ABSTRACT
Objetivo: conocer la situación actual, en términos de organización y administración, de las Unidades del Dolor Crónico (UDO) de los hospitales públicos de la Región de Murcia. Material y método: encuesta on-line que exploraba aspectos de estructura y de proceso, dirigida a cada uno de los responsables de las UDO de todos los hospitales públicos del Servicio Murciano de Salud. Resultados: respondieron el 87,5% de las UDO, que representan una cobertura poblacional del 90% de la Región, todas ellas dirigidas por un anestesiólogo, de las que el 85,7% eran multi-disciplinares. Cada UDO realiza una media de 4,6 consultas y 0,75 quirófanos semanales. El 42,8% dedican a la asistencia menos de 8 h a la semana. Con una demora media para primera demanda de 66 días y de 49,2 para las revisiones, siendo la demanda mensual de primeras visitas de 32,5 pacientes. Algunas UDO expresan rechazar ciertos procesos dolorosos. El 42,8% realiza triaje, pero solo el 28,6% utiliza para ello criterios explícitos. Sólo el 28,6% emplea criterios explícitos de derivación, y solo el 57,1% dispone de protocolos de actuación clínica. Conclusiones: las UDO de la Región de Murcia presentan una gran disparidad en accesibilidad, presión asistencial, continuidad en los cuidados, gestión de la demanda y estructura, lo que hace muy difícil la posibilidad de comparación de resultados entre centros, al no disponer de la homogeneidad necesaria en la estructura y en los procesos asistenciales (AU)
Objective: to know about the current situation in terms of organization and management of Chronic Pain Clinics (UDO) of public hospitals in the Region of Murcia. Material and methods: on-line questionnaires that explored aspects of structure and process, addressed to each of the heads of the UDO of every public hospitals of Murcia Health Service. Results: the 87.5% of the UDO answered the questions, representing a 90% of population coverage in the region, all of them directed by an anaesthesiologist, 85.7% of which were multi-disciplinary. Each UDO develops an average of 4.6 consults per week and 0.75 operating rooms. 42.8% of them dedicate less than 8 h per week to assistance. With an average delay of 66 days for the first demand and 49.2 days for the reviews, being the monthly demand for the first visits of 32.5 patients. Some UDO expresses rejection to certain painful processes. 42.8% of them make triage, but only 28.6% use explicit criteria for it. Furthermore, only 28.6% use explicit criteria to send patients to another hospital, and only 57.1% have clinical intervention protocols. Conclusions: UDO in the Region of Murcia has a wide disparity in accessibility, workload, continuity of care, demand management and structure, making it very difficult to compare the results between units, due to the lack of the necessary homogeneity in the structure and care processes (AU)
Subject(s)
Humans , Male , Female , Pain Clinics/organization & administration , Pain Clinics/trends , Hospital Units/trends , Hospitals, Public/organization & administration , Pain Clinics/standards , Pain Clinics , Hospitals, Public/statistics & numerical data , Hospitals, Public/trends , Hospitals, Public , Socioeconomic SurveyABSTRACT
OBJETIVOS: Evaluar la mejora obtenida tras la implementación de una Unidad del Dolor Agudo basada en laenfermería (UDABE) en un Hospital de Área, utilizandométodos de control estadístico de procesos.MATERIAL Y MÉTODO: Medimos mensualmente 3 indicadoresde la calidad de la UDABE (prevalencia de dolor, alivio y satisfacción con su manejo). Monitorizamoslos indicadores mediante gráficos P de control estadístico de procesos para conocer su ajuste a los estándares fijados, así como su variabilidad.RESULTADOS: En un año hemos conseguido estabilizarel dolor agudo en todo el hospital en una prevalencia del30%, que el 85% de nuestros pacientes consigan alivioadecuado, y que su satisfacción con el manejo del dolorsea del 90%.CONCLUSIONES: La implementación de una UDABEdiseñada y gestionada con herramientas procedentes delControl de Calidad, produce mejoras significativas,absoluta y relativa, en la prevalencia del dolor, en su alivio, y en la satisfacción de los pacientes (p<0,001), consiguiendo ahorrar en un año, más de 15.000 días de sufrimiento innecesario
