Contradicción anestesiológica en una gestante con adenoma pleomórfico y alergia a los anestésicos locales / Anesthesiological contradiction in a pregnant woman with pleomorphic adenoma and allergy to local anesthetics

Introducción: El adenoma del paladar blando es frecuente en mujeres, aunado a los cambios fisiológicos que suceden durante el embarazo, es de presumir que la gestante puede presentar una vía aérea difícil. Objetivo: Describir el abordaje de la vía aérea en una gestante con adenoma del paladar blando. Presentación del caso: Se trata de una gestante de 20 años de edad con antecedentes patológicos personales de asma bronquial, alergia a los anestésicos locales, que presenta un adenoma en el paladar blando que impide ver la estructura de la orofaringe, Mallampatti IV, anunciada para procedimiento quirúrgico de urgencia para realizarle cesárea segmentaria anterior. Conclusiones: La embarazada presenta mayor incidencia de vía aérea difícil comparado con la población general, debido a los cambios fisiológicos que presenta en este periodo, si a ello se le adiciona la presencia de un tumor oro faríngeo que imposibilita la manipulación de la vía aérea, la evaluación preoperatoria y trazar una estrategia multidisciplinaria, constituyen los pilares para evitar complicaciones potencialmente fatales(AU)

Introduction: Adenoma of soft palate is frequent in women, together with the physiological changes that occur during pregnancy. The pregnant woman is to be presumed to have a difficult airway. Objective: To describe the airway managment in a pregnant woman with adenoma of soft palate. Case presentation: This is a 20-year-old pregnant woman (Mallampati IV) with a personal pathological history of bronchial asthma and allergy to local anesthetics, who presents an adenoma of soft palate that avoids seeing the oropharynx structure, announced for emergency surgical procedure for an anterior segmental cesarean section. Conclusions: The pregnant woman has a higher incidence of difficult airway compared to the general population, due to the physiological changes that she presents in this period. If, apart from this situation, the presence is considered of an oropharyngeal tumor that makes it impossible to manipulate the airway, preoperative assessment and tracing a multidisciplinary strategy are the pillars to avoid potentially fatal complications(AU)

Importancia del anestesiólogo en la prevención del dolor crónico / Importance of the anesthesiologist in the prevention of chronic pain

The development of chronic pain after surgery or persistent postoperative pain is a significant public health problem that affects between 10%-56% of patients undergoing surgical intervention. It produces great restrictions of mobility, limitation of daily activities, dependence on opioids, anxiety, depression, a great alteration of the quality of life and important legal and medical-economic consequences. There is a very close correlation between acute postoperative pain, and persistent postoperative pain. For this reason, pain must be treated effectively in its acute phase to reduce the incidence of chronic pain after surgery. There are risk factors that predispose to its appearance and that must be known by the anesthesiologist. In an individualized and meticulous pre-anesthetic consultation, these risk factors can be detected, as well as the presence of surgical procedures related to chronic pain, with the purpose of the therapeutic approach of the first ones if necessary, and a good planning of the anesthetic and analgesic technique, which reduces the participation of the second, in the chronicity of acute pain. The role of the anesthesiologist in the pre-anesthetic consultation is essential for the planning of preventive and multimodal analgesia that, together with other resources, should reduce the incidence of persistent postoperative pain.

El desarrollo del dolor crónico después de la cirugía o dolor posoperatorio persistente, es un problema de salud pública significativo que afecta entre el 10%-56% de los pacientes sometidos a una intervención quirúrgica. Produce grandes restricciones de la movilidad, limitación de las actividades de vida diaria, dependencia a los opioides, ansiedad, depresión, una gran alteración de la calidad de vida e importantes consecuencias legales y médico-económicas. Hay una correlación muy estrecha entre el dolor agudo posoperatorio, y el dolor posoperatorio persistente. Por esa razón, el dolor debe ser tratado de manera eficaz en su fase aguda para disminuir la incidencia del dolor crónico posterior a la cirugía. Existen factores de riesgo que predisponen a su aparición y que deben ser conocidos por el anestesiólogo. En una consulta pre-anestésica individualizada y minuciosa, se podrán detectar estos factores de riesgo, como también la presencia de procedimientos quirúrgicos relacionados con el dolor crónico, con la finalidad del abordaje terapéutico de los primeros de ser necesario, y una buena planificación de la técnica anestésica y analgésica, que disminuya la participación de los segundos, en la cronicidad del dolor agudo. El rol del anestesiólogo en la consulta pre-anestésica, es fundamental para la planificación de la analgesia preventiva y multimodal que junto a otros recursos deberían disminuir la incidencia del dolor postoperatorio persistente.

Update on biological risk for anesthetists taking care of patients affected by SARS-CoV2, COVID19 / Actualizacion de los riesgos biologicos para anestesiologos en la atencion de pacientes afectados por SARS-CoV-2, COVID-19

Abstract Biological risks are currently of great interest and concern due to the coronavirus disease 19 (COVID-19) pandemic. In this setting, the exposure of anesthetists and healthcare personnel to patients infected with severe acute respiratory syndrome-CoV-2 causing COVID-19 in their professional practice makes an update in the knowledge of the subject essential. The aim is prevention and protection during procedures entailing a higher risk, as is the case of the so-called aerosol generators (by inhalation of droplets). Therefore, we recommend extreme standard precautions focused on hand washing and barrier protection through the use of personal protective equipment in accordance with comprehen sive prevention and protection protocols for anesthetists, patients, and operating rooms.

