Anestesia total intravenosa en cirugia laparoscopica de tumor suprarrenal: reporte de un caso / Total intravenous anesthesia in laparoscopic adrenal tumor surgery: Case report

El hiperaldosteronismo primario es una condición caracterizada por una producción excesiva de aldosterona, que no depende del sistema renina-angiotensina-aldosterona. Una de las manifestaciones clínicas más frecuentes es la hipertensión arterial resistente al tratamiento convencional. Se estima que aproximadamente el 10% de los casos de hipertensión secundaria están asociados con el hiperaldosteronismo primario, siendo aproximadamente el 50% de estos casos causados por un adenoma suprarrenal. Los tumores de las glándulas suprarrenales presentan desafíos para el anestesiólogo, requiriendo una evaluación preoperatoria minuciosa, un adecuado control hemodinámico durante el perioperatorio. El objetivo del presente caso clínico es reportar la utilización de la anestesia total intravenosa en una cirugía laparoscópica de tumor suprarrenal en un paciente con hiperaldosteronismo primario. Se busca describir la técnica anestésica empleada, evaluar la respuesta hemodinámica del paciente durante el procedimiento y analizar los resultados obtenidos en términos de estabilidad cardiovascular, control del dolor y prevención de complicaciones postoperatorias. Se presenta el caso de una paciente de 28 años con hipertensión arterial sistémica de 4 años de evolución, que ha sido difícil de controlar. Debido a la sospecha de hiperaldosteronismo primario, se llevó a cabo la prueba de cociente aldosterona/actividad de renina plasmática, la cual mostró niveles elevados. Como parte del manejo, se realizó una adrenalectomía izquierda laparoscópica bajo anestesia total intravenosa...(AU)

Dos concentraciones de ketofol en anestesia total intravenosa para cirugía mínimamente invasiva / Tow concentrations of ketofol in total intravenous anesthesia for minimally invasive surgery

Introducción: En los últimos años se ha iniciado un interés especial por la combinación de ketamina/propofol para pacientes intervenidos por procedimientos mínimamente invasivos. Objetivo: Evaluar la efectividad y seguridad de la anestesia intravenosa total con ketofol en concentración 1:4 contra la concentración 1:2 en pacientes intervenidos por cirugía mínimamente invasiva. Métodos: Estudio analítico, cuasiexperimental, prospectivo y longitudinal, en el Hospital Universitario General Calixto García entre diciembre de 2019 a diciembre de 2020, en 30 pacientes divididos en dos grupos de 15 pacientes: grupo estudio (GE): Ketofol 1:4 y grupo control (GC): Ketofol 1:2. Se analizaron: tensión arterial media y frecuencia cardiaca intra operatoria, grado de hipnosis, grado de nocicepción, necesidad de rescate para hipnosis y analgesia, tiempo de recuperación anestésica, analgesia posoperatoria y efectos adversos. Resultados: Entre los grupos fueron similares la edad, el sexo, el peso, estado físico y tipo de intervención quirúrgica. La frecuencia cardiaca no mostró diferencias entre los grupos. En relación a la tensión arterial mediapos-incisión, fue mayor en el grupo control con diferencias significativas (p=0,03). La necesidad de rescate intraoperatorio para la hipnosis y analgesia fue significativamente mayor en el grupo control. Con respecto a la recuperación anestésica, analgesia posoperatoria y efectos adversos no hubo diferencias significativas. Conclusiones: La combinación ketofol resultó segura y efectiva para proveer una adecuada anestesia en procedimientos quirúrgicos mínimamente invasivos con tiempos quirúrgicos menores a 30 min. La concentración de 1:4 brindó mejor estabilidad hemodinámica, adecuada hipnosis y analgesia intraoperatoria, con menor incidencia de efectos adversos(AU)

Introduction: In recent years, a special interest has appeared in the ketamine/propofol combination for patients intervened by minimally invasive procedures. Objective: To evaluate the effectiveness and safety of total intravenous anesthesia with ketofol at 1:4 concentration versus 1:2 concentration in patients undergoing minimally invasive surgery. Methods: An analytical, quasiexperimental, prospective and longitudinal study was carried out at General Calixto García University Hospital, between December 2019 and December 2020, with thirty patients divided into two groups of fifteen patients each: study group (SG; ketofol 1:4) and control group (CG; ketofol 1:2). The following aspects were analyzed: mean blood pressure and intraoperative cardiac frequency, degree of hypnosis, degree of nociception, necessity of rescue for hypnosis and analgesia, anesthetic recovery time, postoperative analgesia and adverse effects. Results: Age, sex, weight, physical condition and type of surgery were similar between groups. Heart rate showed no differences between groups. Mean blood pressure after incision was higher in the control group, with significant differences (P=0.03). The necessity of intraoperative rescue for hypnosis and analgesia was significantly higher in the control group. Regarding anesthetic recovery, postoperative analgesia and adverse effects, there were no significant differences. Conclusion: The ketofol combination was safe and effective for providing adequate anesthesia in minimally invasive surgical procedures with surgical times of less than thirty minutes. The 1:4 concentration provided better hemodynamic stability, adequate hypnosis and intraoperative analgesia, with lower incidence of adverse effects(AU)

Comparison of direct costs associated with the use of balanced general anesthesia and total intravenous anesthesia (TIVA) techniques / Comparación de los costos directos asociados al uso de técnicas de anestesia general balanceada y anestesia total intravenosa (TIVA)

Abstract Introduction: Healthcare costs are increasing against the backdrop of scarce resources. Surgical procedures are an important part of healthcare spending, and the cost of anesthetic techniques is relevant as part of the total cost of care and it is a potential target for expenditure optimization. Although important economic differences have been reported internationally for general anesthesia options, there are no publications in Colombia that compare current costs and allow for informed and financially responsible decision-making. Objective: To quantify and compare direct costs associated with the various general anesthesia options most frequently used at the present time. Methods: Cost minimization analysis based on a theoretical model of balanced general anesthesia using isoflurane, sevoflurane, desflurane in combination with remifentanil, and TIVA (propofol and remifentanil). Initial results were obtained using a deterministic simulation method and a sensitivity analysis was performed using a Monte Carlo simulation. Results: The average total cost per case for the different anesthetic techniques was COP 126381 for sevoflurane, COP 97706 for isoflurane, COP 288605 for desflurane and COP 222 960 for TIVA. Conclusions: Balanced general anesthesia with desflurane is the most costly alternative, 1.2 times more expensive than TIVA, and 2 and 3 times more costly than balanced anesthesia with sevoflurane and isoflurane, respectively. TIVA ranks second with a cost 1.8 times higher than balanced anesthesia with sevoflurane and 2.5 times higher than balanced anesthesia with isoflurane.

