Implementing a mHealth-Based Patient and Nurse Educational Program to Reduce Wound Infection in Rural Philippines.

Background: Surgical site infection (SSI) is a prevalent but preventable complication in low-and-middle income countries (LMIC), with reported incidence varying from 8-30%. In 2018, the MEDIPINAS surgical mission to the Philippines observed a 28.8% rate of SSI despite adherence to WHO intraoperative protocols.The objective of this study was to introduce an educational program for wound care and early identification of wound infection. This program included provision of wound care materials and systematic protocol to ensure adequate and effective follow-up. Barriers to SSI prophylaxis in the Philippines include limited resources in regional hospitals and isolation of patients living in rural areas. The MEDIPINAS mission utilized mobile health software to connect with regional providers and to reinforce the wound care educational program introduced at discharge. Methods: The 2019 MEDIPINAS mission returned to the Philippines and operated on 187 patients in San Antonio de Padua Diocesan Hospital and Santa Maria Josefa Hospital. Before discharge, patients were individually consulted about maintaining the cleanliness of their surgical wound. Each patient was discharged with a wound care infographic and a kit to change dressings. In collaboration with regional care providers, we utilized a secure mobile health software to monitor wound healing 7 and 30 days following the operation. Results: Between the 2018 and 2019 surgical missions, we observed a decrease in SSI from 28.8% to 9.7%. Fourteen patients (7.5%) were lost to follow-up. Postoperative infection was diagnosed using photos provided by hospital-based nurses. Individuals with infections were treated with antibiotics and all but two SSI resolved after 30 days. Conclusions: Patient education, discharge with basic sanitary resources, and development of a mobile health-based follow-up infrastructure may contribute to significant reductions in SSI in LMICs. A limitation to implementation of such a program was integration of the mobile health software into the practice of local healthcare providers.

Collaborative intervention to improve airway assessment and safety in management for anaesthesia: the Qualitat & Via Aèria (QUAVA) study.

BACKGROUND: Airway assessment and management are cornerstones of anaesthesia, yet airway complications remain an important source of morbidity. OBJECTIVE: We performed a before-and-after evaluation of a collaborative intervention to improve adherence to airway assessment and management guidelines in patients scheduled for surgery under general anaesthesia. DESIGN: A prospective, multicentre before-and-after evaluation of a collaborative intervention. SETTING: Collaborative intervention to improve adherence to airway assessment and management guidelines in patients scheduled for surgery under general anaesthesia. Data were collected on 21 consecutive days before and after the intervention. PARTICIPANTS: Anaesthetists with staff or residency positions at 22 hospitals. Patients aged 18 years or older undergoing nonemergency surgery were recruited. INTERVENTION: Establishing a learning network that included local leaders, meetings to share experiences and knowledge, interactive sessions and provision of printed materials on airway assessment and management. Clinical airway management for general anaesthesia was provided by the anaesthetists participating in the study. MAIN OUTCOME MEASURES: Outcomes were the completion of airway assessment at the preanaesthetic visit, rates of unanticipated difficult airway, algorithm adherence and related airway complications. RESULTS: The study included 3753 patients (1947 preintervention and 1806 postintervention). The percentage of patients with a complete airway assessment increased from 25.1% preintervention to 48.4% postintervention (P <0.001). The incidences of unanticipated difficult airway were 4.1% before the intervention and 3% after it (P = 0.433). Rates of adherence to the algorithms for anticipated and unanticipated difficult airway management were similar in the two periods. The incidences of related adverse events were also similar. CONCLUSION: The collaborative intervention was effective in improving airway assessment but not in changing difficult airway management practices.

Anesthesia for urological surgery in a European region with 6.7 million inhabitants (Catalonia, Spain).

