Consulta de preanestesia en cirugía mayor ambulatoria / No disponible

La consulta de preanestesia en la unidad de cirugía mayor ambulatoria, es un elemento muy importante desde el punto de vista organizativo, ya que gracias a un buen planteamiento de la misma podemos obtener un mayor rendimiento así como mejorar la seguridad del paciente. En este trabajo se presenta de manera descriptiva el modo en el que estamos organizados, que se divide fundamentalmente en tres aspectos: a) el cuestionario de salud, que es rellenado por el paciente, consiguiendo así que participen en su salud; b) los algoritmos o flujo gramas que en base a la edad, estado físico, comorbilidades y tipo de cirugía orientan a la hora de pedir pruebas complementarias, consiguiendo así una indicación más precisa de las mismas; y por último c) la clasificación del tipo de cirugía, realizada en base a la experiencia acumulada en nuestro centro y el tipo de cirugía. Este diseño de entre muchos válidos es muy dinámico, permitiendo su adaptación a las necesidades de cada centro, mejorando así el rendimiento y la seguridad del paciente (AU)

Pre-anaesthetic evaluation constitutes an important organizational component in a day surgery unit. A careful set up may lead to major efficiency and improved patient safety. This work presents a description of the organizational model of our unit, which consists of three fundamental elements: a) the health questionnaire, filled in by the patient, thus achieving implication in her/his health related questions; b)the algorithms or flow-charts which, based on patients’ age, ASA, comorbidities, and type of surgery, indicate more precisely the complementary analyses to be done; and c) finally classification of the surgery to be carried out, based on the body of experience accumulated in our centre. This design is, among many other valid ones, very dynamic and permits being adapted to the necessities of varying centres obtaining better efficiency and patient safety (AU)

Survey of cardiac rhythm management and device implant patterns in Puerto Rico: analysis of 13.854 cardiac implants

BACKGROUND: Surveys of cardiac pacing and implantable cardiovertor defibrillators (ICD) have been reported since 1969 and 1993 respectively. Increasing costs of medical technology, budget constraints and emergent new clinical indications prompted our committee to conduct the first survey of cardiac rhythm management and device implant patterns in Puerto Rico. METHOD: Clinical and demographic data were obtained for all cardiac devices sold and implanted from 2000 to 2006, through a joint agreement with official representatives of the 2 largest manufacturers and distributors of cardiac pacemakers and ICD in Puerto Rico. RESULTS: 13,854 cardiac devices were implanted from 2000 to 2006. The number of permanent pacemakers (PP) implanted per million population has varied from 430 in the year 2000 to 482 in the year 2006. A significant greater number of males received PP than females (P < .05). Yearly increases in implant rates for cardiac resynchronization therapy (CRT) and ICD were observed, mainly due to new emergent clinical indications, appropriate insurance coverage and availability of implanting electrophysiologists. CONCLUSIONS: Sales figures from PP and ICD manufacturers are a reliable system to calculate and analyze changes in cardiac device implant patterns. The rate of 482 PP per million population positions Puerto Rico as the third largest implant market in North and South America. This finding should be useful to insurance health providers since 76% of the implants are performed in patients over 65 years old. In the year 2006, Puerto Rico was the 10th largest implant market in the world with 67 CRT implanted per million population. A significant greater number of CRT and ICD were implanted in males than females. This gender difference has increased in spite of strict requirements to include more females in clinical trials and intensive, educational and awareness efforts conducted among physicians and patients. A summary of the current guidelines and...

Acute renal failure following cerebral angiography and infusion computerized tomography. Case report.

The authors report a case in which acute renal failure developed following angiography and computerized tomography with infusion of contrast material performed within the same day.