Recogida y análisis sistemático de problemas anestésicos intraoperatorios / Systematic collection and analysis of intraoperative anaesthetic-related problems

Objetivo. El objetivo de este estudio fue la recogida sistemática y el análisis de la frecuencia, tipo y severidad de todos los problemas anestésicos intraoperatorios ocurridos en nuestro hospital durante 6 meses. Métodos. Estudio observacional, sistemático, prospectivo y transversal, en el que se estudia el suceso y sus factores de riesgo. Se basó en una recogida de datos rutinaria de todas las anestesias. Incluye anestesia, sedación y analgesia de parto. Las variables recogidas fueron demográficas y de procedimiento, así como una lista de verificación con el tipo de problema y su grado de severidad. Los datos se analizaron mediante los tests de Chi al cuadrado, Fisher, o t de Student, aceptando p<0,05 como significativa. Resultados. La frecuencia de problemas anestésicos intraoperatorios fue de 17,2%, con 1,3 problemas por caso, siendo 9 veces mas frecuentes los problemas con bajo grado de severidad. Durante la anestesia, aparecieron problemas respiratorios en 13, circulatorios en 8, y técnicos en 2 de cada 100 procedimientos. Los factores asociados con los pacientes que presentaron problemas anestésicos se asociaron al uso de la anestesia general, cirugía supraumbilical y mayor riesgo anestésico preoperatorio. Conclusiones. La recogida sistemática de problemas intraoperatorios relacionados con la anestesia, mediante una lista de verificación de problemas y severidad, juega un importante papel en las estrategias de gestión de calidad. El análisis de problemas menores puede ayudar a establecer acciones correctivas antes de la aparición de morbilidad, separando los problemas propios de la cirugía de los de la anestesia(AU)

Objective. The purpose of the study was to systematically collect and analyse the frequency, type and severity of all untoward intraoperative anaesthetic-related problems in a hospital over a 6-month period. Methods. An observational, systematic, prospective, and cross sectional study was conducted on the events and their risk factors. The study is based on a system in which anaesthesia-related data are recorded from all anaesthetic cases on a routine basis, including sedation and obstetric analgesia. The variables were demographic, procedural data, and a checklist with problem type and severity. Data were analysed using chi-square, Fisher's test, or Student's test. A P<.05 was considered statistically significant. Results. The frequency of intraoperative anaesthetic-related problems was 17.2%, with 1.3 anaesthetic problems per case, being 9 times more frequent the adverse effects with low severity grade. During anaesthesia, respiratory problems occurred in 13, circulatory problems in 8, and technical problems in 2 out of every 100 procedures. The factors associated with the patient in whom the anaesthetic problem occurred were: the use of general anaesthesia, supraumbilical surgery, and a higher preoperative anaesthetic risk. Conclusions. Use of a systematic intraoperative anaesthetic-related database with a checklist of problems and severity plays an important part in quality assurance strategies. An analysis of non-fatal problems provides a basis for establishing corrective strategies before significant morbidity occurs, and by separating the surgical and anaesthesia problems(AU)

[Systematic collection and analysis of intraoperative anaesthetic-related problems]. / Recogida y análisis sistemático de problemas anestésicos intraoperatorios.

OBJECTIVE: The purpose of the study was to systematically collect and analyse the frequency, type and severity of all untoward intraoperative anaesthetic-related problems in a hospital over a 6-month period. METHODS: An observational, systematic, prospective, and cross sectional study was conducted on the events and their risk factors. The study is based on a system in which anaesthesia-related data are recorded from all anaesthetic cases on a routine basis, including sedation and obstetric analgesia. The variables were demographic, procedural data, and a checklist with problem type and severity. Data were analysed using chi-square, Fisher's test, or Student's test. A P<.05 was considered statistically significant. RESULTS: The frequency of intraoperative anaesthetic-related problems was 17.2%, with 1.3 anaesthetic problems per case, being 9 times more frequent the adverse effects with low severity grade. During anaesthesia, respiratory problems occurred in 13, circulatory problems in 8, and technical problems in 2 out of every 100 procedures. The factors associated with the patient in whom the anaesthetic problem occurred were: the use of general anaesthesia, supraumbilical surgery, and a higher preoperative anaesthetic risk. CONCLUSIONS: Use of a systematic intraoperative anaesthetic-related database with a checklist of problems and severity plays an important part in quality assurance strategies. An analysis of non-fatal problems provides a basis for establishing corrective strategies before significant morbidity occurs, and by separating the surgical and anaesthesia problems.