STUDY OBJECTIVE: To describe the characteristics of anesthetic and postoperative care applied in urologic surgery. DESIGN: Prospective, cross-sectional survey. SETTING: 131 authorized public and private hospitals in Catalonia, Spain. MEASUREMENTS: Data were collected from a representative sample of 23,136 patients and all questionnaires related to urologic surgery were analyzed. MAIN RESULTS: Data included patient characteristics, anesthetic techniques, and type of procedure. Eighty-five hospitals performed urologic surgery and 75.4% of activity took place in public hospitals. The median age of patients was 61 years and 87.3% were men. Preoperative physical status was poorer than in the rest of the surgical population. Surgery was elective in 93.2% of the cases, and the most frequent procedure was transurethral resection of bladder tissue (25.6%). The median duration of anesthesia was 60 minutes, and 9.7% of patients required postoperative admission to an intensive care unit. Regional anesthesia, especially subarachnoid block, was the most frequently used anesthetic technique. CONCLUSIONS: The older age and poor physical status of urology patients make high demands on anesthetic resources and must be considered in the organization of services and training programs.

The posterior approach to the sciatic nerve in the popliteal fossa: a comparison of single- versus double-injection technique.

We compared single-injection and double-injection of the sciatic nerve with nerve stimulation in the posterior popliteal approach using mepivacaine 1% in a prospective, randomized and single-blind study to evaluate effectiveness, delay of onset, and complications in patients undergoing foot and ankle surgery. In the single-injection group (Group S, n = 30), 25 mL of mepivacaine 1% was administered after eliciting foot inversion or plantar flexion. In the double-injection group (Group D, n = 30), 12.5 mL of the solution was injected after eversion or dorsiflexion and 12.5 mL after plantar flexion of the foot. Mean differences (SD) between the two groups from onset time to complete sensory block were not significant (21.9 [14.2] min vs 22.1 [13.8] min) except for the superficial peroneal nerve block (18 [13] min vs 11.4 [7.5] min, Group S and D, respectively; P < 0.05) and, in Group D, between the superficial peroneal and tibial nerve blocks (11.4 [7.5] min vs 22.3 [11.3] min, respectively; P < 0.05). Complete analgesia was achieved in 77% of Group S patients and in 87% of Group D (P = 0.22). Complete analgesia of the deep peroneal nerve was achieved in 80% and 97% in Group S and D, respectively; P < 0.05. There were more paresthesias during block procedure in Group D (17% vs 40%) (P < 0.05). We conclude that double-nerve stimulation of the sciatic nerve gives similar complete onset times and overall success rate to single-nerve stimulation and more paresthesias during block performance.

[Anesthesia practice in Catalan hospitals and other health care facilities]. / Actividad anestésica en Cataluña según las características de los centros sanitarios.

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. PATIENTS AND METHOD: We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. RESULTS: A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident training programs. The numbers of postoperative admissions to critical care units and of specialized analgesic techniques performed were higher in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. CONCLUSIONS: The complexity of both anesthesia and surgical practice and the severity of patient condition increased with hospital size and public funding status.

[Anesthesia practice in Catalonia, Spain: background, objectives, and design of the ANESCAT 2003 survey]. / Antecedentes, objetivos y método de la encuesta de actividad anestésica en Cataluña (ANESCAT 2003).

BACKGROUND AND OBJECTIVE: The increasing workload in anesthesiology together with the shortage of anesthetists has led to worldwide concern within the specialty. In 2003, the Catalan Society of Anesthesiology, Critical Care and Pain Therapy undertook the ANESCAT survey to determine the anesthesia practice workload in Catalonia, Spain. PATIENTS AND METHOD: A set of 3 questionnaires was used to quantify anesthesia practice and resources. A sample size of 12,228 events was estimated to be necessary to be representative of the number of anesthetic procedures carried out in Catalonia annually. A prospective, cross-sectional survey was carried out on 14 randomly chosen days in 2003. Each hospital designated a coordinator responsible for ensuring that a questionnaire was filled in for each anesthetic procedure, to provide information about patient characteristics, anesthetic technique, and the intervention for which anesthesia was needed. RESULTS: All 131 public and private hospitals in which anesthetic procedures were carried out participated. The geographic distribution was as follows: Barcelona city, 54 (41.2%); rest of the province of Barcelona, 39 (29.8%); Tarragona, 15 (11.5%); Girona, 14 (10.7%), and Lleida, 9 (6.9%). A total of 23,136 questionnaires about anesthesia procedures were received; the number of questionnaires returned on the selected workdays varied by 1.85% and the percentage of incomplete returns was less than 5%. The number of individual anesthetists returning questionnaires for processing was 765. CONCLUSIONS: This large-scale study was possible thanks to a simple design and the strong motivation of a community of anesthesiologists. The results have provided an accurate picture of anesthesia practice within a specific geographical area. Such studies are necessary for introducing organizational changes and applying for additional resources.

