Recomendaciones de «no hacer» de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Proyecto «Compromiso por la Calidad de las Sociedades Científicas» / «Do not do» recommendations of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy. «Commitment to Quality by Scientific Societies» project

El Ministerio de Sanidad (MSSSI) aprobó (abril de 2013) el proyecto denominado «Compromiso por la Calidad de las Sociedades Científicas en España», en respuesta a la demanda social y profesional por la sostenibilidad del sistema de salud. La iniciativa se enmarca en las actividades de la Red Española de Agencias de Evaluación de Tecnologías y Prestaciones, del Sistema Nacional de Salud, y está coordinado de forma conjunta por la Subdirección General de Calidad y Cohesión, por el Instituto Aragonés de Ciencias de la Salud (IACS), y por la Sociedad Española de Medicina Interna (SEMI). A este Proyecto se han incorporado todas las sociedades científicas de nuestro país, y su objetivo principal es disminuir la utilización de intervenciones sanitarias innecesarias, con el fin de acordar recomendaciones de «no hacer», basadas en la evidencia científica. Nuestro objetivo primario fue identificar intervenciones que no han demostrado eficacia, tienen efectividad escasa o dudosa, no son coste-efectivas o no son prioritarias. Los objetivos secundarios fueron: la reducción de la variabilidad en la práctica clínica, la difusión entre médicos y pacientes para orientar en la toma de decisiones, el uso adecuado de los recursos sanitarios y, por último, la promoción de la seguridad clínica y la reducción de la iatrogenia. El proceso de selección de las 5 recomendaciones de «no hacer» se realizó mediante la metodología Delphi. 25 panelistas (todo anestesiólogos) eligieron entre 15 propuestas basadas en: evidencia de calidad que la sustenta, relevancia o impacto clínico de la misma y población a la que afecta. Las 5 recomendaciones propuestas fueron: No mantener niveles profundos de sedación en pacientes críticos sin una indicación específica; No realizar radiografía preoperatoria de tórax en pacientes menores de 40 años con estado físico ASA I o II; No realizar, de manera sistemática, pruebas preoperatorias en cirugía de cataratas, salvo indicación basada en historia clínica y exploración física; No programar cirugía electiva con riesgo de hemorragia en pacientes con anemia hasta realizar estudio diagnóstico y tratamiento adecuados; y No realizar pruebas de laboratorio (hemograma, bioquímica y estudio de coagulación) en pacientes sanos o con enfermedad sistémica leve (ASA I y II) previo a cirugías de bajo riesgo, con pérdida estimada de sangre mínima (AU)

In April 2013 the Ministry of Health (MSSSI) adopted the project called «Commitment to Quality by Scientific Societies in Spain», in response to social and professional demands for sustainability of the health system. The initiative is part of the activities of the Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System, and is coordinated jointly by the Quality and Cohesion Department, the Aragon Institute of Health Sciences (IACS), and the Spanish Society of Internal Medicine (SEMI). All the scientific societies in Spain have been included in this project, and its main objective is to reduce the unnecessary use of health interventions in order to agree «do not do» recommendations, based on scientific evidence. The primary objective was to identify interventions that have not proven effective, have limited or doubtful effectiveness, are not cost-effective, or do not have priority. Secondary objectives were: reducing variability in clinical practice, to spread information between doctors and patients to guide decision-making, the appropriate use of health resources and, the promotion of clinical safety and reducing iatrogenesis. The selection process of the 5 «do not do» recommendations was made by Delphi methodology. A total of 25 panellists (all anaesthesiologists) chose between 15 proposals based on: evidence that supports quality, relevance, or clinical impact, and the people they affect. The 5 recommendations proposed were: Do not maintain deep levels of sedation in critically ill patients without a specific indication; Do not perform preoperative chest radiography in patients under 40 years-old with ASA physical status I or II; Do not systematically perform preoperative tests in cataract surgery unless otherwise indicated based on clinical history and physical examination; Do not perform elective surgery in patients with anaemia at risk of bleeding until a diagnostic workup is performed and treatment is given; and not perform laboratory tests (blood count, biochemistry and coagulation) prior to surgery in healthy or low risk patients (ASA I and II) with minimal estimated blood loss (AU)

"Do not do" recommendations of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy. "Commitment to Quality by Scientific Societies" Project. / Recomendaciones de «no hacer¼ de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Proyecto «Compromiso por la Calidad de las Sociedades Científicas¼.

In April 2013 the Ministry of Health (MSSSI) adopted the project called "Commitment to Quality by Scientific Societies in Spain", in response to social and professional demands for sustainability of the health system. The initiative is part of the activities of the Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System, and is coordinated jointly by the Quality and Cohesion Department, the Aragon Institute of Health Sciences (IACS), and the Spanish Society of Internal Medicine (SEMI). All the scientific societies in Spain have been included in this project, and its main objective is to reduce the unnecessary use of health interventions in order to agree "do not do" recommendations, based on scientific evidence. The primary objective was to identify interventions that have not proven effective, have limited or doubtful effectiveness, are not cost-effective, or do not have priority. Secondary objectives were: reducing variability in clinical practice, to spread information between doctors and patients to guide decision-making, the appropriate use of health resources and, the promotion of clinical safety and reducing iatrogenesis. The selection process of the 5 "do not do" recommendations was made by Delphi methodology. A total of 25 panellists (all anaesthesiologists) chose between 15 proposals based on: evidence that supports quality, relevance, or clinical impact, and the people they affect. The 5 recommendations proposed were: Do not maintain deep levels of sedation in critically ill patients without a specific indication; Do not perform preoperative chest radiography in patients under 40 years-old with ASA physical status I or II; Do not systematically perform preoperative tests in cataract surgery unless otherwise indicated based on clinical history and physical examination; Do not perform elective surgery in patients with anaemia at risk of bleeding until a diagnostic workup is performed and treatment is given; and not perform laboratory tests (blood count, biochemistry and coagulation) prior to surgery in healthy or low risk patients (ASA I and II) with minimal estimated blood loss.