Resumen En la actualidad, los riesgos biológicos han tomado un gran interés y preocupación debido a la pandemia por COVID-19. En ese escenario, la exposición en su ejercicio profesional de los anestesiólogos y personal sanitario a pacientes infectados con SARS-CoV-2 causante de la COVID-19 hace imprescindible una actualización en el conocimiento del tema apuntando a la prevención y protecciones durante procedimientos que revisten mayor riesgo, como los denominados generadores de aerosoles (por inhalación de gotas). Por lo tanto, se recomienda extremar las precauciones estándar enfocadas al lavado de manos y protecciones de barrera equipo de protección personal (EPP) siguiendo protocolos de prevención y protección integral del anestesiólogo, del paciente y del quirófano. Dados los rápidos cambios en la evidencia disponible en esta patología emergente, muchas de las recomendaciones aquí pre sentadas serán sujeto de modificaciones o ajustes futuros.

Intraoperative Surgeon Administered Adductor Canal Blockade Is Not Inferior to Anesthesiologist Administered Adductor Canal Blockade: A Prospective Randomized Trial.

BACKGROUND: Controlling postoperative pain and reducing opioid requirements after total knee arthroplasty remain a challenge, particularly in an era stressing rapid recovery protocols and early discharge. A single-shot adductor canal blockade (ACB) has been shown to be effective in decreasing postoperative pain. The purpose of the present study is to compare the efficacy of an anesthesiologist administered ACB and a surgeon administered intraoperative ACB. METHODS: Patients undergoing primary total knee arthroplasty were prospectively randomized to receive either an anesthesiologist administered (group 1) or surgeon administered (group 2) ACB using 15 mL of ropivacaine 0.5%. Primary outcomes were pain visual analog scale, range of motion, and opioid consumption. RESULTS: Thirty-four patients were randomized to group 1 and 29 to group 2. Opioid equivalents consumed were equal on postoperative day (POD) 0, 1, and 2. Patients in group 1 had statistically less pain on POD 0, but this did not reach clinical significance and there was no difference in pain on POD 1 or 2. Patients in group 1 had significantly increased active flexion POD 1, but there was no difference in active flexion on POD 0 or 6 weeks postop. There was no difference in patient satisfaction with pain control or short-term functional outcomes. CONCLUSION: Surgeon administered ACB is not inferior to anesthesiologist administered ACB with respect to pain, opioid consumption, range of motion, patient satisfaction, or short-term functional outcomes. Surgeon administered ACB is an effective alternative to anesthesiologist administered ACB.

[Subjective method for tracheal tube cuff inflation: performance of anesthesiology residents and staff anesthesiologists. Prospective observational study]. / Insuflação de balonete de tubo traqueal por método subjetivo: desempenho de médicos residentes e especialistas em anestesiologia. Estudo prospectivo observacional.

BACKGROUND AND OBJECTIVES: Poor monitoring of tracheal tube cuff pressure may result in patient complications. The objective method of using a manometer is recommended to keep safe cuff pressure values (20-30 cm H2O). However, as manometers are not readily available, anesthesiologists use subjective methods. We aimed to assess appropriateness of a subjective method for attaining cuff pressure and the expertise level of manometer handling among anesthesiology staff and residents in a university teaching hospital. METHODS: Prospective observational study, recruiting participants that performed tracheal intubation and the subjective method for tube cuff inflation. Patients with difficult airway, larynx and trachea anatomic abnormality and emergency procedures were not included. Up to 60 minutes after tracheal intubation, an investigator registered the cuff pressure using an aneroid manometer (AMBU®) connected to the tube pilot balloon. RESULTS: Forty-seven anesthesiologists were included in the study - 24 residents and 23 staff. Mean (SD) and medians (IQR) measured in cm H2O were, respectively, 52.5 (27.1) and 50 (30-70). We registered 83% of measurements outside the recommended pressure range, with no difference between specialists and residents. The level of expertise with the objective method was also similar in both groups. Pressure adjustments were performed in 76.6% of cases. CONCLUSION: The subjective method for inflating the tracheal tube cuff resulted in a high rate of inadequate cuff pressures, with no difference in performance between anesthesiology specialists and residents.

Subjective method for tracheal tube cuff inflation: performance of anesthesiology residents and staff anesthesiologists. Prospective observational study / Insuflação de balonete de tubo traqueal por método subjetivo: desempenho de médicos residentes e especialistas em anestesiologia. Estudo prospectivo observacional

Abstract Background and objectives: Poor monitoring of tracheal tube cuff pressure may result in patient complications. The objective method of using a manometer is recommended to keep safe cuff pressure values (20‒30 cm H2O). However, as manometers are not readily available, anesthesiologists use subjective methods. We aimed to assess appropriateness of a subjective method for attaining cuff pressure and the expertise level of manometer handling among anesthesiology staff and residents in a university teaching hospital. Methods: Prospective observational study, recruiting participants that performed tracheal intubation and the subjective method for tube cuff inflation. Patients with difficult airway, larynx and trachea anatomic abnormality and emergency procedures were not included. Up to 60 minutes after tracheal intubation, an investigator registered the cuff pressure using an aneroid manometer (AMBU®) connected to the tube pilot balloon. Results: Forty-seven anesthesiologists were included in the study - 24 residents and 23 staff. Mean (SD) and medians (IQR) measured in cmH2O were, respectively, 52.5 (27.1) and 50 (30‒70). We registered 83% of measurements outside the recommended pressure range, with no difference between specialists and residents. The level of expertise with the objective method was also similar in both groups. Pressure adjustments were performed in 76.6% of cases. Conclusion: The subjective method for inflating the tracheal tube cuff resulted in a high rate of inadequate cuff pressures, with no difference in performance between anesthesiology specialists and residents.