[Anesthesia for diagnostic and nonsurgical procedures in Catalonia, Spain, in 2003]. / Anestesia para exploraciones y procedimientos no quirúrgicos en Cataluña el año 2003.

BACKGROUND AND OBJECTIVE: This arm of the ANESCAT survey sought to characterize and quantify nonsurgical anesthesia practice in Catalonia, Spain. PATIENTS AND METHOD: Information about anesthesia for nonsurgical procedures in 131 Catalan hospitals was gathered prospectively on 14 days in 2003. We analyzed patient characteristics, anesthetic techniques, procedures, duration, interventional context for the anesthetic procedure, type of hospital, and geographic distribution. RESULTS: Nonsurgical anesthesia accounted for 10.4% of all acts. Endoscopy of the digestive tract accounted for 70.4% of all nonsurgical procedures, electroconvulsive treatment for 11.7%, radiology for 11.5%, and electrical cardioversion for 1.5%. Anesthesia was provided outside an operating room in 73.7% of the cases. Most procedures were scheduled to be performed in outpatients under sedation or general anesthesia. The most commonly performed digestive tract endoscopic examinations were colonoscopy and gastroscopy, and most took place in private hospitals. CONCLUSIONS: Over 10% of anesthesia practice is for nonsurgical procedures and digestive tract endoscopy accounts for the largest proportion of such practice. As the trend is for such procedures to increase in number, their frequency should be studied so that organization and training can be planned.

[Anesthesia for surgical emergencies in Catalonia, Spain, in 2003]. / Actividad anestésica para urgencias quirúrgicas en Cataluña en 2003.

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT 2003 study was to describe the use of emergency anesthesia in surgical specialties in Catalonia, Spain. PATIENTS AND METHOD: The data analyzed came from a prospective study of the anesthetic procedures performed in 131 hospitals in Catalonia on 14 randomly chosen days in 2003. Emergency anesthetic procedures for surgery (excluding obstetrics and nonsurgical procedures) were selected and the following variables analyzed: type of hospital, patient characteristics, procedure, anesthetic technique, time used, postoperative care, and type of emergency (deferrable or not). Data are expressed as medians (10th-90th percentile) and extrapolated to the population of Catalonia. RESULTS: Out of 23,136 anesthetic procedures recorded, 2,088 (corresponding to an estimated 54,437 anesthetic procedures in Catalonia annually) were associated with surgical emergencies; that figure represents 9% of all anesthetic procedures and 11.5% of anesthetic procedures performed for surgery. The emergency was deferrable in 51% of cases (an estimated 26,906 anesthetic procedures annually). A total of 81.2% of the emergency procedures were performed in hospitals belonging to the public system and 18.8% in private hospitals. Procedures performed from Monday to Friday accounted for 80.6% of emergency procedures. Procedures performed between the hours of 08:00 and 16:00 accounted for 46.5% of the total and 8.1% were performed between 00:00 and 08:00. Sixty percent of deferrable procedures were undertaken between 08:00 and 16:00. Men accounted for 52.4% of all patients, the median age was 51 (15-83) years, and 15.3% of patients were severely ill (American Society of Anesthesiologists physical status class 4). Taken together, orthopedic surgery and traumatology, and general and digestive surgery accounted for 74.4% of the anesthesia practice considered. General anesthesia was used in 51% of cases and regional anesthesia in 38%. The length of anesthesia was greater in deferrable emergencies (90 minutes). Patients were admitted to postoperative critical care units in 18% of cases. CONCLUSIONS: Anesthesia for surgical emergencies accounted for around 10% of the anesthetic procedures performed in Catalonia in 2003, and more than 50% of those procedures could have been deferred.