Resumen Introducción: Los costos de la atención en salud son crecientes y se enfrentan a un escenario de recursos escasos. La realización de procedimientos quirúrgicos hace parte importante de la atención y del gasto en salud, el costo de las técnicas anestésicas utilizadas es relevante en el costo total de la atención y es un objetivo potencial para la optimización del gasto. Aunque a escala internacional se han reportado diferencias económicas importantes entre las alternativas para anestesia general, en Colombia no se cuenta con publicaciones que comparen los costos actuales y permitan una toma de decisiones informada y responsable económicamente. Objetivo: Cuantificar y comparar los costos directos para Colombia de las diferentes alternativas para anestesia general usadas con más frecuencia en la actualidad. Métodos: Análisis de minimización de costos basado en un modelo teórico de anestesia general balanceada con isoflurano, sevoflurano, desflurano en combinación con remifentanilo y TIVA (propofol y remifentanilo). Se obtuvieron resultados iniciales utilizando una simulación con un método determinista y se realizó un análisis de sensibilidad con una simulación de Montecarlo. Resultados: El costo total promedio por caso para las diferentes técnicas anestésicas fue de COP 126.381 para sevoflurano, COP 97.706 para isoflurano, COP 288.605 para desflurano y COP 222.960 para TIVA. Conclusiones: La anestesia general balanceada con desflurano es la alternativa de mayor costo, es 1,2 veces más costosa que la TIVA, y 2 y 3 veces más que la balanceada con sevoflurano e isoflurano, respectivamente. La TIVA ocupa el segundo lugar con un costo 1,8 veces superior a la balanceada con sevoflurano y 2,5 veces a la balanceada con isoflurano.

Sedación endovenosa versus lidocaína intraarticular en pacientes con luxación glenohumeral aguda / Endovenous sedation versus intra-articular lidocaine in patients with acute glenohumeral dislocation

INTRODUCCIÓN. La sedación endovenosa y la aplicación de lidocaína intraarticular se han convertido en las técnicas anestésicas preferidas en el área de emergencia para la reducción de la luxación glenohumeral, sin embargo, no están exentas de complicaciones. OBJETIVO. Determinar las diferencias y complicaciones entre el uso de sedación endovenosa y lidocaína intraauricular en la reducción de luxación glenohumeral. MATERIALES Y MÉTODOS. Estudio de evaluación, descriptivo, correlacional, retrospectivo, no experimental. Población de 125 Historias Clínicas, se tomó una muestra 82, que fueron atendidos en el Servicio de Emergencia del Hospital General Riobamba, periodo enero 2015 a diciembre 2019. Criterios inclusión: mayores de 15 años de edad con diagnóstico de luxación glenohumeral aguda, que firmaron el Consentimiento Informado. Se dividieron en dos grupos: grupo I: reducciones con lidocaína intraarticular, grupo II: sedación endovenosa. Los datos se obtuvieron del sistema informático MIS-AS400. El análisis de datos se realizó en el programa estadístico IBM SPSS versión 23. RESULTADOS. Se logró la reducción del 96,7% (29; 30) con el grupo I y un 94,2% (49; 52) con el grupo II. Las complicaciones con el grupo II fueron: depresión respiratoria 5,8% (3; 52), mareo 5,8% (3; 52), cefalea 1,9% (1; 52). No se encontraron complicaciones en el grupo I. DISCUSIÓN. Fue indispensable conseguir el alivio del dolor mediante el uso de técnicas anestésicas/analgésicas como: sedación en combinación con opioides y lidocaína intraarticular. CONCLUSIÓN. Se determinó menor número de complicaciones con la aplicación de lidocaína intraarticular y menor tiempo de estancia en emergencia.

INTRODUCTION. Endovenous sedation and the application of intra-articular lidocaine have become the preferred anesthetic techniques in the emergency area for the reduction of glenohumeral dislocation, however, they are not free of complications. OBJECTIVE. To determine the differences and complications between the use of intravenous sedation and intra-atrial lidocaine in the reduction of glenohumeral dislocation. MATERIALS AND METHODS. Evaluation, descriptive, correlational, retrospective, non-experimental study. Population of 125 Clinical Histories, a sample of 82 was taken, who were treated in the Emergency Service of the Riobamba General Hospital, period from January 2015 to December 2019. Inclusion criteria: over 15 years of age with a diagnosis of acute glenohumeral dislocation, who signed Informed Consent. They were divided into two groups: group I: reductions with intra-articular lidocaine, group II: intravenous sedation. The data was obtained from the MIS-AS400 computer system. Data analysis was performed using the IBM SPSS version 23 statistical program. RESULTS. A reduction of 96,7% (29; 30) was achieved with group I and 94,2% (49; 52) with group II. Complications with group II were: respiratory depression 5,8% (3; 52), dizziness 5,8% (3; 52), headache 1,9% (1; 52). No complications were found in group I. DISCUSSION. It was essential to achieve pain relief through the use of anesthetic / analgesic techniques such as: sedation in combination with opioids and intra-articular lidocaine. CONCLUSION. A lower number of complications was determined with the application of intra-articular lidocaine and a shorter stay in the emergency room.

[Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial]. / Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós­operatórios em laparotomia: estudo clínico randomizado.

BACKGROUND: Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. METHODS: A single-blinded prospective randomized clinical trial on 105 patients aged 18-65 years was carried out. Patients were divided in two groups of Total Intravenous Anesthesia (TIVA) and Inhalational anesthesia. The incidence and severity of PONV were examined at 0, 2, 6, 12, and 24hours after the surgery. The use of a rescue antiemetic was also evaluated. RESULTS: Fifty point nine percent of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p <0.001). The incidence of vomiting was reported in 11.3% of the Inhalational group and 3.8% of the TIVA group (p=0.15), and 24.5% of patients in the Inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p=0.043). CONCLUSION: The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug, and the severity of nausea in patients were significantly lower in the TIVA group.

Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial / Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós-operatórios em laparotomia: estudo clínico randomizado

Abstract Background: Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. Methods: A single-blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided into two groups of Total Intravenous Anesthesia (TIVA) and inhalational anesthesia. The incidence and the severity of PONV were examined at 0, 2, 6, 12 and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated. Results: 50.9% of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the inhalational group and 3.8% of the TIVA group (p = 0.15). 24.5% of patients in the inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043). Conclusion: The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug and the severity of nausea in patients were significantly lower in the TIVA group.