Resumo Justificativa e objetivos: O controle inadequado da pressão dos balonetes dos tubos traqueais pode resultar em complicações. A técnica objetiva com uso de manômetro é a recomendada para manutenção de valores seguros de pressão (20-30 cm H2O). Mas como ese instrumento é pouco disponível, os anestesiologistas recorrem a técnicas subjetivas. O objetivo deste estudo foi avaliar a adequação da técnica subjetiva para obtenção das pressões dos balonetes e o nível de experiência com uso do manômetro entre médicos especialistas e residentes de anestesiologia de um Hospital Universitário. Método: Estudo observacional prospectivo, com participantes que realizaram intubação traqueal e técnica subjetiva para insuflação dos balonetes. Pacientes com via aérea difícil, anormalidades anatômicas de laringe e traqueia, risco de broncoaspiração e os casos de emergência não foram incluídos. Até 60 minutos após a intubação, um investigador registrava a pressão do balonete utilizando um manômetro aneroide (AMBU®) conectado ao balonete guia do tubo. Resultados: Quarenta e sete anestesiologistas foram incluídos no estudo - 24 residentes e 23 especialistas. As pressões (cm H2O) média (DP) e mediana (IQR) encontradas foram, respectivamente, 52,5 (27,1) e 50 (30-70). Da amostra, 83% estavam fora da faixa adequada de pressão, sem diferença entre especialistas e residentes. O nível de experiência com a técnica objetiva também foi semelhante entre os grupos. Correção da pressão foi realizada em 76,6% dos casos. Conclusões: A técnica subjetiva para insuflar os balonetes dos tubos traqueais resultou em alta prevalência de pressões inadequadas, sem diferença no desempenho entre especialistas e residentes.

Efectividad de la indometacina vs analgésico habitual en el tratamiento del dolor posthisterectomía / Effectiveness of using indomethacin vs usual analgesic in the management of postoperative pain in hysterectomy

Resumen: OBJETIVO: Determinar la efectividad de la indometacina, por vía rectal, en el tratamiento del dolor posthisterectomía versus paracetamol o metamizol administrados por vía intravenosa. MATERIALES Y MÉTODOS: Estudio experimental, comparativo y prospectivo llevado a cabo en el Hospital Central del Estado de Chihuahua entre noviembre y diciembre de 2019. Criterios de inclusión: pacientes histerectomizadas, con expediente clínico completo y de cualquier edad. Criterios de exclusión: pacientes con alteraciones en el umbral del dolor, inconsistencias en el expediente, histerectomía total no ginecológica. Criterios de eliminación: pacientes con limitantes en la información que no permitieron relacionar la variable dependiente con la independiente. El seguimiento del dolor referido se efectuó con la escala análoga del dolor y valoraciones a las 12 y 24 horas posteriores a la cirugía. RESULTADOS: Se reunieron 141 pacientes, que se dividieron en tres grupos. Grupo 1: metamizol intravenoso e indometacina por vía rectal (n = 24). Grupo 2: paracetamol intravenoso e indometacina por vía rectal (n = 19). Grupo 3: paracetamol y metamizol intravenosos (n = 98). La mayoría de las pacientes de los grupos 1 y 2 reportaron, a las 24 h, una escala visual análoga menor de 3 vs las del grupo 3. Diez de 98 pacientes requirieron tratamiento en el servicio de Anestesiología. CONCLUSIÓN: La administración de indometacina por vía rectal a pacientes histerectomizadas demostró menor dolor que con metamizol y paracetamol, y evolución clínica y alta hospitalaria más temprana.

Abstract: OBJECTIVE: To determine the effectiveness of indomethacin in the treatment of post-hysterectomy pain versus paracetamol or metamizole administered intravenously. MATERIALS AND METHODS: Experimental, comparative and prospective study at the Central Hospital of the State of Chihuahua, period November to December 2019, patients undergoing hysterectomy with complete clinical record, any age. Patients with alterations in the pain threshold, inconsistencies in the file, total non-gynecological hysterectomy were excluded, patients with information limitations were eliminated, which did not allow to relate the dependent variable, with the independent one. RESULTS: 141 patients were collected, which were divided into three groups. Group 1: intravenous metamizole and indomethacin rectally (n = 24). Group 2: intravenous paracetamol and indomethacin rectally (n = 19). Group 3: intravenous paracetamol and metamizole (n = 98). Most of the patients in groups 1 and 2 reported, at 24 hours, a visual analog scale of less than 3 vs those of group 3. Ten of 98 patients required treatment in the Anesthesiology service. CONCLUSION: The administration of indomethacin rectally in postoperative patients of hysterectomy has been shown to reduce pain more effectively than conventional analgesics such as metamizole and paracetamol, relating to clinical evolution and early hospital discharge.

Coronavirus y anestesia: Consideraciones en torno a la solidaridad / Anesthesia and coronavirus: Solidarity issues

COVID-19 coronavirus infection has led us to reflect on the role of the enormous responsibility that the individual plays within his community for the free enjoyment and enjoyment of life on this planet that belongs to everyone, and the natural cooperation that it must exist between countries to build trust and progress. The WHO declared it a pandemic, and the repercussions of a health and economic emergency have dramatically altered social relations and daily life. The health system has been overwhelmed in high-income countries like Spain and Italy, creating a panorama that ranges from bewilderment to panic. In all the hospitals of the 180 countries that are experiencing this pandemic, the service has been provided with heroism, regardless of the current public health crisis, due to the mercantilist models and the privatization of the system. The high risk of general contagion has not mattered either, there is that large contingent of health workers firm and determined to serve, and anesthesiologists are not far behind. Still, we must be aware that the community needs us, that we must be well informed, and we must take care of ourselves with all the biosecurity measures that this challenge demands. The purpose of this article is to draw attention to these topics, highlighting that the importance of humanity depends on their behavior, their solidarity, and social responsibility.

