Manejo anestésico versus seguridad del paciente en tiempos de COVID-19 / Anesthetic management vs patient safety in times of COVID-19

Resumen: La pandemia del COVID-19 ha tenido un impacto significativo en los servicios sanitarios de todo el mundo. Desde el punto de vista anestésico, algunos de los retos clínicos son el alto riesgo del paciente de sufrir complicaciones pulmonares durante el período perioperatorio y el de infección del personal sanitario por la manipulación de la vía aérea y los aerosoles. Se describe la conducta anestésica realizada a una paciente oncológica con PCR para COVID-19 positiva que deseaba preservar su fertilidad antes de comenzar tratamiento oncológico adyuvante y que, según los protocolos establecidos en el momento del caso, se debían demorar las intervenciones no urgentes hasta la negativización de la PCR, lo que conllevaría a retrasar la intervención sin poder comenzar el tratamiento médico para el proceso tumoral, escogiéndose la técnica anestésica más fiable para evitar complicaciones a la paciente y al personal sanitario.

Abstract: The COVID-19 pandemic has had a significant impact on healthcare services worldwide. From the anesthetic point of view, some of the clinical challenges are the high patient risk of pulmonary complications during the perioperative period and the risk of infection of healthcare personnel due to airway and aerosol handling. We describe the anesthetic management of an oncological patient with positive PCR for COVID-19 who wished to preserve her fertility before starting adjuvant oncological treatment and that, according to the protocols established at the time of the case, non-urgent interventions should be delayed until the PCR was negative, which would lead to delaying the intervention without being able to start medical treatment for the tumor process, choosing the most reliable anesthetic technique to avoid complications for the patient and the health personnel.

Neuraxial anesthesia in patients with multiple sclerosis - a systematic review / Anestesia neuraxial em pacientes com esclerose múltipla - uma revisão sistemática

Abstract Background and objectives: Current guidelines for neuraxial analgesia in patients with multiple sclerosis are ambiguous and offer the clinician only a limited basis for decision making. This systematic review examines the number of cases in which multiple sclerosis has been exacerbated after central neuraxial analgesia in order to rationally evaluate the safety of these procedures. Methods: A systematic literature search with the keywords "anesthesia or analgesia" and "epidural, peridural, caudal, spinal, subarachnoid or intrathecal" in combination with "multiple sclerosis" was performed in the databases PubMed and Embase, looking for clinical data on the effect of central neuraxial analgesia on the course of multiple sclerosis. Results and conclusions: Over a period of 65 years, our search resulted in 37 reports with a total of 231 patients. In 10 patients multiple sclerosis was worsened and nine multiple sclerosis or neuromyelitis optica was first diagnosed in a timely context with central neuraxial analgesia. None of the cases showed a clear relation between cause and effect. Current clinical evidence does not support the theory that central neuraxial analgesia negatively affects the course of multiple sclerosis.

Resumo Justificativa e objetivos: As diretrizes atuais para analgesia neuraxial em pacientes com esclerose múltipla (EM) são ambíguas e oferecem ao clínico apenas uma base limitada para a tomada de decisão. Esta revisão sistemática examina o número de casos nos quais a EM foi exacerbada após analgesia neuraxial central para avaliar racionalmente a segurança desses procedimentos. Métodos: Uma busca sistemática da literatura com as palavras-chave "anestesia ou analgesia" e "epidural, peridural, caudal, espinhal, subaracnóideo ou intratecal" em combinação com multiple sclerosis foi feita nas bases de dados PubMed e Embase à procura de dados clínicos sobre a efeito da analgesia neuraxial central sobre o curso da esclerose múltipla. Resultados e conclusões: Durante um período de 65 anos, nossa busca resultou em 37 relatos com um total de 231 pacientes. Em 10 pacientes, a esclerose múltipla foi agravada e, em nove, a esclerose múltipla ou neuromielite óptica foi diagnosticada pela primeira vez em momento concomitante com a analgesia neuraxial central. Nenhum dos casos apresentou uma clara relação entre causa e efeito. A evidência clínica atual não sustenta a teoria de que a analgesia neuraxial central afeta negativamente o curso da esclerose múltipla.