Resumo Justificativa: Náusea e Vômito no Pós-Operatório (NVPO) é uma complicação multifatorial com etiologia não esclarecida. A técnica anestésica, as características dos pacientes e o tipo de cirurgia são considerados fatores que afetam a NVPO. O presente estudo foi desenhado para comparar o efeito da anestesia inalatória com anestesia intravenosa na incidência e gravidade de NVPO na cirurgia abdominal. Método: Foi realizado estudo clínico mono-cego prospectivo randomizado com 105 pacientes com idades de 18 − 65 anos. Os pacientes foram divididos em dois grupos, Anestesia Total Intravenosa (TIVA) e anestesia inalatória. A incidência e gravidade de NVPO foram avaliadas em cinco momentos: 0, 2, 6, 12 e 24 horas pós-cirurgia. O uso de antiemético de resgate também foi avaliado. Resultados: NVPO ocorreu em 50,9% dos pacientes no grupo inalatória e 17,3% dos pacientes no grupo TIVA (p< 0,001). A incidência de vômitos relatados foi 11,3% no grupo Inalatória e 3,8% no grupo TIVA (p = 0,15). Necessitaram de medicação antiemética 24,5% dos pacientes no grupo Inalatória e 9,6% dos pacientes no grupo TIVA (p = 0.043). Conclusão: A incidência de náusea e vômito no pós-operatório, a necessidade de administração de droga antiemética de resgate e a gravidade da náusea foram significantemente mais baixas no grupo TIVA.

Ventajas de la anestesia intravenosa libre de opioides en cirugía ambulatoria oncológica de mama / Advantages of opioid-free intravenous anesthesia over anesthesia in ambulatory breast cancer surgery

RESUMEN Introducción: la anestesia general libre de opioides surge ante la necesidad de evasión del uso de opioides en el transoperatorio y sus efectos indeseados en el posoperatorio. Objetivo: evaluar el comportamiento hemodinámico y la recuperación anestésica en pacientes intervenidas mediante cirugía ambulatoria por cáncer de mama, en las cuales se administró anestesia general total intravenosa libre de opioides o general balanceada. Métodos: se realizó un estudio cuasiexperimental, prospectivo en pacientes a las que se aplicó anestesia general balanceada (n=34) y total intravenosa libre de opioides (n=34) intervenidas quirúrgicamente por cáncer de mama, en el Hospital General Docente "Abel Santamaría Cuadrado", durante el 2018. Resultados: el grupo de anestesia general balanceada mostró mayor variación intraoperatoria de los parámetros evaluados, con diferencias significativas (p=0,019). El tiempo medio de despertar fue menor en el grupo de anestesia total intravenosa (2,10 ± 0,907 min vs 5,35 ± 1,250 min; p<0,01), al igual que el dolor, con diferencia significativa (p<0,05) y el tiempo de recuperación, donde una hora después de la intervención, el 85 % cumplía los criterios de alta anestésica. El retraso en el alta de la unidad de recuperación ocurrió principalmente por el bajo nivel de actividad motora, con mayor incidencia en el grupo de anestesia general balanceada (71 % vs 26 %; p=0,00). Conclusiones: la anestesia total intravenosa libre de opioides fue superior al método general balanceado, pues mostró mayor estabilidad hemodinámica y analgesia, menor incidencia de complicaciones posoperatorias y menor tiempo de estancia en sala de recuperación posanestésica.

ABSTRACT Introduction: opioid-free general anesthesia arises from the need to avoid the use of opioids in the transoperative period and the undesirable effects in the postoperative period. Objective: to assess the hemodynamic behavior and anesthetic recovery in patients who underwent ambulatory surgery for breast cancer and those who were given either opioid-free intravenous general or balanced general anesthesia. Methods: a quasi-experimental, prospective study was carried out on patients who received balanced general anesthesia (n=34) and total opioid-free intravenous anesthesia (n=34), who underwent breast cancer surgery at Abel Santamaria Cuadrado General Teaching Hospital during 2018. Results: the group of balanced general anesthesia showed greater intraoperative variation of the parameters assessed, with significant differences (p=0.019). The mean time of awakening was lower in the intravenous total anesthesia group (2.10 ± 0,907 min vs. 5,35 ± 1,250 min; p<0.01), as was pain, with significant difference (p<0.05) and the recovery time, where one hour after the surgery, 85 % met the criteria for anesthesia discharge. The delay in discharge from the recovery unit occurred mainly because of the low level of motor activity, with a higher incidence in the group of balanced general anesthesia (71% vs. 26 %; p=0.00). Conclusions: intravenous opioid-free total anesthesia was higher to the balanced general approach because it showed greater hemodynamic and analgesic stability, lower incidence of postoperative complications, and shorter time spent in the post-anesthesia recovery room.

Utilização de anestesia total intravenosa em felino submetido a oóforosalpingohisterectomia / Use of total intravenous anesthesia in feliÍe submitted to oophoosalpingohisterectomomy

O presente estudo objetivou analisar um protocolo de anestesia intravenosa total para a realização de ovariosalpingohisterectomia em gato doméstico (Felis catus), fêmea, sem raça definida, com idade de 2 anos e pesando 3,425 kg. A medicação pré-anestésica foi realizada com maropitant (1mg/kg), metadona (0,3mg/kg), midazolam (0,3mg/kg) e dexmedetomidina (3mcg/kg), na indução foi utilizado propofol (4mg/kg). Na manutenção utilizou-se propofol (0,15mg/kg/h) e remifentanila (0,15µg/kg/min), ambos em infusão contínua. Como parâmetros, foram mensurados e avaliados eletrocardiograma, frequência cardíaca e respiratória, onda pletismográfica de pulso, oximetria, capnografia, temperatura, pressão arterial não invasiva sistólica, diastólica e média. Ademais, também foram avaliados o grau de sedação, qualidade da indução anestésica, tempo de recuperação e dor pós-operatória. A paciente apresentou grau de sedação satisfatório após a medicação préanestésica. Durante o período trans-anestésico observou-se constância no plano anestésico, alto grau de analgesia e relaxamento suficiente, além de estabilidade cardiovascular e hemodinâmica, permitindo a realização do procedimento cirúrgico sem intercorrências. A remifentanila promoveu intensa analgesia, permitindo que velocidade de infusão do propofol permanecesse na dose de 0,15mg/kg/h durante toda a manutenção anestésica. A infusão de cloridrato de remifentanila associado ao propofol provocou depressão respiratória, porém os demais parâmetros mostraram-se dentro dos padrões sugeridos para a espécie felina. No pós-operatório não houve complicações e a paciente apresentou tempo de recuperação rápido. O grau de dor pós-operatória observado foi considerado leve (3,3%). Sendo assim o protocolo empregado neste estudo foi seguro, visto as mínimas alterações fisiológicas que provocou, além de adequado para o procedimento de OSH em gatos.(AU)