La infección por el coronavirus COVID-19 nos ha puesto a reflexionar en torno al papel de enorme responsabilidad que juega el individuo dentro de su comunidad para el libre disfrute y goce de la vida en este planeta que es de todos, y la cooperación natural que debe existir entre los países para generar confianza y progreso. La OMS la declaró una pandemia y las repercusiones de emergencia sanitaria y económica han alterado de forma dramática las relaciones sociales y la cotidianeidad. El sistema de salud ha sido desbordado en países de altos ingresos como España e Italia, sembrando un panorama que va desde el desconcierto hasta el pánico. En todos los hospitales de los 180 países que cursan con esta pandemia, el servicio se ha venido prestando con heroísmo, sin importar la crisis de salud pública existente, a causa de los modelos mercantilistas y de privatización del sistema. No ha importado tampoco el alto riesgo de contagio general, allí está ese gran contingente de trabajadores de salud firme y decidido a servir, y los anestesiólogos no nos quedamos atrás, pero tenemos que ser conscientes que la comunidad nos necesita, que debemos estar bien informados y debemos cuidarnos con todas las medidas de bioseguridad que exige este reto. El propósito de este artículo es, llamar la atención sobre estos tópicos, destacando que la trascendencia de la humanidad depende de su comportamiento, de su solidaridad y de su responsabilidad social.

Seguridad de la sedación con propofol administrado por gastroenterólogos en endoscopia digestiva / Safety of propofol sedation administered by gastroenterologists in digestive endoscopy

Resumen Objetivo: tradicionalmente, la sedación con propofol ha estado a cargo de especialistas en anestesiología; sin embargo, una extensa cantidad de información publicada ha demostrado que la sedación con propofol administrado por no anestesiólogos, es segura y eficaz. El estudio se realizó con el objetivo de evaluar la seguridad en la administración de propofol por gastroenterólogos, para la realización de procedimientos en endoscopia digestiva. Métodos: se hizo un estudio retrospectivo en el cual se revisaron los expedientes de 1135 pacientes sometidos a endoscopias digestivas diagnósticas y terapéuticas, en el período comprendido entre enero de 2016 y marzo de 2017. Los pacientes se organizaron por su: edad, género, clasificación de riesgo de la Sociedad Americana de Anestesiólogos, indicación para la endoscopia, y dosis utilizada de propofol. Se registraron los efectos adversos asociados al uso de Propofol, tales como: episodios de hipoxemia transitoria, complicaciones cardiopulmonares serias y muerte. Resultados: se incluyeron los datos de 1135 pacientes (56 % fueron mujeres) que se practicaron endoscopia digestiva bajo sedación con propofol administrado por gastroenterólogos, en un período de 14 meses. La dosis promedio utilizada de propofol fue de 154 +/- 66 mg. Según la clasificación de riesgo de la Sociedad Americana de Anestesiólogos, el 84 % de los pacientes corresponde a las clasificaciones I y II, un 14,8 % a pacientes con clasificación de riesgo III y un 1,1 %, riesgo IV. Los estudios efectuados fueron mayoritariamente gastroscopias (52,6 %) y según la indicación, el 79,6 % corresponde a estudios diagnósticos, seguido de un 12,1% para los sangrados digestivos altos de emergencia. En cuanto a las complicaciones documentadas, se identificaron 70 episodios de hipoxemia que corresponden a un 6,2 % de las sedaciones realizadas. (IC 95%, 4,7-7,6). Solamente un 3,7 % de los pacientes presentó un episodio de hipoxemia por debajo del 80 %. Todos los episodios de hipoxemia, excepto uno, resolvieron con maniobras simples, como la elevación del mentón. Durante el estudio no se presentaron complicaciones cardiopulmonares serias o muertes. Se identificaron, como factores de riesgo para la aparición de hipoxemia, una clasificación de riesgo de la Sociedad Americana de Anestesiólogos mayor a 3, y la realización del estudio endoscópico para dilatación esofágica o colocación de gastrostomía percutánea. Conclusiones: el uso de sedación con propofol administrado por no anestesiólogos en el estudio, no evidenció incremento en la aparición de complicaciones cardiopulmonares serias, ni en los episodios de hipoxemia.

Abstract Aim: Traditionally, sedation with propofol has been approved exclusively for use by anethesiologists, however, an extensive amount of published information has shown that sedation with propofol administered by non-anesthesiologists is safe and effective. The present study was conducted with the objective of evaluating the safety in the administration of propofol by gastroenterologists for the performance of procedures in digestive endoscopy. Methods: A retrospective study was conducted in which the records of 1135 patients who underwent digestive and therapeutic digestive endoscopies were reviewed in the period between January 2016 and March 2017. The patients were classified by age, gender, risk classification of the American Society of Anesthesiologists (ASA), indication for endoscopy, and dose of propofol. The adverse effects associated with the use of propofol were recorded, such as episodes of transient hypoxemia, serious cardiopulmonary complications and death. Results: We included data from 1135 patients (56% were women) who underwent gastrointestinal endoscopy under sedation with propofol administered by gastroenterologist in a period of 14 months. The average dose used for propofol was 154 +/- 66 mg of propofol. According to the American Society of Anesthesiologists risk classification, 84% of the patients correspond to risk I and II, 14.8% to risk level III and 1.1% to risk level IV. The study carried out the most were gastroscopies (52.6%) and according to the indication, 79.6% corresponded to diagnostic studies, followed by 12.1% for upper gastrointestinal bleeding. Regarding the documented complications,70 episodes of hypoxemia were identified, corresponding to 6.2% of the sedations performed. (95% CI, 4.7-7.6). Only 3.7% of patients had an episode of hypoxemia below 80%. All episodes of hypoxemia, except one, resolved with simple maneuvers such as chin elevation. There were no serious cardiopulmonary complications or deaths during the study. We identified as risk factors for the appearance of hypoxemia a risk classification of the American Society of Anesthesiologists greater than 3 and performance of the endoscopic study for esophageal dilation or percutaneous gastrostomy placement. Conclusions: The use of sedation with propofol administered by non-anesthesiologists in the present study did not show an increase in the appearance of serious cardiopulmonary complications, or in episodes of hypoxemia.

