Retrospective observational study on safety of sedation for colonoscopies in ASA I and II patients performed by a nurse and under the supervision of anesthesiology.

INTRODUCTION: Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol: NAAP) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. OBJECTIVE: The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion (TCI) of propofol in colonoscopies supervised by anaesthesiologists. MATERIAL AND METHODS: Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1-5, and pain was assessed on a numerical verbal scale of 1-5. RESULTS: A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. CONCLUSION: Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.

Estudio observacional retrospectivo sobre la seguridad de la sedación para colonoscopias en pacientes ASA I y II realizada por enfermería y tutelada por anestesiología / Retrospective observational study on safety of sedation for colonoscopies in ASA I and II patients performed by a nurse and under the supervision of anesthesiology

Introducción: La sedación con propofol por no anestesiólogos es una práctica creciente en áreas fuera de quirófano resultado del incremento de procedimientos diagnóstico-terapéuticos mínimamente invasivos que precisan sedación y de la dificultad de los servicios de anestesiología para responder adecuadamente a esta demanda. Objetivo: El objetivo principal de este estudio es valorar la seguridad de un programa de sedación para colonoscopias administrada por enfermería formada y tutelada por anestesiólogos, aplicando un protocolo de sedación con sistemas Target Controlled Infusion. Material y métodos: Durante un periodo de 6 meses se incluyeron en el estudio todos los pacientes ASA I y II que precisaron la realización de una colonoscopia programada y cumplían los criterios de inclusión. Se realizaron 381 colonoscopias. En el procedimiento se analizaron los episodios de desaturación, hipo- o hipertensión, bradicardia o taquiarritmia y la necesidad de asistencia por anestesiología. Tras el procedimiento se evaluó en una escala de 1 a 5 el nivel de satisfacción y el dolor mediante escala verbal numérica de 0 a 10. Resultados: El 5% de los pacientes presentó una saturación de oxígeno menor del 90% sin requerir ventilación con máscara; el 7,35% presentó hipotensión, el 3,94% bradicardia y fue necesario consultar al anestesiólogo responsable en el 22% de los casos. El grado de satisfacción alcanzado por los pacientes al final del proceso fue de 4,27 sobre 5. Conclusión: La sedación durante colonoscopias, en pacientes ASA I y II, siguiendo un protocolo consensuado puede ser administrada de forma segura por personal de enfermería tutelado por anestesiología.(AU)

Introduction: Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. Objective: The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion of propofol in colonoscopies supervised by anaesthesiologists. Material and methods: Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1 to 5, and pain was assessed on a numerical verbal scale of 1 to 5. Results: A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. Conclusion: Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.(AU)

Mortalidad precoz en el postoperatorio inmediato del trasplante hepático / Premature death in the early postoperative period after a liver transplant

OBJETIVOS: Se han analizado las complicaciones que aparecen en el postoperatorio inmediato del trasplante hepático estudiando su relación con la mortalidad precoz en dicho proceso. MATERIAL v MÉTODOS: Se han revisado de forma retrospectiva los trasplantes hepáticos en adultos realizados en nuestro hospital, confeccionando dos grupos, el I con los pacientes fallecidos y el II con los pacientes que han sobrevivido en el postoperatorio inmediato, viendo la diferencia de incidencia de las complicaciones en ambos grupos y estudiando su significación estadística mediante la prueba de XI para el análisis univariante y mediante una regresión logística para el análisis multivariante. RESULTADOS: En los 827 trasplantes hepáticos estudiados se ha producido la muerte del receptor en 86 casos, 7 casos en quirófano (0,85 por ciento) y 79 casos en el postoperatorio (9,63 por ciento), lo que significa una mortalidad global para la intervención y el postoperatorio inmediato de un 10,4 por ciento. Las complicaciones que hemos evidenciado con significación estadística respecto a la mortalidad en el análisis multivariante son el síndrome postreperfusión, la fibrillación auricular, el fracaso renal agudo y la presencia de infección. CONCLUSIONES: Sólo una de estas complicaciones es específica del trasplante hepático: el síndrome postreperfusión, las otras son propias de cualquier paciente gravemente enfermo, y prácticamente todas conducen a un aumento de las infecciones, que es la causa más frecuente de fallecimiento en el postoperatorio inmediato. (AU)

[Premature mortality in the early postoperative period of liver transplantation]. / Mortalidad precoz en el postoperatorio inmediato del trasplante hepático.

OBJECTIVES: To analyze the relation between premature death and complications that develop in the early postoperative period after liver transplantation. MATERIAL AND METHODS: Liver transplants performed in adults in our hospital were reviewed retrospectively. Patients were distributed in 2 groups, those who died and those who survived the early recovery period, and the incidences of complications in the two groups were compared using a chi 2 for single variables and logistic regression for multiple variables. RESULTS: In the 827 liver transplants studied, the recipient died in 86 cases, 7 inside the operating room (0.85%) and 79 during recovery (9.63%), for an overall mortality rate of 10.4% for surgery and the immediate postoperative period. Complications that were significantly different with respect to mortality in the multivariant analysis were post-reperfusion syndrome, atrial fibrillation, acute renal failure, and infection. CONCLUSIONS: Only one of the complications was specific to liver transplantation: post-reperfusion syndrome. The others were of the type found in any critically ill patient, an nearly all led to an increase in infections, which is the most common reason for death during surgical recovery.

Vena cava superior izquierda persistente: una localización infrecuente del catéter venoso central / Persistent superior vena cava: a rare location of the central venous catheter

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