The present study aimed to analyze a protocol of total intravenous anesthesia for the performance of ovariosalpingohisterectomy in domestic cat (Felis catus), female, mixed breed, aged 2 years and weighing 3.425 kg. Pre-anesthetic medication was performed with maropitant (1mg/kg), methadone (0.3mg/kg), midazolam (0.3mg/kg) and dexmedetomidine (3mcg/kg), propofol (4mg/kg) was used for induction. For maintenance, propofol (0.15mg/kg/h) and remifentanil (0.15µg/kg/min) were used, both in continuous infusion. As parameters, electrocardiogram, heart and respiratory rate, pulse plethysmography wave, oximetry, capnography, temperature, non-invasive systolic, diastolic and mean blood pressure were measured and evaluated. In addition, the degree of sedation, quality of anesthetic induction, recovery time and postoperative pain were also evaluated. The patient had a satisfactory level of sedation . During the trans-anesthetic period, constancy was observed in the anesthetic plan, a high degree of analgesia and sufficient relaxation, in addition to cardiovascular and hemodynamic stability, allowing the surgical procedure to be performed without complications. Remifentanil promoted intense analgesia, allowing the propofol infusion rate to remain at a dose of 0.15mg/kg/h throughout the anesthetic maintenance. The infusion of remifentanil hydrochloride associated with propofol caused respiratory depression, but the other parameters were within the standards suggested for the feline species. In the postoperative period there were no complications and the patient had a quick recovery time. The degree of postoperative pain observed was considered mild (3.3%). Thus, the protocol used in this study was safe, given the minimal physiological changes it caused, in addition to being suitable for the OSH procedure in cats.(AU)

Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en Bucaramanga (Santander, Colombia) en el año 2017 / Postoperative cognitive dysfunction incidence for regional and general anesthesia in a level four institution in Bucaramanga (Santander, Colombia) during 2017 / Incidência do déficit cognitivo pós-operatório em anestesia regional e geral em uma instituição de quarto nível em Bucaramanga (Santander, Colômbia) em 2017

Introducción. En el proceso de envejecimiento, la mayoría de los sistemas orgánicos mantienen su funcionamiento basal, pero existe una reducción de la reserva funcional y de la capacidad para compensar el estrés fisiológico, lo que hace que los pacientes de mayor edad sean más propensos a complicaciones postoperatorias. Se realizó un estudio en instituciones de Bucaramanga para determinar la incidencia de déficit cognitivo postoperatorio y los factores de riesgo asociados. Metodología. Estudio observacional analítico de cohorte prospectivo realizado en instituciones de salud de Bucaramanga durante 2017 con pacientes mayores de 55 años intervenidos bajo anestesia regional, general balanceada o anestesia total intravenosa. Resultados. Se estudiaron 173 pacientes, 112 mujeres (64.74%) y 61 hombres (35.26%) operados. Las técnicas anestésicas más empleadas fueron: Regional (46.24%) y General balanceada (44.51%). La incidencia de Déficit Cognitivo Postoperatorio a corto plazo fue 6.36% en pacientes previamente sanos, con valor P significativo (0.001) ajustado. Se detectó deterioro cognitivo del 51.41% con alteraciones en los dominios de lenguaje, atención y memoria; con aumento en la evaluación a largo plazo. Durante el seguimiento de pacientes a largo plazo resultó en un 11.55%, determinando la incidencia de Déficit Cognitivo Postoperatorio tardío en un 17.91%. La técnica anestésica con mayor proporción de déficit a largo plazo fue la anestesia mixta, comparada con anestesia regional. Discusión. En la actualidad no existe una definición estandarizada de Déficit Cognitivo Postoperatorio, se ha observado mayor frecuencia y mayor prolongación en pacientes de edad avanzada. El estudio demostró una incidencia temprana significativamente menor, comparándolo con artículos internacionales, pero una incidencia mayor en déficit postoperatorio tardío, resultado de mayores complicaciones intraoperatorias, comparado con otros estudios. Conclusiones. El Déficit Cognitivo Postoperatorio involucra múltiples factores de riesgo; en el estudio se encontró mayor asociación con la edad, la escolaridad, la hipotensión y la anestesia general. No hubo asociación entre comorbilidades y el Déficit Cognitivo Postoperatorio. Se determinó la presencia de hipotensión para desarrollo de este déficit. Cómo citar: Contreras-Forero FJ, Ochoa ME, Perez M, Pinillos M, Celis L, Valencia-Guampe JS, et al. Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en bucaramanga (santander, colombia) en el año 2017. MedUNAB. 2020;23(3): 450-463. Doi: https://doi.org/10.29375/01237047.3711

Introduction. Within the aging process, most organic systems maintain their basal functions. However, there is a reduction in functional reserve and the capacity to compensate physiological stress, which makes older patients more prone to postoperative complications. A study was performed in institutions in Bucaramanga to determine the incidence of postoperative cognitive dysfunction and the associated risk factors. Methodology. This was a analytical observational prospective cohort study performed in healthcare institutions in Bucaramanga in 2017 with patients older than 55 years of age under regional, balanced general or total intravenous anesthesia. Results. One hundred and seventy-three operated patients were studied, among which 112 (64.74%) were women and 61 (35.26%) were men. The most commonly used anesthetic techniques were: regional (46.24%) and balanced general (44.51%). Short-term Postoperative Cognitive Dysfunction incidence was 6.36% in previously healthy patients, with an adjusted significant P value (0.001). Cognitive deterioration was detected in 51.41% of patients, with alterations in their mastery of language, attention and memory. This increased for the long-term evaluation. During long-term patient follow-up, it resulted in 11.55%, determining the incidence of delayed Postoperative Cognitive Dysfunction at 17.91%. The anesthetic technique with the highest proportion of long- term dysfunction was mixed anesthesia, compared to regional anesthesia. Discussion. There is currently no standardized definition for Postoperative Cognitive Dysfunction. It has been observed more frequently and for longer extensions in older patients. The study demonstrated a significantly lower early incidence when compared to international articles, but a greater incidence of delayed postoperative dysfunction as a result of more intraoperative complications compared to other studies. Conclusions. Postoperative Cognitive Dysfunction involves multiple risk factors. The study observed a greater association with age, level of education, hypotension and general anesthesia. There was no association between comorbidities and Postoperative Cognitive Dysfunction. The presence of hypotension was determined for developing this dysfunction. Cómo citar: Contreras-Forero FJ, Ochoa ME, Perez M, Pinillos M, Celis L, Valencia-Guampe JS, et al. Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en bucaramanga (santander, colombia) en el año 2017. MedUNAB. 2020;23(3): 450-463. Doi: https://doi.org/10.29375/01237047.3711

