[Agreement between verbal numerical scale and visual analog scale assessments in monitoring acute postoperative pain]. / Concordancia entre la escala verbal numérica y la escala visual analógica en el seguimiento del dolor agudo postoperatorlo.

OBJECTIVE: To determine the agreement between verbal numerical and visual analog scale assessments of acute postoperative pain on 3 consecutive days. METHODS: Pain data were recorded for 2 months for sequentially enrolled patients receiving parenteral opioids or neuraxial blocks for analgesia after major surgery in a tertiary level hospital. Each patient was asked to assess pain on the visual analog and verbal numerical scales every 24 hours for 3 consecutive days. Agreement was estimated by the intraclass correlation coefficient and the Spearman correlation coefficient. The results were analyzed in 2 age strata: age 65 years or younger and older than 65 years. RESULTS: Data for 159 patients (105 < or =65 years; 54 >65 years) were analyzed. The visual analog scale could not be used with 12 patients; all patients were able to assess pain on the verbal numerical scale. The intraclass correlation coefficient was > 0.70 for all 3 days; the highest coefficients were for patients over 65 years of age. CONCLUSIONS: Agreement between pain assessments on the visual analog and verbal numerical scales can be considered good or very good on all 3 days, with stronger agreement when the scales are used in patients over the age of 65 years. Cooperation was better for the numerical scale than for the visual analog scale. Scores on the verbal numerical scale were consistently higher than scores on the visual analog scale.

Concordancia entre la escala verbal numérica y la escala visual analógica en el seguimiento del dolor agudo postoperatorio / Agreement between verbal numerical scale and visual analog scale assessments in monitoring acute postoperative pain

Objetivo: Evaluar la concordancia entre la escala verbal numérica y la escala visual analógica en la valoración del seguimiento del dolor agudo postoperatorio durante 3 días consecutivos. Métodos: Recogida secuencial de datos a los pacientes sometidos a cirugía mayor subsidiaria de pauta de analgesia postoperatoria con opiáceos parenterales o técnicas neuroaxiales en un hospital terciario durante 2 meses consecutivos. Se interrogó a los pacientes durante 3 días consecutivos con intervalos de 24 horas mediante las escalas visual numérica (EVN) y visual analógica (EVA). Para valorar la concordancia entre variables cuantitativas se utilizó el coeficiente de correlación intraclase, y coeficiente de correlación de Spearman, estratificándose los resultados por edad (menos o mayor de 65 años). Resultados: Se analizaron datos de 159 pacientes (105 <= 65 años y 54 > 65 años). La valoración de la EVA no fue posible realizarla en 12 pacientes, mientras que la valoración de la EVN fue posible en todos los pacientes. Los valores del coeficiente de correlación interclase fueron globalmente > 0,70 durante los tres días, siendo más altos los coeficientes en mayores de 65 años. Conclusiones: La concordancia entre las EVA y EVN de dolor se puede considerar como buena o muy buena durante los tres días de seguimiento, siendo mejor en pacientes con edad superior a 65 años. El grado de colaboración para recoger los datos fue mejor para la EVN que para la EVA. En la comparación de las valores numéricos del dolor la EVN mostró repetidamente valores más altos que la EVA(AU)

Objective: To determine the agreement between verbal numerical and visual analog scale assessments of acute postoperative pain on 3 consecutive days. Methods: Pain data were recorded for 2 months for sequentially enrolled patients receiving parenteral opioids or neuraxial blocks for analgesia after major surgery in a tertiary level hospital. Each patient was asked to assess pain on the visual analog and verbal numerical scales every 24 hours for 3 consecutive days. Agreement was estimated by the intraclass correlation coefficient and the Spearman correlation coefficient. The results were analyzed in 2 age strata: age 65 years or younger and older than 65 years. Results: Data for 159 patients (105 65 years; 54 > 65 years) were analyzed. The visual analog scale could not be used with 12 patients; all patients were able to assess pain on the verbal numerical scale. The intraclass correlation coefficient was > 0.70 for all 3 days; the highest coefficients were for patients over 65 years of age. Conclusions: Agreement between pain assessments on the visual analog and verbal numerical scales can be considered good or very good on all 3 days, with stronger agreement when the scales are used in patients over the age of 65 years. Cooperation was better for the numerical scale than for the visual analog scale. Scores on the verbal numerical scale were consistently higher than scores on the visual analog scale(AU)

[Evaluation of a protocol for predicting difficult airway in routine practice: interobserver agreement]. / Evaluación de un protocolo de predicción de vía aérea difícil en la práctica habitual: estudio de concordancia.