[Neuraxial anesthesia in patients with multiple sclerosis - a systematic review]. / Anestesia neuraxial em pacientes com esclerose múltipla ­ uma revisão sistemática.

BACKGROUND AND OBJECTIVES: Current guidelines for neuraxial analgesia in patients with multiple sclerosis are ambiguous and offer the clinician only a limited basis for decision making. This systematic review examines the number of cases in which multiple sclerosis has been exacerbated after central neuraxial analgesia in order to rationally evaluate the safety of these procedures. METHODS: A systematic literature search with the keywords "anesthesia or analgesia" and "epidural, peridural, caudal, spinal, subarachnoid or intrathecal" in combination with "multiple sclerosis" was performed in the databases PubMed and Embase, looking for clinical data on the effect of central neuraxial analgesia on the course of multiple sclerosis. RESULTS AND CONCLUSIONS: Over a period of 65 years, our search resulted in 37 reports with a total of 231 patients. In 10 patients multiple sclerosis was worsened and nine multiple sclerosis or neuromyelitis optica was first diagnosed in a timely context with central neuraxial analgesia. None of the cases showed a clear relation between cause and effect. Current clinical evidence does not support the theory that central neuraxial analgesia negatively affects the course of multiple sclerosis.

Incidencia de complicaciones en anestesia neuroaxial en el Hospital Maternologico Germán Urquidi / Incidence of neuroaxial anesthesia complicaions at Hospital Maternológico Germán Urquidi

Resumen En nuestro medio no existen datos estadísticos con respecto a las complicaciones de la anestesia neuroaxial, y específicamente en hospitales con residentes en entrenamiento. Durante el año 2007 se realizaron 4.235 (100%) procedimientos quirúrgicos bajo anestesia en el Hospital Materno Infantil Germán Urquidi, de los cuales el 57,87% (2.451) fueron realizados con anestesia neuroaxial. El presente etudio es descriptivo y retrospectivo, en el cual se registró la incidencia de las complicaciones en anestesial neuroaxial, utilizando un muestréo aleatorio durante el periodo de un año. El 38,63 % (1 .635) de las pacientes que recibieron anestesia neuroaxial presentó algún tipo de complicación. Sólo el 1 ,48% (14) tuvo una complicación mayor reportada como punción dural advertida; de las cuales 4 pacientes presentaron cefalea postpunción. Entre las pacientes) con complicaciones menores 96,51% (1.577) de las pacientes cursaron con hipotensión arterial; 8 pacientes tuvieron bloqueos fallidos y en 11 pacientes se presentaron punciones vasculares reportadas. La incidencia de complicaciones en anestesia neuroaxial en el Hospital Maternológico Germán Urquidi se encuentra por debajo de lo reportado en la literatura, pues el ser un Hospital Universitario no constituye un factor adicional de riesgo que aumente las complicaciones, en procedimientos permanentemente supervisados.

Abstract During the year 2007 were carried out 4.235 (1 00%) surgical procedures under it anesthetizes in the Hospital Maternal Infantile Germán Urquidi, ofthose which 57,87% (2.451) they were carried out with regional anesthesia. In our means statistical data don't exist with regard to the complications of the regional anesthesia, and specifically in hospitals with residents in training. By means of a descriptive and retrospective study oftraverse court he/she registered the incidence ofthe complications in regional anesthesia, using a random sampling during the period of one year. 38,63% (1 .635) ofthe patients that received regional anesthesia it presented some complication type. Only the 1 ,48%(14) he/she had a bigger complication reported as perforation noticed dural punction; of which 4 patients presented migraine postpuntion. Among the patients with complications smaller 96,51 % (1 .577) ofthe patients they studied with arterial hypotension; 8 patients had bankrupt blockades and in 11 patients reported vascular puntions was presented. The incidence of complications in regional anesthesia in the Hospital Maternológico Germán Urquidi is below that reported in the literature, because the being an University Hospital doesn't constitute an additional factor of risk that increases the complications, in permanently supervised procedures.