Introdução. No processo de envelhecimento, a maioria dos sistemas orgânicos mantém seu funcionamento basal, mas há uma diminuição da reserva funcional e da capacidade de compensar o estresse fisiológico que torna os pacientes idosos mais sujeitos a complicações pós-operatórias. Foi realizado um estudo em instituições da cidade de Bucaramanga para determinar a incidência de déficit cognitivo pós-operatório e os fatores de risco associados. Métodos. Estudo observacional analítico de coorte prospectivo realizado em instituições de saúde em Bucaramanga durante o ano de 2017 em pacientes com idade superior a 65 anos operados sob anestesia regional, geral balanceada ou anestesia geral intravenosa. Resultados. Foram estudados 173 pacientes, 112 mulheres (64.74%) e 61 homens (35.26%) operados. As técnicas anestésicas mais utilizadas foram: regional (46.24%) e geral balanceada (44.51%). A incidência de déficit cognitivo pós-operatório de curto prazo foi de 6.36% em pacientes previamente saudáveis, com um valor P significativo (0.001) ajustado. Detectou- se deterioração cognitiva de 51.41% com alterações nos domínios da linguagem, atenção e memória; com aumento na avaliação de longo prazo. No seguimento a longo prazo dos pacientes resultou em 11.55%, determinando a incidência de déficit cognitivo pós-operatório tardio em 17.91%. A técnica anestésica com maior proporção de déficit no longo prazo foi a anestesia mista, em comparação com a anestesia regional. Discussão. Atualmente não existe uma definição padronizada de Déficit Cognitivo Pós-operatório, a qual observa-se com maior frequência e por mais tempo em pacientes idosos. O estudo demonstrou incidência precoce significativamente menor, em comparação com resultados de artigos internacionais, mas maior incidência de déficit pós-operatório tardio, resultado de maiores complicações intraoperatórias, em comparação com outros estudos. Conclusões. O Déficit Cognitivo Pós-operatório envolve múltiplos fatores de risco; o estudo encontrou maior associação com idade, escolaridade, hipotensão e anestesia geral. Não houve associação entre comorbidades e Déficit Cognitivo Pós-operatório. Determinou-se a presença de hipotensão para o desenvolvimento desse déficit. Cómo citar: Contreras-Forero FJ, Ochoa ME, Perez M, Pinillos M, Celis L, Valencia-Guampe JS, et al. Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en bucaramanga (santander, colombia) en el año 2017. MedUNAB. 2020;23(3): 450-463. Doi: https://doi.org/10.29375/01237047.3711

Utilização de anestesia total intravenosa em felino submetido a oóforosalpingohisterectomia / Use of total intravenous anesthesia in feliÍe submitted to oophoosalpingohisterectomomy

O presente estudo objetivou analisar um protocolo de anestesia intravenosa total para a realização de ovariosalpingohisterectomia em gato doméstico (Felis catus), fêmea, sem raça definida, com idade de 2 anos e pesando 3,425 kg. A medicação pré-anestésica foi realizada com maropitant (1mg/kg), metadona (0,3mg/kg), midazolam (0,3mg/kg) e dexmedetomidina (3mcg/kg), na indução foi utilizado propofol (4mg/kg). Na manutenção utilizou-se propofol (0,15mg/kg/h) e remifentanila (0,15µg/kg/min), ambos em infusão contínua. Como parâmetros, foram mensurados e avaliados eletrocardiograma, frequência cardíaca e respiratória, onda pletismográfica de pulso, oximetria, capnografia, temperatura, pressão arterial não invasiva sistólica, diastólica e média. Ademais, também foram avaliados o grau de sedação, qualidade da indução anestésica, tempo de recuperação e dor pós-operatória. A paciente apresentou grau de sedação satisfatório após a medicação préanestésica. Durante o período trans-anestésico observou-se constância no plano anestésico, alto grau de analgesia e relaxamento suficiente, além de estabilidade cardiovascular e hemodinâmica, permitindo a realização do procedimento cirúrgico sem intercorrências. A remifentanila promoveu intensa analgesia, permitindo que velocidade de infusão do propofol permanecesse na dose de 0,15mg/kg/h durante toda a manutenção anestésica. A infusão de cloridrato de remifentanila associado ao propofol provocou depressão respiratória, porém os demais parâmetros mostraram-se dentro dos padrões sugeridos para a espécie felina. No pós-operatório não houve complicações e a paciente apresentou tempo de recuperação rápido. O grau de dor pós-operatória observado foi considerado leve (3,3%). Sendo assim o protocolo empregado neste estudo foi seguro, visto as mínimas alterações fisiológicas que provocou, além de adequado para o procedimento de OSH em gatos.

The present study aimed to analyze a protocol of total intravenous anesthesia for the performance of ovariosalpingohisterectomy in domestic cat (Felis catus), female, mixed breed, aged 2 years and weighing 3.425 kg. Pre-anesthetic medication was performed with maropitant (1mg/kg), methadone (0.3mg/kg), midazolam (0.3mg/kg) and dexmedetomidine (3mcg/kg), propofol (4mg/kg) was used for induction. For maintenance, propofol (0.15mg/kg/h) and remifentanil (0.15µg/kg/min) were used, both in continuous infusion. As parameters, electrocardiogram, heart and respiratory rate, pulse plethysmography wave, oximetry, capnography, temperature, non-invasive systolic, diastolic and mean blood pressure were measured and evaluated. In addition, the degree of sedation, quality of anesthetic induction, recovery time and postoperative pain were also evaluated. The patient had a satisfactory level of sedation . During the trans-anesthetic period, constancy was observed in the anesthetic plan, a high degree of analgesia and sufficient relaxation, in addition to cardiovascular and hemodynamic stability, allowing the surgical procedure to be performed without complications. Remifentanil promoted intense analgesia, allowing the propofol infusion rate to remain at a dose of 0.15mg/kg/h throughout the anesthetic maintenance. The infusion of remifentanil hydrochloride associated with propofol caused respiratory depression, but the other parameters were within the standards suggested for the feline species. In the postoperative period there were no complications and the patient had a quick recovery time. The degree of postoperative pain observed was considered mild (3.3%). Thus, the protocol used in this study was safe, given the minimal physiological changes it caused, in addition to being suitable for the OSH procedure in cats.