[Prospects in light of the Catalan survey of 23,136 anesthetic procedures (ANESCAT 2003)]. / Perspectivas a la luz de la encuesta de 23.136 anestesias en Cataluña (ANESCAT 2003).

The ANESCAT 2003 survey has provided reliable information on all practices within the specialty of anesthesiology in a community comprising 6.7 million inhabitants (namely Catalonia, Spain). In a situation in which official statistics are lacking, the findings allow us to make predictions and plan the clinical and organizational needs of the specialty. We discovered that 9 of every 100 residents of Catalonia received anesthesia in 2003 and that the proportion of elderly and high risk patients among them is high. The rates of obstetric and nonsurgical anesthesia were also high. New information on the characteristics of surgical uses of anesthesia that has emerged can now be used for health care planning. Based on population trends--both overall increase and gradual aging--we can foresee increases in demand for anesthesia of around 12% and 20% in the years 2008 and 2013, respectively, although demand may also rise unpredictably if new health care policy measures are introduced suddenly. A growing demand for anesthesia in nonsurgical interventions, perioperative medicine, critical care, and pain therapy was also documented. The workload of anesthesiologists in developing areas exceeds the volume in surgical anesthesia by 30%. Practice in such areas of anesthesiology is comprised of a large range of techniques that differ substantially in complexity and that require reorganization of human resources, equipment and medical resident training programs. The population density observed was 12.7 anesthesiologists per 100,000 inhabitants, reflecting a current deficit that will probably persist over the next 5 years and lead to a serious human resources availability crisis within 10 years, given the age pyramid and the number of residents in training at present. The ANESCAT 2003 survey demonstrates the ability of a scientific society and its members to analyze health care practices in their field and to foresee the effects of expected trends.

Antecedentes, objetivos y método de la encuesta de actividad anestésica en Cataluña (ANESCAT 2003) / Anesthesia practice in Catalonia, Spain: background, objectives, and design of the ANESCAT 2003 survey

Fundamento y objetivo: En todo el mundo el incremento de la actividad anestésica y la falta de anestesiólogos suscitan preocupación. En 2003 la Societat Catalana d'Anestesiologia, Reanimació i Terapèutica del Dolor llevó a cabo un estudio para cuantificar la actividad anestesiológica en Cataluña (España) (ANESCAT 2003). Pacientes y método: ANESCAT es un conjunto de 3 encuestas para cuantificar la actividad anestesiológica y los recursos. Se estimó que la muestra necesaria para la representación de las anestesias anuales en Cataluña era de 12.228 casos. Se llevó a cabo un estudio prospectivo transversal en forma de encuesta realizada en 14 días aleatorios del año 2003. Cada centro designó un coordinador responsable de que se cumplimentara un cuestionario para cada anestesia, el cual recogía información de las características del paciente, técnica anestésica y procedimiento para el que se realizaba. Resultados: En ANESCAT participaron 131 centros sanitarios públicos y privados, el 100% de los que practicaron anestesias en el año 2003. La distribución geográfica de éstos fue: Barcelona ciudad, 54 (41,2%); resto de la provincia, 39 (29,8%); Tarragona, 15 (11,5%); Girona, 14 (10,7%), y Lleida 9, (6,9%). Se recogieron 23.136 cuestionarios de anestesias; la variación del número de cuestionarios recogidos los días laborables de corte fue de un 1,85% y el porcentaje de datos incompletos fue inferior al 5%. Además, se recibieron 765 cuestionarios unipersonales de actividad individualizada. Conclusiones: Con una organización y método sencillos, y una elevada motivación de un colectivo de anestesiólogos, fue posible conducir un estudio extenso que permitió conocer con una gran precisión la actividad que realiza dentro de un territorio. Este tipo de estudios es necesario para introducir cambios en la organización y los requerimientos de recursos

