Anesthesia and surgery in very precarious conditions. Clinical cases.

We performed herniorrhaphy on 21 children (4 of them infants) and 3 adults, in very precarious conditions, in a hospital in a economically depressed area of the Democratic Republic of Congo. Anesthesia technique used in adults was subarachnoid and intravenous and intramuscular ketamine in children. Ketamine is an irreplaceable anesthetic in many parts of the world without resources, where the minimum safety means are not available. Knowing the simple anesthetic techniques, but with less risk, can also be useful in resourceful places, in unexpected situations. Greater solidarity is needed, both from anesthesia societies and from anesthesiologists, to alleviate the great deficiencies in well-trained professionals and means in places without resources.

Anestesia y cirugía en condiciones muy precarias. Casos clínicos / Anesthesia and surgery in very precarious conditions. Clinical cases

A 21 niños (4 de ellos lactantes) y 3 adultos les fueron realizadas herniorrafias inguinales, en condiciones muy precarias, en un hospital de un área económicamente deprimida de la República Democrática del Congo. Se empleó anestesia subaracnoidea en los adultos y ketamina por vía intravenosa e intramuscular en los niños.La ketamina es un anestésico insustituible en muchos lugares del mundo sin recursos, en los que no se dispone de los mínimos medios de seguridad. Conocer las técnicas anestésicas simples, pero de menor riesgo, puede resultar también útil en sitios con recursos ante situaciones inesperadas. De manera general, hace falta una mayor solidaridad, tanto de las sociedades de anestesia como de los anestesiólogos, para paliar las grandes carencias en medios y profesionales bien formados en lugares sin recursos.(AU)

We performed herniorrhaphy on 21 children (4 of them infants) and 3 adults, in very precarious conditions, in a hospital in a economically depressed area of the Democratic Republic of Congo. Anesthesia technique used in adults was subarachnoid and intravenous and intramuscular ketamine in children.Ketamine is an irreplaceable anesthetic in many parts of the world without resources, where the minimum safety means are not available. Knowing the simple anesthetic techniques, but with less risk, can also be useful in resourceful places, in unexpected situations. Greater solidarity is needed, both from anesthesia societies and from anesthesiologists, to alleviate the great deficiencies in well-trained professionals and means in places without resources.(AU)

Corrigendum to "Tyrosine Kinase Receptor Landscape in Lung Cancer: Therapeutical Implications".

[This corrects the article DOI: 10.1155/2016/9214056.].

Revisión del manejo de la vía aérea díficil en cirugía torácica / Review of difficult airway management in thoracic surgery

El manejo de la vía aérea difícil (VAD) en cirugía torácica es muy específico y más complejo que en otras especialidades debido a la exigencia de separación o aislamiento pulmonar y a una mayor presencia de anormalidades asociadas a la vía aérea superior e inferior. Basándonos en el análisis de las evidencias clínicas de 818 artículos indexados en PubMed, presentamos una revisión actualizada y un algoritmo específico del manejo de la VAD en cirugía torácica. Recomendamos para la VAD prevista la intubación traqueal con fibroncoscopio en ventilación espontánea y el uso de bloqueador bronquial. Para la VAD imprevista, el uso inicial de videolaringoscopios y un adecuado nivel de relajación neuromuscular (rocuronio/sugammadex). Solo se recomienda el uso de tubos de doble luz si hay indicación absoluta de aislamiento pulmonar. Finalmente, la extubación en este contexto debe ejecutarse con la máxima atención y realizarse según las normas de la Difficult Arway Society (AU)

The management of difficult airway (DA) in thoracic surgery is more difficult due to the need for lung separation or isolation and frequent presence of associated upper and lower airway problems. We performed an article review analysing 818 papers published with clinical evidence indexed in Pubmed that allowed us to develop an algorithm. The best airway management in predicted DA is tracheal intubation and independent bronchial blockers guided by fibroscopy maintaining spontaneous ventilation. For unpredicted DA, the use of videolaryngoscopes is recommended initially, and adequate neuromuscular relaxation (rocuronium/sugammadex), among other maneuvers. In both cases, double lumen tubes should be reserved for when lung separation is absolutely indicated. Finally, extubation should be a time of maximum care and be performed according to the safety measures of the Difficult Arway Society (AU)

Review of difficult airway management in thoracic surgery. / Revisión del manejo de la vía aérea díficil en cirugía torácica.