Hemodynamic variables in piglets anesthetized with isoflurane or propofol, kept under spontaneous ventilation and FIO2 of 0. 5 / Variáveis hemodinâmicas em suínos anestesiados com isoflurano ou propofol, mantidos sob ventilação espontânea e FIO2 de 0,5

This study aimed to evaluate comparatively the effects of propofol or isoflurane on hemodynamic variables in piglets that received inspired oxygen fraction (FIO2) of 0.5 under spontaneous ventilation. Therefore, sixteen piglets weighing 16±1.1kg, were randomly divided into two groups: GI (Isoflurane and FIO2 of 0.5) and GP (Propofol and FIO2 of 0.5). Heart rate (HR), systolic, diastolic and mean arterial pressure (SAP, DAP and MAP), central venous pressure (CVP), cardiac output (CO), mean pulmonary arterial pressure (mPAP) and mean capillary pulmonary pressure (mCPP) were assessed 40 minutes after anesthetic induction (T0), followed by 15 minutes intervals (from T15 to T60). The variables cardiac index (CI), stroke volume (SV), stroke index (SI), total peripheral resistance (TPR), total peripheral resistance index (TPRI), pulmonary vascular resistance (PVR), and pulmonary vascular resistance index (PVRI) were calculated. SAP and TPRI were significantly different between groups at T30 and T60 (P< 0.05) with higher GP values being recorded. There were no differences in the other variables, however, GP presented mean closer to normality on most of the analyzed variables. Therefore, we conclude that total intravenous anesthesia with propofol presented greater stability of the hemodynamic variables evaluated.(AU)

O objetivo deste estudo foi avaliar comparativamente os efeitos do propofol ou do isoflurano sobre as variáveis hemodinâmicas em leitões que receberam fração inspirada de oxigênio (FIO2) de 0,5 sob ventilação espontânea. Dezesseis leitões, pesando 16±1,1kg, foram divididos aleatoriamente em dois grupos: GI (isoflurano e FIO2 de 0,5) e GP (propofol e FIO2 de 0,5). A frequência cardíaca (FC), a pressão arterial sistólica, a diastólica e a média (PAS, PAD e PAM), a pressão venosa central (PVC), o débito cardíaco (DC),a pressão média da artéria pulmonar (PAPm) e a pressão média capilar pulmonar (PCPm) foram avaliados 40 minutos após a indução anestésica (T0), seguida por intervalos de 15 minutos (de T15 a T60). As variáveis índice cardíaco (IC), volume sistólico (VS), índice sistólico (SI), resistência periférica total (RPT), índice de resistência periférica total (IRPT), resistência vascular pulmonar (RVP) e índice de resistência vascular pulmonar (IRVP) foram calculadas. PAS e IRPT foram significativamente diferentes entre os grupos em T30 e T60 (P<0,05) com maiores valores de GP sendo registrados. Não houve diferenças nas demais variáveis, entretanto o GP apresentou médias próximas da normalidade na maioria das variáveis analisadas. Portanto, concluiu-se que a anestesia intravenosa total com propofol apresentou maior estabilidade das variáveis hemodinâmicas avaliadas.(AU)

Hemodynamic variables in piglets anesthetized with isoflurane or propofol, kept under spontaneous ventilation and FIO2 of 0. 5 / Variáveis hemodinâmicas em suínos anestesiados com isoflurano ou propofol, mantidos sob ventilação espontânea e FIO2 de 0,5

This study aimed to evaluate comparatively the effects of propofol or isoflurane on hemodynamic variables in piglets that received inspired oxygen fraction (FIO2) of 0.5 under spontaneous ventilation. Therefore, sixteen piglets weighing 16±1.1kg, were randomly divided into two groups: GI (Isoflurane and FIO2 of 0.5) and GP (Propofol and FIO2 of 0.5). Heart rate (HR), systolic, diastolic and mean arterial pressure (SAP, DAP and MAP), central venous pressure (CVP), cardiac output (CO), mean pulmonary arterial pressure (mPAP) and mean capillary pulmonary pressure (mCPP) were assessed 40 minutes after anesthetic induction (T0), followed by 15 minutes intervals (from T15 to T60). The variables cardiac index (CI), stroke volume (SV), stroke index (SI), total peripheral resistance (TPR), total peripheral resistance index (TPRI), pulmonary vascular resistance (PVR), and pulmonary vascular resistance index (PVRI) were calculated. SAP and TPRI were significantly different between groups at T30 and T60 (P< 0.05) with higher GP values being recorded. There were no differences in the other variables, however, GP presented mean closer to normality on most of the analyzed variables. Therefore, we conclude that total intravenous anesthesia with propofol presented greater stability of the hemodynamic variables evaluated.(AU)

O objetivo deste estudo foi avaliar comparativamente os efeitos do propofol ou do isoflurano sobre as variáveis hemodinâmicas em leitões que receberam fração inspirada de oxigênio (FIO2) de 0,5 sob ventilação espontânea. Dezesseis leitões, pesando 16±1,1kg, foram divididos aleatoriamente em dois grupos: GI (isoflurano e FIO2 de 0,5) e GP (propofol e FIO2 de 0,5). A frequência cardíaca (FC), a pressão arterial sistólica, a diastólica e a média (PAS, PAD e PAM), a pressão venosa central (PVC), o débito cardíaco (DC),a pressão média da artéria pulmonar (PAPm) e a pressão média capilar pulmonar (PCPm) foram avaliados 40 minutos após a indução anestésica (T0), seguida por intervalos de 15 minutos (de T15 a T60). As variáveis índice cardíaco (IC), volume sistólico (VS), índice sistólico (SI), resistência periférica total (RPT), índice de resistência periférica total (IRPT), resistência vascular pulmonar (RVP) e índice de resistência vascular pulmonar (IRVP) foram calculadas. PAS e IRPT foram significativamente diferentes entre os grupos em T30 e T60 (P<0,05) com maiores valores de GP sendo registrados. Não houve diferenças nas demais variáveis, entretanto o GP apresentou médias próximas da normalidade na maioria das variáveis analisadas. Portanto, concluiu-se que a anestesia intravenosa total com propofol apresentou maior estabilidade das variáveis hemodinâmicas avaliadas.(AU)

Sufentanil during anesthetic induction of remifentanil-based total intravenous anesthesia: a randomized controlled trial / Sufentanil durante a indução da anestesia intravenosa total à base de remifentanil: ensaio clínico randômico

Abstract Background Postoperative pain represents an important concern when remifentanil is used for total intravenous anesthesia because of its ultrashort half-life. Longer acting opioids, such as sufentanil, have been used during induction of remifentanil-based total intravenous anesthesia as a means to overcome this shortcoming. However, the effectiveness and safety of such strategy still lacks evidence from randomized clinical trials. Hence, we aimed to assess the postoperative analgesic efficacy and safety of a single dose of sufentanil administered during the induction of remifentanil-based total intravenous anesthesia. Methods Forty patients, scheduled for elective open abdominal surgery, were randomized to receive remifentanil-based total intravenous anesthesia with or without a single dose of sufentanil upon induction. We assessed the postoperative morphine consumption administered through a patient-controlled analgesia pump. Self-reported pain scores and the occurrence of nausea, vomiting, pruritus, agitation, somnolence and respiratory depression were also assessed up to 2 days after surgery. Results The mean difference between the sufentanil and control groups regarding morphine consumption in the post-anesthetic care unit and at 12, 24 and 48 h after surgery were -7.2 mg (95%CI: -12.5 to -2.1, p < 0.001), -3.9 mg (95%CI: -11.9 to 4.7, p = 0.26), -0.6 mg (95%CI: (-12.7 to 12.7, p = 0.80), and -1.8 mg (95%CI: (-11.6 to 15.6, p = 0.94), respectively. Neither self-reported pain nor the incidence of adverse events were significantly different between groups at any time point. Conclusion Our findings suggest that the administration of sufentanil during induction of remifentanil-based total intravenous anesthesia is associated with decreased early postoperative opioid consumption.