Background and objective: The increasing workload in anesthesiology together with the shortage of anesthetists has led to worldwide concern within the specialty. In 2003, the Catalan Society of Anesthesiology, Critical Care and Pain Therapy undertook the ANESCAT survey to determine the anesthesia practice workload in Catalonia, Spain. Patients and method: A set of 3 questionnaires was used to quantify anesthesia practice and resources. A sample size of 12,228 events was estimated to be necessary to be representative of the number of anesthetic procedures carried out in Catalonia annually. A prospective, cross-sectional survey was carried out on 14 randomly chosen days in 2003. Each hospital designated a coordinator responsible for ensuring that a questionnaire was filled in for each anesthetic procedure, to provide information about patient characteristics, anesthetic technique, and the intervention for which anesthesia was needed. Results: All 131 public and private hospitals in which anesthetic procedures were carried out participated. The geographic distribution was as follows: Barcelona city, 54 (41.2%); rest of the province of Barcelona, 39 (29.8%); Tarragona, 15 (11.5%); Girona, 14 (10.7%), and Lleida, 9 (6.9%). A total of 23,136 questionnaires about anesthesia procedures were received; the number of questionnaires returned on the selected workdays varied by 1.85% and the percentage of incomplete returns was less than 5%. The number of individual anesthetists returning questionnaires for processing was 765. Conclusions: This large-scale study was possible thanks to a simple design and the strong motivation of a community of anesthesiologists. The results have provided an accurate picture of anesthesia practice within a specific geographical area. Such studies are necessary for introducing organizational changes and applying for additional resources

Actividad anestésica en Cataluña según las características de los centros sanitarios / Anesthesia practice in Catalan hospitals and other health care facilities

Fundamento y objetivo: Conocer la actividad anestésica de Cataluña (España) en 2003 según los centros sanitarios. Pacientes y método: A partir de los datos ANESCAT 2003 estudiamos la actividad anestésica de los centros sanitarios clasificados según su fuente de financiación ­centros públicos del Institut Català de la Salut (ICS), centros públicos concertados (XHUP) o privados (CP)­, según su tamaño ­sin camas de hospitalización, con menos de 250 camas, con 251-500 camas y con más de 500 camas­ y su acreditación o no para la formación de médicos residentes (MIR). Resultados: Participaron 131 centros (11 del ICS, 47 XHUP y 73 CP; 26 sin camas de hospitalización, 78 con menos de 250 camas, 21 con 251-500 camas y 6 con más de 500 camas), de los cuales 17 impartían MIR. Los porcentajes de anestesias fueron: un 44,3% en XHUP, un 36,7% en CP y un 18,5% en ICS; un 5% en centros sin camas de hospitalización, un 42,9% en centros con menos de 250 camas, un 35% en centros con 251-500 camas y un 17,1% en centros con más de 500 camas, y un 35,5% en los MIR. La edad mediana de los pacientes de los CP, de los centros con menos de 250 camas y los no MIR fue menor. El estado físico de los pacientes fue peor en ICS, en los centros con más de 500 camas y en los MIR. Destacó la actividad de urgencias cercana al 25% en XHUP, ICS, centros con más de 250 camas y en los MIR. La anestesia ambulatoria en los CP supuso el 40% y en los otros, el 31%. La duración de la anestesia y de la recuperación postanestésica fue mayor en el ICS, en centros con más de 500 camas y en los MIR. El ingreso en unidades de cuidados críticos en el postoperatorio y la analgesia especializada fueron superiores en ICS, centros con más de 500 camas y MIR. Conclusiones: La complejidad de la actividad tanto anestésica como quirúrgica y la gravedad de los pacientes aumentaron con el número de camas del hospital y su titularidad pública

Background and objective: The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. Patients and method: We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. Results: A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident training programs. The numbers of postoperative admissions to critical care units and of specialized analgesic techniques performed were higher in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. Conclusions: The complexity of both anesthesia and surgical practice and the severity of patient condition increased with hospital size and public funding status

Anestesia para exploraciones y procedimientos no quirúrgicos en Cataluña el año 2003 / Anesthesia for diagnostic and nonsurgical procedures in Catalonia, Spain, in 2003