Reflexiones acerca del rol de enfermería especializado en anestesia en uruguay / Reflections about the nursing role specialized in anesthesia in uruguay / Reflexões sobre o papel de enfermagem especializado na anestesia no uruguai

RESUMEN Los ayudantes de anestesia (nombre utilizado en Uruguay para denominar al enfermero técnico en anestesia) son pilar importante en la administración de anestesia segura y de buena calidad al cumplir un rol de asistente del médico anestesiólogo. El objetivo de este trabajo es investigar la situación (roles, entrenamiento académico y responsabilidades) de los enfermeros que realizan tareas de Ayudante de Anestesia en Uruguay. Materiales y métodos: Se realiza recolección de datos mediante una búsqueda bibliográfica no sistemática, una encuesta a enfermeros del área de block quirúrgico en ocho instituciones públicas y privadas del país y una encuesta semidirigida a la Cap. (M) Karina Rando, Ex Profesora Adjunta de la Catedra de Anestesiología (UDELAR) y Jefa de los Servicios de Anestesiología del Hospital Central de las Fuerzas Armadas y del Instituto Nacional de Ortopedia y Traumatología. Resultados: De los datos recolectados podemos afirmar que en Uruguay la educación y entrenamiento del enfermero especializado en anestesiología no es adecuada. No existe educación formal ni tecnicatura especializada y la educación informal se da de manera heterogénea en las diferentes instituciones. Enfermería no especializada es quien cumple mayoritariamente el rol de Ayudante de Anestesia y la educación es incidental e informal, habitualmente impartida por Licenciados/as de Block Quirúrgico o médicos Anestesiólogos. Conclusiones: Si bien hay roles definidos en América Latina para los Ayudantes de Anestesia, no hay en Uruguay una educación acorde a las exigencias requeridas en dichos roles.

SUMMARY Anaesthesia assistants (the name used in Uruguay to name the technical nurse in anesthesia) are an important pillar in the administration of safe and good quality anesthesia when performing an assistant role of the anesthesiologist. The objective of this study is to investigate the situation (roles, academic training and responsibilities) of nurses performing anesthesia assistant tasks in Uruguay. Materials and methods: Data collection was done through a non-systematic bibliographic search, a survey of nurses from the surgical block area in eight public and private institutions in the country, and a semi-directed survey of Cap. (M) Karina Rando, Former Assistant Professor of the Chair of Anesthesiology (UDELAR) and Head of the Anesthesiology Services of the Central Hospital of the Armed Forces and the National Institute of Orthopedics and Traumatology. Results: From the data collected we can affirm that in Uruguay the education and training of the nurse specialized in anesthesiology is not adequate. There is no formal education or specialized technicature and informal education occurs in a heterogeneous way in different institutions. Non-specialized nursing is the one who mostly fulfills the role of anesthesia assistant and education is incidental and informal, usually taught by Surgical Block Graduates or anesthesiologists. Conclusions: Although there are defined roles in Latin America for Anesthesia Assistants, there is no education in Uruguay according to the requirements required in these roles.

RESUMO Assistentes de anestesia (nome usado no Uruguai para nomear a enfermeira anestesia técnica) são pilar importante na administração de anestesia segura e de boa qualidade para desempenhar um papel de assistente anestesista. O objetivo deste trabalho é investigar a situação (papéis, formação acadêmica e responsabilidades) dos enfermeiros que realizam tarefas de anestesia assistencial no Uruguai. Materiais e métodos: A coleta de dados foi realizada por meio de busca bibliográfica não sistemática, levantamento de enfermeiros da área do bloco cirúrgico em oito instituições públicas e privadas do país e levantamento semidirigido do Chap. (M) Karina Rando, Ex Professor Associado do Departamento de Anestesiologia (UDELAR) e Chefe do Hospital Central Serviços Anestesiologia das Forças Armadas e do Instituto Nacional de Ortopedia e Traumatologia. Resultados: A partir dos dados coletados podemos afirmar que no Uruguai a formação e capacitação do enfermeiro especializado em anestesiologia não é adequada. Não há educação formal ou técnica especializada e a educação informal é dada de maneira heterogênea em diferentes instituições. Enfermeira não especializada é aquela que mais desempenha o papel de anestesia assistente e a educação é incidental e informal, geralmente ministrada por graduados em anestesiologistas ou cirurgiões de bloco. Conclusões: Embora existam papéis definidos na América Latina para os Assistentes de Anestesia, não há educação no Uruguai de acordo com os requisitos exigidos nesses papéis.