The management of difficult airway (DA) in thoracic surgery is more difficult due to the need for lung separation or isolation and frequent presence of associated upper and lower airway problems. We performed an article review analysing 818 papers published with clinical evidence indexed in Pubmed that allowed us to develop an algorithm. The best airway management in predicted DA is tracheal intubation and independent bronchial blockers guided by fibroscopy maintaining spontaneous ventilation. For unpredicted DA, the use of videolaryngoscopes is recommended initially, and adequate neuromuscular relaxation (rocuronium/sugammadex), among other maneuvers. In both cases, double lumen tubes should be reserved for when lung separation is absolutely indicated. Finally, extubation should be a time of maximum care and be performed according to the safety measures of the Difficult Arway Society.

Tyrosine Kinase Receptor Landscape in Lung Cancer: Therapeutical Implications.

Lung cancer is a heterogeneous disease responsible for the most cases of cancer-related deaths. The majority of patients are clinically diagnosed at advanced stages, with a poor survival rate. For this reason, the identification of oncodrivers and novel biomarkers is decisive for the future clinical management of this pathology. The rise of high throughput technologies popularly referred to as "omics" has accelerated the discovery of new biomarkers and drivers for this pathology. Within them, tyrosine kinase receptors (TKRs) have proven to be of importance as diagnostic, prognostic, and predictive tools and, due to their molecular nature, as therapeutic targets. Along this review, the role of TKRs in the different lung cancer histologies, research on improvement of anti-TKR therapy, and the current approaches to manage anti-TKR resistance will be discussed.

Cómo ahorrar en anestesia en tiempos de crisis / How to make savings in anaesthesia in times of financial crisis

No disponible

Aclaraciones a los comentarios sobre "Evaluación y manejo de la vía aérea difícil prevista y no prevista: adopción de guías de práctica" / No disponible

No disponible

[Problem/case-based learning compared to lectures for acquiring knowledge of air embolism in continuing medical education]. / Clase magistral versus aprendizaje basado en caso/problema para la enseñanza del embolismo aéreo en formación médica continuada.

OBJECTIVE: The efficacy of continuing medical education in anesthesiology has been examined very little. This study compared the efficacy of a lecture on air embolism to that of a class that used a problem/case-based learning approach. MATERIAL AND METHODS: Prospective, randomized study enrolling 52 experienced anesthesiologists participating in a professional development course. Twenty-six anesthesiologists attended a lecture on air embolism in anesthesia and 25 attended a problem-based class. The objectives were the same for both groups and had been defined previously. The participants' knowledge was evaluated before and after the instruction with tests based on 2 cases dealing with the same knowledge areas: risk factors and symptoms, diagnosis, monitoring, and treatment. RESULTS: No significant between-group differences were found for any of the knowledge areas before or after the classes. After instruction, participants who listened to the lecture improved their scores for knowledge of monitoring (P = .03) and treatment (P = .001). Participants in the problem-based learning group also improved their scores for knowledge of treatment (P = .003). CONCLUSIONS: No between-group differences in participants' knowledge outcomes were detected; improvements were minimal. The study design allowed the knowledge acquired to be evaluated objectively.

[Cross-sectional survey of anaesthetic practices in Catalonia, Spain]. / Etude transversale de la pratique de l'anesthésie en Catalogne, Espagne.

OBJECTIVE: The aim of this is study was to describe the epidemiology of anaesthesia practice in Catalonia, Spain, in 2003. STUDY DESIGN: A prospective, cross-sectional survey was carried out on 14 randomly chosen days in 2003. METHODS: A questionnaire on each anaesthetic procedure provided information about patient characteristics, technique, and the intervention for which anaesthesia was needed. The results were extrapolated to the population and expressed as annual rates of anaesthetic procedures per 100 inhabitants were calculated. RESULTS: All 131 identified centres (55.7% private, 44.3% public) participated. Based on the 23,136 completed questionnaires collected in the survey, it was estimated that 603,189 procedures were performed. The annual rate of anaesthesia was nine per 100 inhabitants. Women represented 58% of the population. The median age was 52 years and 39.3% of procedures were performed in patients over the age of 60 years. The percentage of patients with an American Society of Anesthesiologists class 3 rating or more was 26.7%. Anaesthesia practice was divided into that associated with surgery (78.4%), obstetrics (11.3%), and other non-surgical procedures (10.4%). Outpatients accounted for 34.3% and emergency patients for 20.3%. Regional anaesthesia was most common (41.4%), with spinal block being the most widely used regional technique. There were an estimated 12.5 anaesthesiologists per 100000 inhabitants. CONCLUSION: Females, older patients, or those with poor physical status make high demands on resources, as do procedures in obstetrics, orthopaedics and ophthalmology. These needs must be planned for in the organization of services and training.