Fundamento y objetivo: Conocer y cuantificar el peso de la actividad anestésica no quirúrgica en Cataluña (España) en el año 2003. Pacientes y método: Estudio prospectivo de las anestesias no quirúrgicas realizadas en 131 hospitales catalanes en 14 días del 2003. Se analizaron: características de los pacientes, técnicas anestésicas, procedimientos, duración, tipo de actividad, tipos de centros y distribución geográfica. Resultados: Las anestesias no quirúrgicas representaron el 10,4% del total de anestesias. De estos procedimientos, la endoscopia digestiva representó un 70,4%, el tratamiento electroconvulsivo el 11,7%, la radiología un 11,5% y las cardioversiones un 1,5%. El 73,7% de estos procedimientos se realizaron fuera de quirófano. Hubo un predominio de actividad programada realizada ambulatoriamente bajo sedación o anestesia general. Las endoscopias digestivas más representativas fueron la colonoscopia y la gastroscopia, realizadas mayoritariamente en centros privados. Conclusiones: La anestesia para procedimientos no quirúrgicos, especialmente endoscopias digestivas, fue superior al 10% de todas las anestesias. Estas técnicas tienden a aumentar y es necesario conocer su frecuencia para una correcta planificación y para adelantar las estrategias formativas y organizativas

Background and objective: This arm of the ANESCAT survey sought to characterize and quantify nonsurgical anesthesia practice in Catalonia, Spain. Patients and method: Information about anesthesia for nonsurgical procedures in 131 Catalan hospitals was gathered prospectively on 14 days in 2003. We analyzed patient characteristics, anesthetic techniques, procedures, duration, interventional context for the anesthetic procedure, type of hospital, and geographic distribution. Results: Nonsurgical anesthesia accounted for 10.4% of all acts. Endoscopy of the digestive tract accounted for 70.4% of all nonsurgical procedures, electroconvulsive treatment for 11.7%, radiology for 11.5%, and electrical cardioversion for 1.5%. Anesthesia was provided outside an operating room in 73.7% of the cases. Most procedures were scheduled to be performed in outpatients under sedation or general anesthesia. The most commonly performed digestive tract endoscopic examinations were colonoscopy and gastroscopy, and most took place in private hospitals. Conclusions: Over 10% of anesthesia practice is for nonsurgical procedures and digestive tract endoscopy accounts for the largest proportion of such practice. As the trend is for such procedures to increase in number, their frequency should be studied so that organization and training can be planned

Actividad anestésica para urgencias quirúrgicas en Cataluña en 2003 / Anesthesia for surgical emergencies in Catalonia, Spain, in 2003

Fundamento y objetivo: Conocer la actividad anestésica urgente de las especialidades quirúrgicas en Cataluña (España). Pacientes y método: Estudio prospectivo de las anestesias realizadas en 131 hospitales en 14 días aleatorios de 2003 (ANESCAT 2003), se seleccionaron las anestesias urgentes para cirugía (excluyendo obstetricia y procedimientos no quirúrgicos) y se analizaron: tipo de hospital, características de los pacientes, procedimientos, técnicas anestésicas, tiempos empleados, destino de los pacientes y tipo de urgencia (diferible o no). Los datos se expresan como mediana y percentiles del 10-90%, y se extrapolaron a la población catalana. Resultados: De las 23.136 anestesias, 2.088 (estimación de 54.437 anestesias anuales) fueron urgencias quirúrgicas, lo que supone el 9% del total de anestesias y el 11,5% de las anestesias para procedimientos quirúrgicos. El 51% fueron urgencias diferibles (estimación de 26.906 anestesias anuales). El 81,2% de las urgencias se realizó en centros del Institut Català de la Salut y el 18,8% en centros privados. De lunes a viernes se realizó el 80,6% de las urgencias. El 46,5% de la actividad urgente se efectuó entre las 8 y 16 h y el 8,1% entre las 0 y 8 h. El 60% de la actividad diferible se realizó entre las 8 y 16 h. El 52,4% de los pacientes eran varones, la edad mediana era de 51 años (15-83) y un 15,3% eran pacientes graves (clase 4 de la clasificación de la American Society of Anesthesiologists ­ASA­). La cirugía ortopédica y traumatología y la cirugía general y digestiva sumaban el 74% de la actividad. Se aplicó anestesia general en el 51% de los casos y locorregional en el 38%. La duración de la anestesia fue mayor en las urgencias diferibles (90 min). El 18% de los pacientes ingresaron en unidades de cuidados críticos en el postoperatorio. Conclusiones: Anestesia para urgencias quirúrgicas supuso alrededor del 10% de las anestesias que se realizaron en Cataluña en el año 2003, y más de un 50% de ellas podían haberse diferido