OBJECTIVE: To evaluate improvement after implementationof care through a nurse-managed acute pain unit in adistrict hospital, using statistical process control (SPC) methods.MATERIAL AND METHODS: Each month we measured 3acute pain unit quality indicators: pain prevalence, painrelief, and satisfaction with pain management. Theindicators were monitored on P-charts according to SPCprocedures that determine their distribution withincontrol limits and track variability.RESULTS: The hospital prevalence of acute painstabilized at 30% after a year. Eight-five percent ofpatients achieved adequate pain relief and 90% weresatisfied with pain management.CONCLUSIONS: A nurse-managed acute pain unitdesigned and managed with tools for monitoring qualityassurance produces significant absolute and relativeimprovements in the prevalence of pain, pain relief, andpatient satisfaction (P<.001), leading to a savings of 15000 days of unnecessary suffering per year
Subject(s)
Humans , Pain/therapy , Pain Clinics/organization & administration , Quality Assurance, Health Care , Quality Indicators, Health Care , Outcome and Process Assessment, Health CareABSTRACT
No disponible
Subject(s)
Humans , Pain Clinics/organization & administration , Quality Assurance, Health Care , Total Quality Management/trendsSubject(s)
Anesthesia, Intravenous , Rubinstein-Taybi Syndrome/complications , Tooth Extraction , Anesthetics, Intravenous/administration & dosage , Case Management , Child , Contraindications , Humans , Intraoperative Complications/prevention & control , Male , Maxilla/abnormalities , Neuromuscular Nondepolarizing Agents , Oxygen Inhalation Therapy , Palate, Hard/abnormalities , Pneumonia, Aspiration/prevention & control , Premedication , Propofol/administration & dosage , Rubinstein-Taybi Syndrome/geneticsABSTRACT
No disponible
Subject(s)
Humans , Anesthesia, Intravenous/adverse effects , Anesthesia, Epidural/adverse effects , Medical Records Department, HospitalABSTRACT
No disponible
No disponible
Subject(s)
Humans , Male , Child , Surgery, Oral/methods , Anesthesia/methods , Rubinstein-Taybi Syndrome/complications , Risk Factors , Intraoperative Care/methodsABSTRACT
OBJECTIVE: To evaluate improvement after implementation of care through a nurse-managed acute pain unit in a district hospital, using statistical process control (SPC) methods. MATERIAL AND METHODS: Each month we measured 3 acute pain unit quality indicators: pain prevalence, pain relief, and satisfaction with pain management. The indicators were monitored on P-charts according to SPC procedures that determine their distribution within control limits and track variability. RESULTS: The hospital prevalence of acute pain stabilized at 30% after a year. Eight-five percent of patients achieved adequate pain relief and 90% were satisfied with pain management. CONCLUSIONS: A nurse-managed acute pain unit designed and managed with tools for monitoring quality assurance produces significant absolute and relative improvements in the prevalence of pain, pain relief, and patient satisfaction (P < .001), leading to a savings of 15 000 days of unnecessary suffering per year.
Subject(s)
Medical Audit , Pain Clinics/statistics & numerical data , Pain/prevention & control , Adult , Female , Hospitals, Urban/statistics & numerical data , Humans , Male , Middle Aged , Pain/epidemiology , Pain/nursing , Pain Management , Pain Measurement , Patient Satisfaction , Prevalence , Program Evaluation/statistics & numerical data , Quality Assurance, Health Care , SpainABSTRACT
Cerebellar hemorrhage is a rare complication of spinal anesthesia. We report a case in a 51-year-old woman with a history of hypertension who underwent uterine dilatation and curettage with spinal anesthesia. During recovery she vomited and complained of headache. Postdural puncture headache was diagnosed. When there was no response to conventional treatment, computed tomography and magnetic resonance scans of the head were performed. The scans confirmed cerebellar hemorrhage due to rupture of a cavernous angioma. The patient recovered fully without surgical decompression. We review the pathogenesis of headache and cerebral hemorrhage after spinal anesthesia and propose differential diagnosis between spontaneous rupture related to hypertension and cerebrospinal fluid hypotension syndrome caused by trauma from lumbar spinal puncture. Patients with prolonged severe headache after spinal anesthesia require neurologic and radiologic monitoring to rule out the possibility of intracranial complications.