Resumo Justificativa A dor pós-operatória é uma grande preocupação quando o remifentanil é usado para anestesia intravenosa total devido à sua meia-vida ultracurta. Os opioides de ação mais longa, como o sufentanil, têm sido usados durante a indução de anestesia intravenosa total à base de remifentanil como um meio de superar essa deficiência. Porém, a eficácia e segurança de tal estratégia ainda precisam de evidências advindas de ensaios clínicos randômicos. Portanto, objetivamos avaliar a eficácia analgésica e a segurança pós-operatória de uma dose única de sufentanil administrada durante a indução de anestesia intravenosa total à base de remifentanil. Métodos Quarenta pacientes eletivamente agendados para cirurgia abdominal aberta foram randomizados para receber anestesia intravenosa total à base de remifentanil, com ou sem uma dose única de sufentanil, após a indução da anestesia. Avaliamos o consumo de morfina no pós-operatório, administrado através de uma bomba de analgesia controlada pelo paciente. Os escores de dor autorrelatados e a ocorrência de náusea, vômito, prurido, agitação, sonolência e depressão respiratória também foram avaliados até dois dias após a cirurgia. Resultados A diferença média entre os grupos sufentanil e controle em relação ao consumo de morfina em sala de recuperação pós-anestesia e após 12, 24 e 48 horas da cirurgia foi de -7,2 mg (IC 95%: -12,5 a -2,1, p < 0,001), -3,9 mg (IC 95%: -11,9 a 4,7, p = 0,26), -0,6 mg (IC 95%: (-12,7 a 12,7, p = 0,80) e -1,8 mg (IC 95%: -11,6 para 15,6, p = 0,94), respectivamente. Não houve diferença significativa tanto nos escores de dor autorrelatados, quanto na incidência de eventos adversos entre os grupos. Conclusão Nossos achados sugerem que a administração de sufentanil durante a indução de anestesia intravenosa total à base de remifentanil está associada à redução do consumo de opioides no pós-operatório imediato.

[Sufentanil during anesthetic induction of remifentanil-based total intravenous anesthesia: a randomized controlled trial]. / Sufentanil durante a indução da anestesia intravenosa total à base de remifentanil: ensaio clínico randômico.

BACKGROUND: Postoperative pain represents an important concern when remifentanil is used for total intravenous anesthesia because of its ultrashort half-life. Longer acting opioids, such as sufentanil, have been used during induction of remifentanil-based total intravenous anesthesia as a means to overcome this shortcoming. However, the effectiveness and safety of such strategy still lacks evidence from randomized clinical trials. Hence, we aimed to assess the postoperative analgesic efficacy and safety of a single dose of sufentanil administered during the induction of remifentanil-based total intravenous anesthesia. METHODS: Forty patients, scheduled for elective open abdominal surgery, were randomized to receive remifentanil-based total intravenous anesthesia with or without a single dose of sufentanil upon induction. We assessed the postoperative morphine consumption administered through a patient-controlled analgesia pump. Self-reported pain scores and the occurrence of nausea, vomiting, pruritus, agitation, somnolence and respiratory depression were also assessed up to 2 days after surgery. RESULTS: The mean difference between the sufentanil and control groups regarding morphine consumption in the post-anesthetic care unit and at 12, 24 and 48h after surgery were -7.2mg (95%CI: -12.5 to -2.1, p<0.001), -3.9mg (95%CI: -11.9 to 4.7, p=0.26), -0.6mg (95%CI: (-12.7 to 12.7, p=0.80), and -1.8mg (95%CI: (-11.6 to 15.6, p=0.94), respectively. Neither self-reported pain nor the incidence of adverse events were significantly different between groups at any time point. CONCLUSION: Our findings suggest that the administration of sufentanil during induction of remifentanil-based total intravenous anesthesia is associated with decreased early postoperative opioid consumption.

Anestesia intravenosa contínua com dextrocetamina e detomidina em cadelas submetidas à ovário-histerectomia e pré-medicadas com midazolam e morfina / Continuous intravenous anesthesia by dextroketamine and detomidine in bitches subjected to ovariohysterectomy and premedicated with midazolam and morphine

Background: The use of injectable anesthetics to induce and maintain anesthesia has been the subject of extensive research.Ketamine induces dissociative anesthesia, which is characterized by sensory loss, analgesia and amnesia without loss of consciousness. The levorotatory isomer of ketamine is dextroketamine. Detomidine, a potent myorelaxant that acts as a sedative andanalgesic, is commonly used on horses but rarely tested in dogs. The purpose of this study was to evaluate the cardiorespiratoryand anesthetic effects promoted by a combination of detomidine and dextroketamine applied via continuous intravenous infusionin bitches premedicated with midazolam and morphine.Materials, Methods & Results:Eight bitches treated at the veterinary hospital of the Federal University of Campina Grande werereferred for elective ovariohysterectomy (OHE). The animals were premedicated with 0.3 mg/kg of midazolam and 0.1 mg/kgof morphine intramuscular (IM) followed, after 15 min, with 0.02 mg/kg of detomidine IM. Fifteen min after the administration of detomidine, 3.5 mg/kg of dextroketamine was administered intravenously (IV), followed by continuous IV infusion of14 mg/kg/h of dextroketamine and 30 μg/kg/h of detomidine. Heart rate (HR), respiratory rate (RR), body temperature (BT),mean arterial pressure (MAP), myorelaxation and electrocardiogram were recorded before and 15 min after the administrationof midazolam and morphine (M0 and M1), 15 min after detomidine (M2), immediately after starting the infusion (M3), at 10min intervals up to 60 min (M4, M5, M6, M7, M8 and M9) and 30 min after the end of the infusion (M10). Blood gas variableswere analyzed at M0, M1, M2, M6, M9 and M10. Analgesia was evaluated by measuring cortisol and glucose levels at M0, threemin after dermotomy, three min after clamping the ovarian pedicle, and three min after dermorrhaphy. The quality and durationof recovery were evaluated. HR dropped significantly from...(AU)

Anestesia intravenosa contínua com dextrocetamina e detomidina em cadelas submetidas à ovário-histerectomia e pré-medicadas com midazolam e morfina / Continuous intravenous anesthesia by dextroketamine and detomidine in bitches subjected to ovariohysterectomy and premedicated with midazolam and morphine