Background and objective: The aim of this arm of the ANESCAT 2003 study was to describe the use of emergency anesthesia in surgical specialties in Catalonia, Spain. Patients and method: The data analyzed came from a prospective study of the anesthetic procedures performed in 131 hospitals in Catalonia on 14 randomly chosen days in 2003. Emergency anesthetic procedures for surgery (excluding obstetrics and nonsurgical procedures) were selected and the following variables analyzed: type of hospital, patient characteristics, procedure, anesthetic technique, time used, postoperative care, and type of emergency (deferrable or not). Data are expressed as medians (10th-90th percentile) and extrapolated to the population of Catalonia. Results: Out of 23,136 anesthetic procedures recorded, 2,088 (corresponding to an estimated 54,437 anesthetic procedures in Catalonia annually) were associated with surgical emergencies; that figure represents 9% of all anesthetic procedures and 11.5% of anesthetic procedures performed for surgery. The emergency was deferrable in 51% of cases (an estimated 26,906 anesthetic procedures annually). A total of 81.2% of the emergency procedures were performed in hospitals belonging to the public system and 18.8% in private hospitals. Procedures performed from Monday to Friday accounted for 80.6% of emergency procedures. Procedures performed between the hours of 08:00 and 16:00 accounted for 46.5% of the total and 8.1% were performed between 00:00 and 08:00. Sixty percent of deferrable procedures were undertaken between 08:00 and 16:00. Men accounted for 52.4% of all patients, the median age was 51 (15-83) years, and 15.3% of patients were severely ill (American Society of Anesthesiologists physical status class 4). Taken together, orthopedic surgery and traumatology, and general and digestive surgery accounted for 74.4% of the anesthesia practice considered. General anesthesia was used in 51% of cases and regional anesthesia in 38%. The length of anesthesia was greater in deferrable emergencies (90 minutes). Patients were admitted to postoperative critical care units in 18% of cases. Conclusions: Anesthesia for surgical emergencies accounted for around 10% of the anesthetic procedures performed in Catalonia in 2003, and more than 50% of those procedures could have been deferred

Perspectivas a la luz de la encuesta de 23.136 anestesias en Cataluña (ANESCAT 2003) / Prospects in light of the catalan survey of 23'136 anesthetic procedures (ANESCAT 2003)

El estudio ANESCAT 2003 ha proporcionado datos fiables de toda la actividad de la especialidad de anestesiología en una comunidad de 6,7 millones de habitantes y, a falta de información oficial, permite prever y planificar las necesidades de anestesia y la organización de la especialidad. Ha permitido conocer que en Cataluña (España), en 2003, recibieron anestesia 9 de cada 100 habitantes, con un alto porcentaje de pacientes mayores y de alto riesgo y una alta frecuencia de anestesia en obstetricia y áreas no quirúrgicas. Se ha obtenido información inédita sobre las características de la actividad quirúrgica y, por tanto, se convierte en una herramienta para la planificación sanitaria. La previsión del aumento de la población y de su progresivo envejecimiento anuncia unos incrementos de la demanda de anestesia del 12 y el 20% en los años 2008 y 2013, respectivamente, aunque medidas bruscas de política sanitaria pueden aumentar la demanda de forma imprevisible. A esto hay que añadir el crecimiento de la demanda de otras áreas de la especialidad ligadas a la medicina perioperatoria, los cuidados críticos y el tratamiento del dolor. El ámbito de desarrollo de la anestesiología supera en un 30% la anestesia quirúrgica y se caracteriza por una gran variedad de actuaciones, con diferencias notables en complejidad, que exigen una reorganización de los recursos humanos, de equipamiento y de los programas de formación de especialistas. La densidad de anestesiólogos encontrada, de 12,7 por 100.000 habitantes, está asociada actualmente a un déficit de estos profesionales, déficit que, dada la pirámide de edades y el número actual de residentes, es previsible que perdure en los próximos 5 años, con una crisis grave de recursos humanos en un plazo de 10 años. La encuesta ANESCAT 2003 demuestra la capacidad de una sociedad científica y sus profesionales para analizar la asistencia sanitaria que les corresponde y prevenir los efectos de los cambios esperables