Síndrome de Burnout en residentes y especialistas de anestesiología / Burnout syndrome in residents and anesthesiologists

El síndrome de Burnout (SB) constituye un tipo de estrés laboral que se observa en profesionales de la salud que mantienen contacto directo y constante con otras personas. El objetivo del estudio fue determinarla prevalencia del síndrome de Burnout en residentes y médicos especialistas del servicio de anestesiología de la Ciudad Hospitalaria “Dr. Enrique Tejera”, periodo enero-julio 2015; distribuirlos según edad, cargo, centro de trabajo, años laborales; determinar su situación emocional según el agotamiento emocional, despersonalización y realización personal; además, diagnosticar el nivel de estrés laboral de los mismos. Se realizó una investigación de tipo descriptivo, con diseño de campo y transversal, cuya muestra estuvo constituida por la totalidad de la población, 64 médicos entre especialistas y residentes, previa firma de un consentimiento informado. Se utilizó el cuestionario de Maslach Burnout Inventory, para indagar la presencia del SB. Los resultados arrojaron la presencia de SB en un 64,1% de los médicos encuestados, siendo mayor en los residentes 73,3%, hubo predominio del género femenino 62,5%; en lo referente a cansancio emocional 34,4%, despersonalización 39,1% y falta de realización personal 81,2%. Se concluyó que el SB es prevalente en las tres cuartas partes de los médicos, que además tenían 32 años o menos, seis de cada diez eran mujeres y poco más de la mitad eran médicos residentes, demostrándose la necesidad de mejorar las condiciones de trabajo del servicio de anestesiología.

Burnout syndrome (BS) is a kind of occupational stress that is observed in health professionals who maintain direct and constant contact with others. The aim of the study wasdetermine the prevalence of Burnout syndrome in residents and medical service specialists of anesthesiology at the City Hospital “Dr. Enrique Tejera”, period January-July 2015; distribuit them according to age, office, workplace, working years; also the emotional situation as emotional exhaustion, depersonalization and personal accomplishment was determined, besides the level of work stress of them was diagnosed. It was made a descriptive, with field design and transversal research, whose sample consisted of the entire population, 64 medical specialists and residents, after signing an informed consent. The Maslach Burnout Inventory questionnaire was used to investigate the presence of BS. The results showed the presence of BS in 64.1% of the surveyed physicians, being higher in residents with 73.3%, there was predominance of female 62.5%; in terms of emotional exhaustion 34.4 %, depersonalization 39.1% and lack of personal fulfillment 81.2%. It was concluded that BS is prevalent in the three quarters of doctors, who also had 32 years or less, six out of ten were women and just over half were resident physicians, demonstrating the need for better working conditions of anesthesiology service.

Anesthetic considerations for robotic cystectomy: a prospective study.

BACKGROUND AND OBJECTIVES: Robotic cystectomy is rapidly becoming a part of the standard surgical repertoire for the treatment of prostate cancer. Our aim was to describe respiratory and hemodynamic challenges and the complications observed in robotic cystectomy patients. PATIENTS: Sixteen patients who underwent robotic surgery between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg+pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. RESULTS: There were significant differences between T0-T1 and T0-T2 with lower heart rates. The mean arterial pressure value at T1 was significantly lower than T0. The central venous pressure value was significantly higher at T1, T2, T3, and T4 than at T0. There was no significant difference in the PET-CO2 value at any time point compared with T0. There were no significant differences in respiratory rate at any time point compared with T0. The mean f values at T3, T4, and T5 were significantly higher than T0. The mean minute ventilation at T4 and T5 were significantly higher than at T0. The mean plateau pressures and peak pressures at T1, T2, T3, T4, and T5 were significantly higher than the mean value at T0. CONCLUSIONS: Although the majority of patients generally tolerate robotic cystectomy well and appreciate the benefits, anesthesiologists must consider the changes in the cardiopulmonary system that occur when patients are placed in Trendelenburg position, and when pneumoperitoneum is created.

Knowledge of anaesthesiologists in Recife with respect to potential risks in the operating room-cross-sectional study.

OBJECTIVES: the health care should be a safe act, free of adverse events. However, in daily practice an excessive exposure to factors that endanger the health of the professional is observed. The surgical center stands out as one of the sites where the professional involved is more vulnerable. This environment is the anaesthesiologist's workplace, and this professional must deal with its potential complicators. This study aimed to evaluate the knowledge of anaesthesiologists in Recife on various situations of risk in the workplace. METHOD: a cross-sectional study in which structured questionnaires, completed voluntarily and anonymously by the anesthesiologist itself, were applied to assess the knowledge of the potential risks in the operating room. Data were analyzed using Epi Info version 7. RESULTS: a total of 162 anaesthesiologists responded to the questionnaire, 38.02% of these professionals registered at Cooperative of Anaesthesiologists of Pernambuco. Of these, 3.7% read the manual of the Committee on Hospital Infection Control (Comissão de Controle de Infecção Hospitalar) of their institution and 40.74% chose the correct option, "technical director", as responsible for ensuring proper working conditions. Of the total, 5.56% stated that the anaesthetics' pollution index in the operating theater was monitored. Only 1.85% of the sample was subjected to periodic screening for tuberculosis. By analyzing the hypothetical situation of contamination with a patient with hepatitis C, only 43.83% knew that there is no effective post-exposure prophylaxis. CONCLUSION: educational campaigns should be implemented to improve the knowledge of health professionals and clarify institutions and professionals' rights and duties.