OBJECTIVES: To evaluate a protocol for routine assessment of potential risk factors for difficult airway intubation in an anesthesia department, by measuring interobserver agreement and the behavior of the factors in a predictive model. MATERIAL AND METHODS: A cross-sectional study group of 320 consecutive patients undergoing major surgery requiring orotracheal intubation was assessed for possible difficult airway. We calculated interrater agreement for recording of the Mallampati score, thyromental distance less than 6 cm, thick neck, kyphosis, small mouth, macroglossia, and dental prosthesis during the preanesthesia examination (by an anesthetist) and on the day of the operation (by an anesthetist and a resident). We constructed a model to predict difficult intubation (requiring 3 or more attempts). RESULTS: The kappa indices of agreement between the anesthetists at the preoperative examination and in the operating room or the resident were all less than 0.6. Factors like thyromental distance, small mouth, and kyphosis had kappa indices less than 0.21. The kappa index between the resident and the anesthetist in the operating room was over 0.55. The only factor that had a different level of agreement was the presence or not of a dental prosthesis. None of the studied individual factors, nor these factors in association with the Mallampati score, achieved significance in a bivariate regression model to predict difficult intubation. CONCLUSIONS: There is poor interobserver agreement on factors for predicting difficult airway in comparisons between preoperative and operating room assessment by an anesthetist or a resident. The individual predictive factors and their association with the Mallampati score did not prove useful for predicting difficult intubation.

¿La hora del día en la toma de la presión arterial determina el grado de control de los pacientes hipertensos? / Is degree of blood pressure control in hypertensive patients determined by what time of the day readings are taken?

Introducción. Conocer si las cifras de presión arterial (PA) determinadas en la consulta a pacientes con hipertensión arterial (HTA) son diferentes en función de la hora del día en que se tomen. Material y métodos. Estudio descriptivo transversal y analítico en ZBS urbana con una muestra de 107 pacientes con criterios diagnósticos HTA JNC-VI. Se realiza una primera medición de la PA a las 9:00 previa administración de medicación antihipertensiva, con medicinas sucesivas después de la toma de medicación a las 11:00, 17:00 y 19:00 horas. Análisis estadístico mediante ANOVA y posterior prueba de contrastes múltiples de Tukey. Resultados. Edad media: 71,81ñ7,98 (57 por ciento mujeres).Media PA sistólica a las 9,00 horas: 154,29; DE: 19,72. A las 11,00 horas: 143,30; DE: 19,18. A las 17,00 horas: 144,79; DE: 17,84. A las 19,00 horas: 144,83; DE: 18,92. F de Snedecor: 7,59; p < 0,001.Media PA diastólica 9,00 horas: 78,62; DE: 13,85. A las 11,00 horas: 74,21; DE: 13,91. A las 17,00 horas: 72,88; DE: 13,22. A las 19,00 horas: 74,18; DE: 12,18; F de Snedecor: 3,80; p = 0,010. Mínima diferencia significativa método de Tukey; PA sistólica (p<0,05): 6,05; diastólica (p<0,05):4,25.Discusión. Entre la primera medición de la mañana, previa a la toma de medicación y el resto de las mediciones a las 2, 6 y 8 horas, se observan diferencias estadísticamente significativas. Estas diferencias no se presentan entre el resto de las mediciones. Existe un progresivo aumento de consultas de horario de tarde, no objetivándose diferencias después de la toma de medicación entre los pacientes que acuden a los distintos horarios. Podemos concluir que la hora de toma de la medicación influye en las determinaciones de PA posteriores; así, la cuestión a plantear sería cuál es el momento ideal para la toma de la medicación antihipertensiva para el control de nuestros pacientes (AU)