The ANESCAT 2003 survey has provided reliable information on all practices within the specialty of anesthesiology in a community comprising 6.7 million inhabitants (namely Catalonia, Spain). In a situation in which official statistics are lacking, the findings allow us to make predictions and plan the clinical and organizational needs of the specialty. We discovered that 9 of every 100 residents of Catalonia received anesthesia in 2003 and that the proportion of elderly and high risk patients among them is high. The rates of obstetric and nonsurgical anesthesia were also high. New information on the characteristics of surgical uses of anesthesia that has emerged can now be used for health care planning. Based on population trends--both overall increase and gradual aging--we can foresee increases in demand for anesthesia of around 12% and 20% in the years 2008 and 2013, respectively, although demand may also rise unpredictably if new health care policy measures are introduced suddenly. A growing demand for anesthesia in nonsurgical interventions, perioperative medicine, critical care, and pain therapy was also documented. The workload of anesthesiologists in developing areas exceeds the volume in surgical anesthesia by 30%. Practice in such areas of anesthesiology is comprised of a large range of techniques that differ substantially in complexity and that require reorganization of human resources, equipment and medical resident training programs. The population density observed was 12.7 anesthesiologists per 100,000 inhabitants, reflecting a current deficit that will probably persist over the next 5 years and lead to a serious human resources availability crisis within 10 years, given the age pyramid and the number of residents in training at present. The ANESCAT 2003 survey demonstrates the ability of a scientific society and its members to analyze health care practices in their field and to foresee the effects of expected trends

The diagnosis and treatment of a patient with puerperal infection and subdural hygromas.

We describe a patient readmitted after developing a persistent postural headache resulting from an accidental lumbar puncture during labor 10 days earlier. Magnetic resonance imaging demonstrated bifrontal subdural hygromas and diffuse pachymeningeal enhancement. The patient had signs of a puerperal infection, and an epidural patch was performed with dextran 40 instead of blood, after which gradual improvement was noted. The patient was discharged totally asymptomatic 3 days later.

A comparison of a triple-injection axillary brachial plexus block with the humeral approach.

BACKGROUND AND OBJECTIVES: This prospective, randomized, and single-blind study compared effectiveness, performance, onset, and total anesthetic time and complications of the multiple axillary block (median, radial, and musculocutaneous nerves) with the humeral approach. METHODS: One hundred patients were randomly assigned to 2 groups. In group A (axillary) median, radial, and musculocutaneus nerves were located by a nerve stimulator and injections were made. In group H (humeral) all 4 terminal nerves of the brachial plexus were located and injections were made. A total of 40 mL mepivacaine of 1% was used. RESULTS: Complete sensory block of all 6 peripheral nerves occurred in 94% and 79% of patients in groups A and H, respectively (P < .05). The time to perform the block was shorter in group A (8 +/- 4 minutes v 11 +/- 4 minutes; P < .001); onset time was shorter in group A (16 +/- 8 minutes v 21 +/- 9 minutes; P < .05); total anesthetic time was shorter in group A (24 +/- 8 minutes v 33 +/- 10 minutes; P < .0001). Complete motor block was greater in group A (88% v 66%; P < .05). More vascular punctures occurred in group A (22% v 8%, P < .05). CONCLUSION: The triple-injection axillary block was more effective than the humeral approach as it was associated with more cases of sensory and complete motor block and gave shorter performance and onset times.