Considerações anestésicas para cistectomia robótica: estudo prospectivo / Anesthetic considerations for robotic cystectomy: a prospective study / Consideraciones anestésicas para la cistectomía robótica:estudio prospectivo

Experiência e objetivos: a cistectomia robótica vem rapidamente se tornando parte do repertório cirúrgico de rotina para o tratamento do câncer de próstata. Nosso objetivo foi descrever os desafios respiratórios e hemodinâmicos e as complicações observadas em pacientes de cistectomia robótica. Pacientes: foram prospectivamente recrutados 16 pacientes tratados com cistectomia robótica entre dezembro de 2009 e janeiro de 2011. As medidas de desfecho primário foram monitoração não invasiva, monitoração invasiva e análise de gases sangüíneos feita nas posições supina (T0), Trendelenburg (T1), Trendelenburg + pneumoperitônio (T2), Trendelenburg antes da dessuflação (T3), Trendelenburg depois da dessuflacão (T4) e supina (T5). Resultados: houve diferencas significativas entre T0 - T1 e T0 - T2 com frequências cardíacas mais baixas. O valor médio para a pressão arterial em T1 foi significativamente mais baixo do que em T0. O valor da pressão venosa central foi significativamente mais elevado em T1, T2, T3 e T4 versus T0. Não foi observada diferença significativa no valor de PET-CO2 em qualquer ponto temporal, em comparação com T0. Também não foram notadas diferenças significativas na frequência respiratória em qualquer ponto temporal, em comparação com T0. Os valores médios de ƒ em T3, T4 e T5 foram significativamente mais elevados versus T0. A ventilação minuto média em T4 e T5 foi significativamente mais elevada versus T0. As pressões de platô e de pico médias em T1, T2, T3, T4 e T5 foram significativamente mais elevadas versus T0. Conclusões: embora a maioria dos pacientes geralmente tolere satisfatoriamente a cistectomia robótica e perceba os benefícios, os ...

Background and objectives: Robotic cystectomy is rapidly becoming a part of the standard surgical repertoire for the treatment of prostate cancer. Our aim was to describe respiratory and hemodynamic challenges and the complications observed in robotic cystectomy patients. Patients: Sixteen patients who underwent robotic surgery between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. Results: There were significant differences between T0 - T1 and T0 - T2 with lower heart rates. The mean arterial pressure value at T1 was significantly lower than T0. The central venous pressure value was significantly higher at T1, T2, T3, and T4 than at T0. There was no significant difference in the PET-CO2 value at any time point compared with T0. There were no significant differences in respiratory rate at any time point compared with T0. The mean ƒ values at T3, T4, and T5 were significantly higher than T0. The mean minute ventilation at T4 and T5 were significantly higher than at T0. The mean plateau pressures and peak pressures at T1, T2, T3, T4, and T5 were significantly higher than the mean value at T0. Conclusions: Although the majority of patients generally tolerate robotic cystectomy well and appreciate the benefits, anesthesiologists must consider the changes in the cardiopulmonary system that occur when patients are placed in Trendelenburg position, and when pneumoperitoneum is created. .

Antecedentes y objetivos: la cistectomía robótica se ha convertido rápidamente en parte del repertorio quirúrgico de rutina para el tratamiento del cáncer de próstata. Nuestro objetivo ha sido describir los retos respiratorios y hemodinámicos, junto con las complicaciones observadas en pacientes sometidos a cistectomía robótica. Pacientes: diesiséis pacientes tratados con cistectomía robótica entre diciembre de 2009 y enero de 2011 se reclutaron de forma prospectiva. Las medidas de resultado primario fueron la monitorización no invasiva, la monitorización invasiva y la gasometría sanguínea realizada en las posiciones supina (T0), Trendelenburg (T1), Trendelenburg + neumoperitoneo (T2), Trendelenburg antes del desinflado (T3), Trendelenburg después del desinflado (T4), y supina (T5). Resultados: hubo diferencias significativas entre T0-T1 y T0-T2 con frecuencias cardíacas más bajas. El valor medio para la presión arterial en T1 fue significativamente más bajo que en T0. El valor de la presión venosa central fue significativamente más elevado en T1, T2, T3, y T4 versus T0. No se observó diferencia significativa en el valor de PET-CO2 en ningún momento en comparación con T0. Tampoco se encontraron nunca diferencias significativas en la frecuencia respiratoria en comparación con T0. Los valores medios de ƒ en T3, T4, y T5 fueron significativamente más elevados versus T0. La ventilación minuto promedio en T4 y T5 fue significativamente más elevada versus T0. Las presiones de meseta y de pico promedios en T1, T2, T3, T4, y T5 fueron significativamente más elevadas versus T0. Conclusiones: aunque la mayoría de los pacientes generalmente tolere satisfactoriamente la cistectomía robótica y se dé cuenta de los beneficios, los anestesiólogos deben tener ...

Conhecimento dos anestesiologistas da cidade do Recife com relação aos riscos potenciais no centro cirúrgico - estudo transversal / Knowledge of anaesthesiologists in Recife with respect to potential risks in the operating room-cross-sectional study / Conocimiento de los anestesistas de la ciudad de Recife con relación a los riesgos potenciales en el quirófano - estudio transversal

Objetivos: o cuidado com a saúde deve ser um ato seguro e livre de eventos adversos. Todavia, na prática diária se observa exposição excessiva a fatores que põem em risco a saúde do profissional. O centro cirúrgico sobressai como um dos locais em que o profissional envolvido está mais vulnerável. O anestesiologista faz desse ambiente o seu local de trabalho e convive com seus agravantes potenciais. Este estudo objetivou avaliar o conhecimento dos anestesiologistas da cidade do Recife acerca das diversas situações de risco do seu ambiente de trabalho. Método: estudo tipo corte transversal, no qual foram aplicados questionários estruturados, preenchidos pelo próprio anestesiologista de forma voluntária e anônima, para avaliar o conhecimento acerca dos riscos potenciais no centro cirúrgico. Os dados foram analisados com o programa software Epi Info versão 7. Resultados: responderam ao questionário 162 anestesiologistas, 38,02% dos cadastrados na Cooperativa de Anestesiologistas de Pernambuco. Desses, 3,7% leram o manual da Comissão de Controle de Infecção Hospitalar (CCIH) da sua instituição de trabalho e 40,74% optaram acertadamente pela opção diretor técnico como o responsável por assegurar condições adequadas de trabalho. Do total, 5,56% afirmaram existir monitoração do índice de poluição anestésica nos centros cirúrgicos. Apenas 1,85% da amostra foi submetido à triagem periódica para tuberculose. Ao analisar a situação hipotética de contaminação com paciente portador de hepatite C, apenas 43,83% sabiam não haver profilaxia efetiva após exposição. Conclusão: campanhas educativas devem ser feitas para melhorar o conhecimento dos profissionais de saúde e esclarecer direitos ...