Subject(s)
Anesthesia, Spinal/adverse effects , Intracranial Hemorrhages/etiology , Cerebellum , Female , Humans , Middle Aged , Post-Dural Puncture Headache/etiologyABSTRACT
La hemorragia cerebelosa es una complicación rarade la anestesia subaracnoidea. Presentamos el caso deuna mujer de 51 años, con antecedentes de hipertensiónarterial, que fue anestesiada por vía subaracnoidea paralegrado uterino. En el postoperatorio desarrolló cefaleay vómitos, diagnosticándose de cefalea postpuncióndural. Al no responder al tratamiento convencional, serealizó tomografía computarizada craneal y resonanciacerebral, que confirmó el cuadro de hemorragia cerebelosapor ruptura de angioma cavernoso. La paciente serecuperó completamente sin precisar medidas quirúrgicasdescompresivas.Revisamos la patogénesis de la cefalea y la hemorragiaintracerebral tras anestesia subaracnoidea, planteandoel diagnóstico diferencial etiológico entre la roturaespontánea por hipertensión arterial y el síndromede hipotensión de líquido cefalorraquídeo de causatraumática tras punción lumbar. Pacientes con cefaleasevera y prolongada tras anestesia subaracnoidearequieren un cuidadoso seguimiento neurológico yradiológico para excluir una posible complicaciónintracraneal
Cerebellar hemorrhage is a rare complication of spinalanesthesia. We report a case in a 51-year-old womanwith a history of hypertension who underwent uterinedilatation and curettage with spinal anesthesia. Duringrecovery she vomited and complained of headache. Postduralpuncture headache was diagnosed. When therewas no response to conventional treatment, computedtomography and magnetic resonance scans of the headwere performed. The scans confirmed cerebellar hemorrhagedue to rupture of a cavernous angioma. Thepatient recovered fully without surgical decompression.We review the pathogenesis of headache and cerebralhemorrhage after spinal anesthesia and propose differentialdiagnosis between spontaneous rupture related tohypertension and cerebrospinal fluid hypotension syndromecaused by trauma from lumbar spinal puncture.Patients with prolonged severe headache after spinalanesthesia require neurologic and radiologic monitoringto rule out the possibility of intracranial complications
Subject(s)
Female , Middle Aged , Humans , Anesthesia, Spinal/adverse effects , Intracranial Hemorrhages/etiology , Cerebellum , Headache DisordersSubject(s)
Hospitalization , Pain Management , Acute Disease , Hospitals , Humans , Pain/epidemiology , Pain, Postoperative/epidemiology , Pain, Postoperative/therapy , Spain , Time FactorsABSTRACT
No disponible
No disponible
Subject(s)
Humans , Pain Clinics , Pain Measurement , Pain, Postoperative/therapy , Acute Disease , Prevalence , Analgesia/statistics & numerical dataSubject(s)
Anesthesiology , Anticoagulants/therapeutic use , Nerve Block , Practice Patterns, Physicians' , Adult , Female , Humans , Male , Spain , Surveys and QuestionnairesABSTRACT
Una mujer de 33 años de raza gitana, obesa y gestante a término, en el período de dilatación anteparto presentó signos de preeclampsia seguidos de edema agudo de pulmón de instauración súbita y paro cardiorrespiratorio. Se le practicó operación cesárea durante las maniobras de reanimación cardiopulmonar con resultado de muerte fetal y materna. El diagnóstico anatomopatológico confirmó la existencia de una cardiomiopatía periparto. La asociación de esta cardiopatía con episodios de hipertensión arterial, eleva enormemente el riesgo de muerte materno-fetal y requiere un exquisito manejo anestésico y rigurosas medidas encaminadas a afrontar un posible litigio (AU)
Subject(s)
Pregnancy , Adult , Female , Humans , Obstetric Labor Complications , Fatal Outcome , Pre-Eclampsia , Pulmonary Edema , Heart ArrestABSTRACT
A 33-year-old obese gypsy woman was admitted in labor with signs of preeclampsia followed by sudden pulmonary edema and cardiac arrest. Cesarean delivery was performed during resuscitation maneuvers, but both mother and fetus died. The diagnosis of peripartum cardiomyopathy was confirmed by pathology. The association of latent peripartum cardiomyopathy and episodes of hypertension greatly increases the risk of maternal and fetal death. Careful management of anesthesia and rigorous measures are necessary with a view to possible litigation.
Subject(s)
Heart Arrest/complications , Obstetric Labor Complications , Pre-Eclampsia/complications , Pulmonary Edema/complications , Adult , Fatal Outcome , Female , Humans , PregnancyABSTRACT
Un paciente de 68 años fue sometido a recambio acetabular de cadera bajo anestesia subaracnoidea con bupivacaína y fentanilo. A los dos días de la intervención el paciente presentó un cuadro de afectación unilateral de la cola de caballo que afectaba a cinco raíces nerviosas (L4 a S3), sin afectación esfinteriana. Dos años y medio después, la lesión es permanente. Se discute la posible etiología del cuadro clínico, planteándose el diagnóstico diferencial entre causas mecánicas (posición-movilización) y toxicidad del anestésico (AU)
Subject(s)
Aged , Male , Humans , Arthroplasty, Replacement, Hip , Anesthesia, Spinal , Polyradiculopathy , Bupivacaine , Anesthetics, LocalABSTRACT
OBJECTIVES: To compare the clinical efficacy of hyperbaric 0.5% ropivacaine and 0.5% bupivacaine in subarachnoid blockade for ambulatory surgery. MATERIAL AND METHOD: Randomized double-blind study of 90 patients undergoing lower abdominal surgery. Subarachnoid blockade was achieved with 0.5% ropivacaine (12.5 mg) or 0.5% bupivacaine (12.5 mg) in 10% glucose. We recorded age, sex, weight, latency, extension of motor and sensory blocks, duration of surgery, side effects and quality as perceived by the surgeon and the patient. RESULTS: The two groups were similar with respect to latency time and extension of sensory block. Durations of motor (68.9 +/- 22.9 min) and sensory (127.0 +/- 24.3 min) blocks were significantly shorter with ropivacaine than with bupivacaine (133.3 +/- 29.4 and 174.9 +/- 25.5 min, respectively). Patients in the ropivacaine group also experienced a less intense motor block (Bromage 1, 11.1% vs. 93.3%) and fewer episodes of hypotension 0% vs. 17.7%) or bradycardia (4.4% vs. 8.8%) than those in the bupivacaine group. No neurotoxic effects or instances of postdural puncture headache were recorded. CONCLUSIONS: Hyperbaric 0.5% ropivacaine offers certain advantages over hyperbaric 0.5% bupivacaine for subarachnoid block in outpatient surgery. Duration and intensity of the sensory-motor blockade is less with ropivacaine and fewer cardiovascular side effects develop.