Marco legal del anestesiólogo en la cirugía mayor ambulatoria / Legal framework of the anesthesioiogist in a day case surgery

El marco legal del anestesiólogo en Cirugía Mayor Ambulatoria está cobrando relativa importancia en los últimos años. Cada vez más los profesionales vamos tomando conciencia de las implicaciones legales en las que podemos incurrir al realizar nuestro trabajo diario. El análisis de sentencias judiciales en España demuestra que es una especialidad con altas cuantías indemnizatorias. Es muy importante que los anestesiólogos conozcamos todo lo relativo a las normas de los servicios y centros donde desarrollamos nuestra labor asistencial, de igual manera debemos conocer las normas de los colegios profesionales y de las sociedades científicas, y las leyes de ámbito regional y estatal que afectan a nuestro trabajo (AU)

The legal framework anesthesiologist at Ambulatory Surgery, is gaining on importance in recent years, more and more professionals will become aware of the legal implications you may incur while performing our daily work. Analysis of court decisions in Spain shows that anesthesiology is a specialty with high compensatory amounts. It is very important that anesthesiologists know everything about standards of services and facilities where we do care work, just as we must know the rules of professional associations and scientific societies, and the laws of regional and state level that affect our work (AU)

Actualización en Medicina de Familia. Intercepción postcoital: levonorgestrel, actualidad de un fármaco / Up-date In Family Medicine. Postcoital contraception: current usage of levonorgestrel

Desde el primer uso de un fármaco como método anticonceptivo de urgencia (sin indicación en ficha técnica para este uso específico) hasta el momento actual, en que se utiliza levonorgestrel, no sólo han variado los fármacos y las pautas de administración, sino que también han evolucionado las leyes y el conocimiento por parte de usuarios y profesionales. Por parte de los usuarios, son la mayor accesibilidad y el mayor conocimiento en temas relacionados con la salud, en general, y la anticoncepción, en particular, los que han hecho que se hayan incrementado las demandas en lo referente a anticoncepción postcoital. En el caso de los profesionales han contribuido el desarrollo de nuevas tecnologías que han hecho más fácil el acceso a esta información y el desarrollo en los últimos años de los diferentes programas de promoción y prevención de la salud, así como el mayor conocimiento científico sobre el fármaco

Since a drug was first used as an emergency contraceptive method (without indication in the data sheet for this specific use) up to current times, in which levonorgestrel is used, not only the drugs and the usage guidelines have changed but also the laws and the knowledge which the patients and professionals have. The greater access and knowledge which the patients have on health-related issues in general and contraception in particular have increased demands in postcoital contraception. Professionals have contributed to the development of new technology which has made access to this information and development in recent years to different programs of promotion and prevention in health care as well as increased scientific knowledge on the drug

Fármacos coadyuvantes no opioides en anestesia-analgesia regional en pediatría / Non-opioids analgesic adjuvant in pediatrics anaesthesia

Existen evidencias que sugieren que el uso de anestesia-analgesia regional, mejora la calidad del intra y del postoperatorio. Así, se vienen investigando formas de mejorar la duración y calidad de la analgesia como la asociación a los anestésicos locales de diferentes fármacos coadyuvantes. Revisamos los coadyuvantes no opiáceos usados junto a anestésicos locales en anestesia pediátrica

Evidence suggests that the use of regional analgesia-anaesthesia can improve the intra and postoperative care quality. In this way, there has been research directed to improve the duration and quality of analgesia as well as the association to local anaesthetics of adjuvant drugs.We review the non-opioids adjuvant used together with the local anaesthetics in paediatric anaesthesia

[Two cases of postpartum pubis diastasis mistaken for neurological complications of epidural analgesia]. / Dos casos de diástasis de pubis postparto interpretados como complicación neurológica de la analgesia epidural.

Two healthy 31- and 34-year-old parturients received uncomplicated epidural analgesia for labor and delivery using standard techniques. Twenty-four and 12 hours postpartum, respectively, they developed severe lower back pain and difficulty moving their lower extremities. At first the symptoms were attributed to neurological complications of epidural analgesia and for this reason the anesthetist was called. Although both women appeared healthy and the neurological examinations were normal, emergency computed tomography scans were performed to rule out spinal compression because of the severity of pain and difficulty of movement. The diagnosis was only established after suspecting pubis diastasis, confirmed by palpation of symphysis gaps of 3 and 2 cm, respectively. Pelvic dysfunction associated with pregnancy and labour is a complication whose incidence varies from 1 in 300 to 1 in 30,000. It presents with severe pain located in the areas supplied by pudendal and genitofemoral nerves. The pain may radiate to the sacroiliac joints and shoot down the buttocks and legs. In the most severe cases it may be accompanied by urinary dysfunction and inability to walk. If the clinical features are not recognized, it can be difficult to differentiate pubis diastasis from severe neurological complications in women who have received a central nervous system block. We report two cases of peripartum pubis symphysis diastasis that were both initially mistaken for neurological complications of epidural analgesia for labor.