Objectives: the health care should be a safe act, free of adverse events. However, in daily practice an excessive exposure to factors that endanger the health of the professional is observed. The surgical center stands out as one of the sites where the professional involved is more vulnerable. This environment is the anaesthesiologist's workplace, and this professional must deal with its potential complicators. This study aimed to evaluate the knowledge of anaesthesiologists in Recife on various situations of risk in the workplace. Method: a cross-sectional study in which structured questionnaires, completed voluntarily and anonymously by the anesthesiologist itself, were applied to assess the knowledge of the potential risks in the operating room. Data were analyzed using Epi Info version 7. Results: a total of 162 anaesthesiologists responded to the questionnaire, 38.02% of these professionals registered at Cooperative of Anaesthesiologists of Pernambuco. Of these, 3.7% read the manual of the Committee on Hospital Infection Control (Comissão de Controle de Infecção Hospitalar) of their institution and 40.74% chose the correct option, "technical director", as responsible for ensuring proper working conditions. Of the total, 5.56% stated that the anaesthetics' pollution index in the operating theater was monitored. Only 1.85% of the sample was subjected to periodic screening for tuberculosis. By analyzing the hypothetical situation of contamination with a patient with hepatitis C, only 43.83% knew that there is no effective post-exposure prophylaxis. Conclusion: educational campaigns should be implemented to improve the knowledge of health professionals and clarify institutions and professionals' rights and duties. .

Objetivos: El cuidado de la salud debe ser un acto seguro y libre de eventos adversos. Sin embargo, en la práctica diaria, se observa una exposición excesiva a factores que ponen en riesgo la salud del profesional. El centro quirúrgico destaca como uno de los lugares en que el profesional involucrado es más vulnerable. El anestesista convierte ese ambiente en su lugar de trabajo y convive con sus agravantes potenciales. Este estudio quiso evaluar el conocimiento de los anestesistas de la ciudad de Recife sobre las diversas situaciones de riesgo de su ambiente de trabajo. Método: Estudio de tipo corte transversal, en el cual se aplicaron cuestionarios estructurados rellenados por el propio anestesista de forma voluntaria y anónima, para evaluar el conocimiento acerca de los riesgos potenciales en el quirófano. Los datos fueron analizados con el programa software Epi Info versión 7. Resultados: Respondieron al cuestionario 162 anestesistas, el 38,02% de los registrados en la Cooperativa de Anestesistas de Pernambuco. De ellos, un 3,7% leyeron el manual de la Comisión de Control de Infección Hospitalaria (CCIH) de su institución de trabajo y un 40,74% optaron acertadamente por la opción director técnico como el responsable de garantizar las condiciones adecuadas de trabajo. Del total, un 5,56% afirmaron que existía una monitorización del índice de contaminación anestésica en los quirófanos. Solamente un 1,85% de la muestra se sometió a la selección periódica para tuberculosis. Al analizar la situación hipotética de contaminación con el paciente portador de hepatitis C, solamente un 43,83% sabían que no había profilaxis efectiva posterior a la exposición. Conclusión: Se deben realizar campa˜nas educativas para mejorar el conocimiento de los profesionales de salud y clarificar los derechos ...

Manejo multidisciplinario de la sedacion intravenosa en Cirugía Bucal

La sedación intravenosa se ha convertido en una de las técnicas más comúnmente empleadas para evitar traumas psicológicos a los pacientes que necesiten de algún tipo de cirugía bucal. Pues como todos sabemos el término Cirugía está asociado a miedo y ansiedad, y si se agrega la palabra Bucal que implica Odontología, para muchos es sinónimo de dolor y angustia. La necesidad de manejar el paciente que se somete a una cirugía bucal sin ansiedad, tensión, miedo, ni dolor, plantea la posibilidad de usar la sedación intravenosa como método para eliminar esas situaciones ante el procedimiento quirúrgico pero es muy importante la presencia del Anestesiólogo como integrante indispensable junto con el Cirujano para poder ser utilizada, además del ayudante del cirujano y el personal auxiliar. En el presente trabajo se revisarán las funciones de cada uno de los integrantes del equipo multidisciplinario que se necesita para que éste tipo de alternativa de tratamiento quirúrgico se aplique coordinada y eficazmente, permitiendo reducir al mínimo o evitando el riesgo que pudiera alguna vez ocasionar su aplicación, brindando al paciente la vigilancia de parámetros vitales y el suficiente confort antes, durante y después de la cirugía.

Intravenous sedation has become the most common procedure to avoid psychological trauma in the oral surgery patients. As we know the word Surgery is associated with fear and anxiety and if we add the word Oral that imply Dentistry for the majority of the people is synonymous of pain and suffer. The importance of management these feelings bring the possibility of use the intravenous sedation as a technique that controls and avoid those situations but it is very important to use an anesthesiologist as a indispensably member with the surgeon besides the surgical assistant and the hygienist. We are going to expose the specific functions of each member of the multidisciplinary team that is needed to apply this kind of surgical treatment efficiently and allowing to minimize or avoid the risks that in any case it should occur, taking good care of the patient before, during and after the surgery.