sin aporte de glucosa en neurocirugía. Repercusiones sobre la glucemia.

INTRODUCTION: Glucose administration to patients about to undergo neurosurgery must be avoided because perioperative cerebral ischemia in a context of hyperglycemia worsens the neurological prognosis. Furthermore, prolonged hypoglycemia can also provoke lesions that resemble those occasioned by states of ischemia-hypoxia. OBJECTIVES: To evaluate glycemic changes in patients undergoing craniotomy who have not received glucose-containing solutions. PATIENTS AND METHODS: Forty-six patients were enrolled and assigned to two groups according to whether they received perioperative corticoid treatment (CC, n = 24) or not (NCC, n = 22). Fasting was maintained without administration of glucose-containing solutions. We measured glycemia, natremia and potassemia at baseline and 60 minutes after surgery. RESULTS: Demographic characteristics, duration of surgery (5.0 +/- 1.6 h in the CC group and 4.6 +/- 1.4 h in the NCC group) and fasting period (18 +/- 2.3 h in the CC group and 17 +/- 1.9 h in the NCC group) were similar in both groups. Glycemia increased and natremia decreased significantly in both groups, with no clinical repercussions. No case of perioperative hypoglycemia occurred. Initial potassemia in the CC group was significantly higher than in the NCC group, but decreased after surgery with no clinical repercussions. No relation was found between fasting time, duration or surgery and differences in glycemia between the two groups. CONCLUSION: Non-administration of glucose in patients undergoing craniotomy eliminates the risk of hyperglycemia, does not lead to perioperative hypoglycemia and is not affected by perioperative corticoid treatment.