Situación actual de las unidades del dolor crónico en la Región de Murcia / No disponible

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)

La producción científica española en anestesiología y reanimación 1983-1995 / Scientific productivity in anesthesia and postoperative recovery in Spain, 1983-1995

OBJETIVOS: Cuantificar y analizar la información disponible internacionalmente sobre la producción científica de la anestesiología española en el período 1983 a 1995. MATERIAL: Publicaciones realizadas por autores españoles que se hallan indizadas en tres repertorios o bases de datos electrónicas: el índice Médico Español (IME) Medline y Embase (correspondiente a Excerpta Médica). MÉTODO: Estudio bibliométrico de la producción contenida en las tres bases, determinando la cuantificación, evolución temporal de los documentos circulantes, el solapamiento y las características de la producción. RESULTADOS: Durante el período estudiado fueron indizados en los tres repertorios un total de 2.608 trabajos producidos por anestesiólogos españoles (IME 79 por ciento Medline 54 por ciento Excerpta 29,5 por ciento). El crecimiento medio anual fue del 16,7 por ciento, con un período de duplicación de 10,2 años. CONCLUSIONES: El crecimiento es exponencial, similar al de otras disciplinas y cumple la ley de Price. Las tres bases recogen mayoritariamente la producción científica de los anestesiólogos españoles. IME y Medflne son los repertorios más importantes para la literatura anestesiológica española. Excerpta presenta el mayor crecimiento en la recopilación de las tres bases. Es imprescindible la inclusión de las tres bases en búsquedas bibliográficas y estudios bibliométricos sobre la anestesiología española (AU)

[Spanish scientific production in anesthesiology and resuscitation 1983-1995]. / La producción científica española en anestesiología y reanimación 1983-1995.

OBJECTIVE: To quantify and analyze the information available internationally on Spanish scientific productivity in anesthesiology from 1983 through 1995. MATERIAL: Publications by Spanish authors indexed in three electronic databases: the Spanish Indice Médico (SIM), MedLine, and Embase (belonging to Excerpta Médica). METHOD: A bibliometric study of productivity as reflected by entries in the 3 databases, quantifying documents in circulation, change over time in circulating documents, overlap, and article's characteristics. RESULTS: During the period studied, a total of 2608 papers by Spanish anesthesiologists were indexed in the 3 databases (SIM 79%, Medline 54%, Excerpta Médica 29.5%). Annual growth was 16.7%, with a period of 10.2 years until duplication. CONCLUSION: Growth is exponential in anesthesiology, as in other disciplines, and the distribution satisfies Price's law. The 3 databases are the major collectors of the papers of Spanish anesthesiologists. The SIM and MedLine are the main indexers of Spanish-authored articles in the literature. Excerpta presents the largest growth on the compilation of articles. The inclusion of the three databases is essential in bibliographic searches and bibliometric studies on Spanish anesthesiology.

[The assessment of the nutritional status of patients with familial amyloid neuropathy type I (Corino Andrade's disease) who are candidates for orthotopic liver transplantation]. / Valoración del estado nutricional de los pacientes con polineuropatía amiloidótica familiar tipo I (enfermedad de Corino Andrade) candidatos a trasplante ortotópico de hígado.

Corino Andrade's disease (Type I Family amyloidotic polyneuropathy) (FAP I) is a slow-evolving hereditary amyloidosis affecting, among other things, the digestive system, with the appearance of an amyloid deposit which produces a malabsorptive syndrome with diarrhea in those affected. At present, the only effective therapeutic option is orthotopic liver transplant (OLT): clearance from the hospital's transplant commission as a candidate requires, among other things, a prior nutritional study. We therefore proposed to carry out a nutritional assessment of these patients, comparing them with a group of terminal liver patients who are OLT candidates. The PAF I group showed a high level of calorie energy malnutrition (86%) and, to a lesser extent, visceral and protein malnutrition. The liver patient group showed 67% of visceral malnutrition and lower levels of calorific energy and protein malnutrition. All the OLT candidates showed a high rate of nutritional deterioration. The greater presence of calorific energy malnutrition in the PAF I patients might be due to the neuropathic gastro-intestinal condition. The high level of malnutrition encountered suggest the need for pre-transplant nutritional intervention designed to minimise post-surgical risk.

[The assessment of the nutritional status of patients in the terminal stage of liver disease who are candidates for orthotopic liver transplantation]. / Valoración del estado nutricional de los pacientes en estadio terminal de enfermedad hepática, candidatos a trasplante ortotópico de hígado.

Orthotopic liver transplant (OLT) is nowadays an accepted procedure for the treatment of patients with end-stage liver disease. Because of the significant state of malnutrition of such patients, we decided to evaluate the nutritional condition of patients accepted by the hospital's Transplants Committee as candidates for this type of therapy, with the eventual aim of discovering the types of malnutrition in the different pathologies, and which were the most frequent. The sample studied showed a significant prevalence of malnutrition. Patients with viral hepatitis showed only visceral type malnutrition, which affected 100% of them. The ethanolic cirrhosis group presented all types of malnutrition-energy-calorific (35%), protein (24%) and visceral (53%), while the group of other liver diseases presented 15% of energy-calorific malnutrition and 85% visceral. From these results, we conclude that the sample studied has a high prevalence of malnutrition and that the importance of its detection makes it possible to reduce pre- and post-surgical morbidity and mortality rates with an appropriate nutritional support.