Subject(s)
Ambulatory Surgical Procedures , Amides/administration & dosage , Anesthesia, Spinal , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , Amides/adverse effects , Amides/pharmacology , Anesthesia Recovery Period , Anesthetics, Local/adverse effects , Anesthetics, Local/pharmacology , Bradycardia/chemically induced , Bupivacaine/adverse effects , Bupivacaine/pharmacology , Double-Blind Method , Female , Hemodynamics/drug effects , Humans , Hypotension/chemically induced , Male , Middle Aged , Neuromuscular Blockade , Patient Acceptance of Health Care , Pressure , Ropivacaine , Subarachnoid SpaceABSTRACT
OBJETIVOS: Objetivo: Comparar la eficacia clínica de ropivacaína al 0,5 por ciento frente a bupivacaína al 0,5 por ciento, ambas hiperbaras, en el bloqueo subaracnoideo para cirugía ambulatoria. MATERIAL Y MÉTODO: Estudio doble ciego aleatorio sobre 90 pacientes de cirugía infraumbilical. Bloqueo subaracnoideo con ropivacaína al 0,5 por ciento (12,5 mg) o bupivacaína al 0,5 por ciento (12,5 mg) en glucosa al 10 por ciento. Se registraron: edad, sexo, peso, latencia, grados de bloqueo motor y sensitivo, duración de la cirugía, efectos adversos, y calidad percibida por el cirujano y por el paciente. RESULTADOS: Ambos grupos fueron comparables en tiempo de latencia y nivel de bloqueo sensorial. La ropivacaína demostró tener significativamente menor duración de bloqueo motor (68,9 ñ 22,9 min.) y sensitivo (127,0 ñ 24,3 min.) que la bupivacaína (133,3 ñ 29,4 y 174,9 ñ 25,5 min. respectivamente). Igualmente, los pacientes del grupo de la ropivacaína, presentaron menor intensidad de bloqueo motor (11,1 por ciento Bromage 1, frente a 93,3 por ciento), y menores episodios de hipotensión (0 por ciento, frente a 17,7 por ciento) y bradicardia (4,4 por ciento, frente a 8,8 por ciento) que la bupivacaína. No se apreciaron efectos neurotóxicos ni cefaleas postpunción dural. CONCLUSIONES: La ropivacaína al 0,5 por ciento hiperbara ofrece ciertas ventajas sobre bupivacaína al 0,5 por ciento hiperbara en bloqueo subaracnoideo para cirugía ambulatoria. La ropivacaína tiene menor duración e intensidad de bloqueo sensitivo-motor, y provoca menos efectos adversos cardiovasculares (AU)
Subject(s)
Middle Aged , Adolescent , Adult , Aged , Aged, 80 and over , Male , Female , Humans , Ambulatory Surgical Procedures , Anesthesia, Spinal , Subarachnoid Space , Neuromuscular Blockade , Patient Acceptance of Health Care , Pressure , Bradycardia , Bupivacaine , Double-Blind Method , Anesthesia Recovery Period , Amides , Anesthetics, Local , Hypotension , HemodynamicsABSTRACT
A 68-year-old man underwent hip surgery under subarachnoid anesthesia with bupivacaine and fentanyl to replace an acetabular component. Two days after surgery the patient developed unilateral cauda equina syndrome, affecting five nerve roots (L4 to S3), with no sphincter involvement. Two and a half years later, the lesion had become permanent. We discuss the possible origin of the condition, suggesting differential diagnoses such as mechanical problems (position-mobilization) and anesthetic toxicity.
