Eficacia y seguridad de la endoscopia gastrointestinal durante un programa de entrenamiento de sedación específico para no anestesiólogos / Effectiveness and safety of gastrointestinal endoscopy during a specific sedation training program for non-anesthesiologists

Introducción: la sedación es un componente fundamental para mejorar la calidad de la sedación. Para su correcta realización es necesaria una formación adecuada. Hemos realizado un estudio con el objetivo de comparar la efectividad y la seguridad de la sedación, así como la satisfacción del paciente, cuando la sedación fue realizada por gastroenterólogos con y sin entrenamiento específico en sedación Métodos: se realizó un programa de formación a un grupo de gastroenterólogos (grupo entrenado, n = 4) y se compararon los resultados con los de otro grupo no entrenado (n = 3). Se incluyeron pacientes ASA 1-3 que se sometieron a sedación administrada por un gastroenterólogo con midazolam y fentanilo durante un periodo de 30 meses. La seguridad se evaluó en términos de tasas de complicaciones; la efectividad, como la tasa de procedimientos endoscópicos completados; y la satisfacción del paciente, mediante una encuesta telefónica el día después del procedimiento. Resultados: en total, 3.475 pacientes fueron sedados por gastroenterólogos durante el periodo de estudio. Se encontraron diferencias significativas a favor del grupo entrenado en la comparación de pruebas completadas (5,6% vs. 8,9%), una menor incidencia de sedación excesiva (1,3% vs. 8,61%) y de hipoxemia (0,72% vs. 2,49%) y menor incidencia de dolor después del procedimiento (1,8% vs. 4,3%). La satisfacción del paciente excedió el 99,5% y no hubo diferencias significativas entre ambos grupos Conclusiones: nuestro programa de formación en sedación mejora los resultados frente a quienes no han realizado dicha formación específica en términos de efectividad y de seguridad

Introduction: sedation is a key component for the improvement of sedation quality. A correct administration requires appropriate training. We performed a study to compare sedation effectiveness, safety and patient satisfaction when administered by gastroenterologists, with and without specific training. Methods: a training program enrolled a group of gastroenterologists (trained group, n = 4) and their results were compared to those from a non-trained group (n = 3). ASA 1-3 patients who had undergone sedation by a gastroenterologist using midazolam and fentanyl were included over a period of 30 months. Safety was assessed in terms of the complication rate, effectiveness was assessed via the rate of completed endoscopic procedures and patient satisfaction was evaluated via a phone interview the day after the procedure. Results: a total of 3,475 patients were sedated by gastroenterologists during the study period. Significant differences were found that favored the trained group for completed procedures (5.6% vs 8.9%). A lower rate of excessive sedation (1.3% vs 8.61%), hypoxemia (0.72% vs 2.49%) and post-procedural pain (1.8% vs 4.3%) were also achieved. Patient satisfaction surpassed 99.5% and there were no significant differences between groups. Conclusions: our sedation training program improved the effectiveness and safety outcomes when compared to sedation administered by gastroenterologists without this specific training

Estudio descriptivo de monitorización de un programa de calidad de sedación por no anestesiólogos / A descriptive monitoring study of a non-anesthetist sedation quality program

Introducción: la sedación mejora sensiblemente la calidad de la endoscopia digestiva, aunque puede tener complicaciones graves. Métodos: protocolo multidisciplinar en base a la joint comission que defina el protocolo de sedación por no anestesiólogos. Se excluyen pacientes ASA 4 o con vía aérea difícil, pruebas complejas y sedación profunda. Controlamos la calidad en base al análisis de 9 indicadores. También se monitorizan las pruebas incompletas para valorar eficacia. Resultados: la seguridad del paciente se establece en base a una incidencia de complicaciones muy baja, con una incidencia de eventos respiratorios de 1,07. Además, se encuentra una baja incidencia de hipotensión y bradicardia, al igual que del dolor durante y después de la endoscopia y una incidencia menor del 0,5% de ingresos no esperados. Los indicadores de calidad medidos nos indican la evolución de los resultados del programa. Conclusiones: la monitorización continuada de los programas de sedación en endoscopia permiten controlar las diferentes dimensiones de la calidad e implementar medidas que mejoren el proceso

Introduction: sedation substantially improves the quality of digestive endoscopy procedures but may result in severe complications. Methods: a joint commission-based multidisciplinary protocol was used to define a protocol for sedation by non-anesthesiologists. ASA 4 patients were excluded, as well as patients with a difficult airway, complex procedures and deep sedation. Quality based on the analysis of 9 indicators were monitored. Incomplete procedures were also monitored in order to assess efficacy. Results: patient safety was established based on a very low incidence of complications and a rate of respiratory events of 1.07. Furthermore, a low rate of hypotension and bradycardia was found, as well as a low rate of pain, either during or after endoscopy and an incidence of unexpected admissions lower than 0.5%. The quality indicators measured reflect the evolution of the results of the program. Conclusions: ongoing sedation program monitoring in endoscopy allows the control of different quality dimensions and the implementation of steps for process improvement

A descriptive monitoring study of a non-anesthetist sedation quality program.

INTRODUCTION: sedation substantially improves the quality of digestive endoscopy procedures but may result in severe complications. METHODS: a joint commission-based multidisciplinary protocol was used to define a protocol for sedation by non-anesthesiologists. ASA 4 patients were excluded, as well as patients with a difficult airway, complex procedures and deep sedation. Quality based on the analysis of 9 indicators were monitored. Incomplete procedures were also monitored in order to assess efficacy. RESULTS: patient safety was established based on a very low incidence of complications and a rate of respiratory events of 1.07. Furthermore, a low rate of hypotension and bradycardia was found, as well as a low rate of pain, either during or after endoscopy and an incidence of unexpected admissions lower than 0.5%. The quality indicators measured reflect the evolution of the results of the program. CONCLUSIONS: ongoing sedation program monitoring in endoscopy allows the control of different quality dimensions and the implementation of steps for process improvement.

Effectiveness and safety of gastrointestinal endoscopy during a specific sedation training program for non-anesthesiologists.

INTRODUCTION: sedation is a key component for the improvement of sedation quality. A correct administration requires appropriate training. We performed a study to compare sedation effectiveness, safety and patient satisfaction when administered by gastroenterologists, with and without specific training. METHODS: a training program enrolled a group of gastroenterologists (trained group, n = 4) and their results were compared to those from a non-trained group (n = 3). ASA 1-3 patients who had undergone sedation by a gastroenterologist using midazolam and fentanyl were included over a period of 30 months. Safety was assessed in terms of the complication rate, effectiveness was assessed via the rate of completed endoscopic procedures and patient satisfaction was evaluated via a phone interview the day after the procedure. RESULTS: a total of 3,475 patients were sedated by gastroenterologists during the study period. Significant differences were found that favored the trained group for completed procedures (5.6% vs 8.9%). A lower rate of excessive sedation (1.3% vs 8.61%), hypoxemia (0.72% vs 2.49%) and post-procedural pain (1.8% vs 4.3%) were also achieved. Patient satisfaction surpassed 99.5% and there were no significant differences between groups. CONCLUSIONS: our sedation training program improved the effectiveness and safety outcomes when compared to sedation administered by gastroenterologists without this specific training.

Afectación colorrectal por cáncer de mama mestastásico / Colorectal involvement in metastatic breast carcinoma

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