[Patient-controlled analgesia using meperidine in the postoperative period after cholecystectomy. Study of possible complications at 2 different levels of surveillance]. / Analgesia controlada por el paciente con meperidina en el postoperatorio de colecistectomía. Estudio de posibles complicaciones a dos niveles de vigilancia diferentes.

OBJECTIVES: To ascertain the side effects of intravenous meperidine in patient-controlled analgesia under two levels of surveillance: one in the recovery room and one in the hospital's surgical ward. PATIENTS AND METHODS: Patient-controlled analgesia with meperidine was made available to 80 patients who had undergone cholecystectomy by laparotomy. Instances of nausea/vomiting, pruritus, urinary retention and technical problems were recorded, as well as arterial gas levels (cooximetry) on the first, third, twelfth and twenty-fourth hours after surgery. We also recorded meperidine consumption and its relationship to side affects. RESULTS: Side effects were associated with higher consumption of meperidine (437.0 +/- 117.7 mg vs 297.7 +/- 135.9 mg in those experiencing no side effects), with more episodes of PO2 < 70 mmHg and SO2 < 90% on the ward than in the recovery room (24 and 10 as compared to 85 and 30, respectively). Patients presenting adverse side effects were significantly older (76.6 +/- 13.5 vs 58.1 +/- 11.1 years). CONCLUSIONS: Given that age and higher meperidine consumption were associated with more frequent occurrence of hypoxic episodes, patients should receive greater surveillance on the ward, with oxygen therapy, monitoring of accumulated consumption and caution used with older patients.

[Nutritional parameters and morbimortality in clinical hospitalization]. / Parámetros nutricionales y morbimortalidad en hospitalización clínica.

The prevalence of malnutrition in patients admitted to hospital in the region of Northwest Murcia and its repercussion on the morbidity rate and length of admission are studied. A protocol of nutritional evaluation according to the computer programme EDECAN-MED was applied, and the corresponding statistical treatment of data and results was done. We find that anthropometric data lack predictive value and that deterioration in the values for albumin, basal energy expenditure and nutritional prognostic index are associated with increased morbidity/mortality and prolongation of the length of hospital stay. The most valuable predictive datum of the length of hospital stay was the nutritional prognostic index, in spite of it being an index of surgical risk.

[The development of an informational logic support for aiding diagnosis and treatment. The Edecan-Med program. I. The assessment of nutritional status]. / Elaboración de soporte lógico informático para ayuda al diagnóstico y tratamiento. Programa Edecan-Med. Parte I: Valoración del estado nutricional.

We present the elaboration of an informatic program (Informatic Logic Support [SLI]) as a clinical help in diagnosis and treatment, for use by compatible computers PC. In this first part dedicated to artificial nutrition, we explain the scientific support, the capture of anthropometric and biochemical data, the processing, the results and the conclusions delivered by the computer that inform us about all the calculated nutritional parameters the type of malnutrition, the surgical risk of morbimortality (nutritional prognostic), and the caloric needs.

[Cardiovascular response to orotracheal intubation using midazolam or etomidate in anesthesia induction]. / Respuesta cardiovascular a la intubación orotraqueal utilizando midazolam o etomidato en la inducción anestésica.

By means of the present study, we compare the variations in the cardiovascular response to the orotracheal intubation while using midazolam or etomidate during the anesthetic induction. For this purpose, we studied 2 groups of 10 patients each one which were premedicated with fentanyl and atropine, and succinylcholine as muscle relaxant. We took the data at a basal state, 10 minutes after premedication and 0, 1, 2, 3, 4, 5 and 10 minutes after the intubation handling. As hemodynamic data we registered heart rate, systolic and diastolic blood pressure and the rate product (PRP). In both groups, the peak response occurred two minutes after intubation in all the studied parameters. Systolic and diastolic blood pressure as well as PRP were significantly lower with midazolam. We conclude that midazolam and etomidate do not prevent the cardiovascular response to the intubation handling, although midazolam smooths pressure response.

[Mixed benzodiazepine poisoning and reversal with flumazenil (Ro 15-1788)]. / Intoxicación benzodiacepínica mixta y reversión por flumacenil (Ro 15-1788).

A case of 17 year old female with acute benzodiazepines (800 mg of bentazepan and 400 mg de chlordiazepoxide) and tricyclic antidepressants (500 mg of imipramine) self poisoning is reported. Initial examination showed comatous patient (Glasgow coma scale 7, sedation scale 4) and a critical respiratory failure with a suspicious of pulmonary aspiration of gastric contents. Supportive measures were started and flumazenil administered intravenous (0.1 mg/min) until a total dose of 1.2 mg; 15 minutes later neurological state was absolutely normal. We conclude that flumazenil is a selective and useful benzodiazepine antagonist in the treatment of acute benzodiazepine poisoning.