[Survey of anesthetic techniques used in Catalonia: results of the analysis of 23,136 anesthesias (2003 ANESCAT study)]. / Encuesta sobre las técnicas anestésicas utilizadas en Cataluña: resultado del análisis de 23.136 anestesias (estudio ANESCAT 2003).

OBJECTIVE: To examine anesthesia practice in Catalonia in 2003 and to describe the specific characteristics and distribution of the anesthesia techniques used and the patient profiles. PATIENTS AND METHODS: We used the data from the ANESCAT epidemiological study that gathered information in questionnaire form on all anesthesias performed in Catalonia on 14 randomly selected days representative of practice in 2003. RESULTS: All 131 hospitals authorized to perform anesthesia participated in the study. We collected 23136 questionnaires, from which we extrapolated to estimate 603189 anesthesias for the year and a rate of 9.0 anesthesias per 100 inhabitants per year. Fifty-eight percent of the patients were women and the mean age was 52 years. The physical status of the patients was as follows: ASA 1 or 2, 73.3%; ASA 3, 213%; ASA 4 or 5, 5.4%. The mean duration of anesthesia was 60 minutes. The most common form of anesthesia was a regional block (41.4%) and spinal block was the one performed most often. General anesthesia was used in 33.5% of the cases, combined anesthesia in 3.5%, and sedation in 21.6%. In descending order, orthopedics/trauma, ophthalmology, general surgery, obstetrics, cataract surgery, vaginal delivery, inguinal hernia repair, and colonoscopy were the procedures for which anesthesia was most commonly administered. CONCLUSIONS: Almost 1 in 10 persons in Catalonia are given anesthesia each year and most of the procedures involve locoregional anesthesia or sedation. These data provide a picture of the current situation of anesthesiology and make it possible to forecast future anesthesia requirements.

Clase magistral versus aprendizaje basado en caso/problema parala enseñanza del embolismo aéreo en formación médica continuada / Problem/case-based learning compared to lectures for acquiring knowledge of air embolism in continuing medical education

OBJETIVO: La eficacia de la formación médica continuada(FMC) en Anestesiología es un área poco explorada.Este estudio compara la eficacia de la clase magistralcon el “aprendizaje basado en caso/problema” (ABCP)para la enseñanza del embolismo aéreo en FMC.MATERIAL Y MÉTODOS: Estudio prospectivo y randomizado.Se incluyeron 52 anestesiólogos con experienciaclínica que participaron en un curso de FMC. Veintisieteanestesiólogos recibieron una clase magistral y 25 unasesión de ABCP sobre “embolismo aéreo en anestesia”.Los objetivos docentes se definieron con antelación yfueron los mismos para ambos grupos. El conocimientode los participantes se evaluó antes y despues de la enseñanzacon tests basados en dos casos clínicos diferentesque exploraban los mismos campos: “factores de riesgoy síntomas”, “diagnóstico”, “monitorización” y “tratamiento”.RESULTADOS: No se encontraron diferencias significativasentre los grupos antes de la enseñanza ni despuésde la misma en ninguno de los campos. Después de laenseñanza, el grupo clase magistral mejoró sus puntuacionesen “monitorización” (p = 0,03) y “tratamiento”(p = 0,001); el grupo caso/problema mejoró sus puntuacionesen “tratamiento” (p = 0,003).CONCLUSIONES: No hubo diferencias en el conocimientode los participantes entre los dos grupos de aprendizaje;las mejorías alcanzadas fueron mínimas. La metodologíadel estudio permitió una valoración objetiva delos conocimientos adquiridos (AU)

OBJECTIVE: The efficacy of continuing medicaleducation in anesthesiology has been examined verylittle. This study compared the efficacy of a lecture onair embolism to that of a class that used a problem/casebasedlearning approach.MATERIAL AND METHODS: Prospective, randomized studyenrolling 52 experienced anesthesiologists participating in aprofessional development course. Twenty-sixanesthesiologists attended a lecture on air embolism inanesthesia and 25 attended a problem-based class. Theobjectives were the same for both groups and had beendefined previously. The participants’ knowledge wasevaluated before and after the instruction with tests based on2 cases dealing with the same knowledge areas: risk factorsand symptoms, diagnosis, monitoring, and treatment.RESULTS: No significant between-group differenceswere found for any of the knowledge areas before orafter the classes. After instruction, participants wholistened to the lecture improved their scores forknowledge of monitoring (P = .03) and treatment(P = .001). Participants in the problem-based learninggroup also improved their scores for knowledge oftreatment (P = .003).CONCLUSIONS: No between-group differences inparticipants’ knowledge outcomes were detected;improvements were minimal. The study design allowedthe knowledge acquired to be evaluated objectively (AU)