Background: The use of injectable anesthetics to induce and maintain anesthesia has been the subject of extensive research.Ketamine induces dissociative anesthesia, which is characterized by sensory loss, analgesia and amnesia without loss of consciousness. The levorotatory isomer of ketamine is dextroketamine. Detomidine, a potent myorelaxant that acts as a sedative andanalgesic, is commonly used on horses but rarely tested in dogs. The purpose of this study was to evaluate the cardiorespiratoryand anesthetic effects promoted by a combination of detomidine and dextroketamine applied via continuous intravenous infusionin bitches premedicated with midazolam and morphine.Materials, Methods & Results:Eight bitches treated at the veterinary hospital of the Federal University of Campina Grande werereferred for elective ovariohysterectomy (OHE). The animals were premedicated with 0.3 mg/kg of midazolam and 0.1 mg/kgof morphine intramuscular (IM) followed, after 15 min, with 0.02 mg/kg of detomidine IM. Fifteen min after the administration of detomidine, 3.5 mg/kg of dextroketamine was administered intravenously (IV), followed by continuous IV infusion of14 mg/kg/h of dextroketamine and 30 μg/kg/h of detomidine. Heart rate (HR), respiratory rate (RR), body temperature (BT),mean arterial pressure (MAP), myorelaxation and electrocardiogram were recorded before and 15 min after the administrationof midazolam and morphine (M0 and M1), 15 min after detomidine (M2), immediately after starting the infusion (M3), at 10min intervals up to 60 min (M4, M5, M6, M7, M8 and M9) and 30 min after the end of the infusion (M10). Blood gas variableswere analyzed at M0, M1, M2, M6, M9 and M10. Analgesia was evaluated by measuring cortisol and glucose levels at M0, threemin after dermotomy, three min after clamping the ovarian pedicle, and three min after dermorrhaphy. The quality and durationof recovery were evaluated. HR dropped significantly from...

Técnica anestésica de rápida recuperación para cirugía de mano ambulatoria / Rapid recovery anesthesia technique for ambulatory hand surgery

Resumen Objetivo: Mostrar los resultados y satisfacción en pacientes operados de cirugía de mano con esta técnica. Materiales y métodos: Se trata de una cohorte prospectiva y observacional de pacientes a los cuales se les practicó cirugía de mano. Se usó la combinación de inducción intravenosa con remifentaníl + Propofol, y bloqueo regional con bupivacaina al 0.5 % y lidocaína al 1 %. Se usó la escala de Fast-track y escala de calidad de recuperación posanestésica (CdR) para evaluar la satisfacción del paciente; adicionalmente se evaluó el dolor con EVA a las 6 horas posoperatorias. Resultados: El promedio de tiempo quirúrgico fue de 11.5 minutos y el tiempo de recuperación 14 minutos desde el inicio de la anestesia. Ningún paciente presentó náuseas o vómito, todos cumplieron criterios de Fast track, con buen patrón respiratorio y saturación parcial de oxígeno mayor a 90 % sin oxígeno suplementario. El 95.8 % estuvieron satisfechos con la cirugía y la técnica anestésica. Conclusión: Esta técnica da excelentes resultados en cirugía de mano ambulatoria. La combinación de anestesia endovenosa y de anestesia local permite ir directamente a la sala de cuidados ambulatorios. Desde que iniciamos el uso de esta técnica, hemos tenido una buena satisfacción y de menor dolor e inconformidad de los pacientes. Es una técnica segura y suficiente en pacientes para cirugía de mano ambulatoria.

Abstract Objective: To show the results and satisfaction in patients undergoing hand surgery with this technique. Materials and methods: This is a prospective and observational cohort of patients who underwent hand surgery. The combination of intravenous induction with remifentaníl + propofol, and regional block with 0.5% bupivacaine and lidocaine 1 % was used. Scale Fast-track and scale for measuring the quality of post-anaesthetic (CdR) for measuring patient satisfaction were used and the pain with EVA at postoperative six hours was evaluated. Results: The average time of surgery was 11.5 minutes, and the time from the onset of anesthesia for recovery was 14 minutes. No patient had nausea or vomiting. All patients had Fast-track critera with good breathing patterns and oxygen partial saturation greater than 90 % without supplemental oxygen. 95.8 % were satisfied with the surgery and anesthetic technique. Conclusions: This technique gives excellent results in outpatient hand surgery. The combination of intravenous anesthesia and local anesthesia can go directly to the ambulatory care unit. Since we started using this technique, we have had high satisfaction and less pain and discomfort for patients. It is a safe and adequate technique for patients who undergo outpatient hand surgery.

Prácticas de manipulación del propofol: resultados de un estudio colombiano de corte transversal / Propofol handling practices: Results from a Colombian cross-sectional study

Abstract Introduction: Propofol is one of the most frequently used intravenous anesthetic agents. Due to its lipid-based composition, propofol requires a strict handling protocol to avoid increased risk of extrinsic contamination. Little is known about propofol handling practices in developing countries. Objective: We conducted a survey among the population of anesthesiologists and anesthesia residents in Colombia, with a view to identify the practices and factors associated with Propofol inadequate propofol handling. Methods: Cross-sectional study based on digital and/or telephone surveys addressed to anesthesiologists and residents of anesthesia in Colombia. The data collection tool comprised thirty questions divided into sections considering socio-demographic conditions, practices and knowledge. Results: A total of 662 answers were analyzed. The reuse of propofol vials in more than one patient and the reuse of propofol syringes in several patients were described as usual practices by 37.9% (251/662) and 6.2% (41/662) respectively, among the subjects surveyed. Multivariate analysis showed a perception of shortage of Propofol, infrequent use of gloves, and reuse of syringes that were significantly associated with the reuse of propofol vials at institutions with few ORs (<9). Conclusions: Notwithstanding the economic conditions, the reuse of propofol in Colombia is similar to developed countries. Further research focusing on the impact of external factors such as economic, administrative, and training conditions is required.

Resumen Introducción: El propofol es uno de los agentes anestésicos más usados. Por su composición liposoluble, el propofol requiere un estricto protocolo para su manipulación con el objetivo de evitar el potencial riesgo de contaminación extrínseca. Poco se conoce sobre las prácticas de manipulación del propofol en países en vía de desarrollo. Objetivo: Hemos desarrollado un estudio en la población de anestesiólogos y residentes de anestesiología en Colombia con el objetivo de identificar las prácticas y factores relacionados con la inadecuada manipulación del propofol. Métodos: Se realizó un estudio de corte transversal basado en encuestas electrónicas y/o telefónicas dirigidas a anestesiólogos y residentes de anestesiología en Colombia. El instrumento de recolección contenía treinta preguntas dividas en secciones que estudiaban condiciones sociodemográficas, prácticas y conocimientos. Resultados: Se analizaron 662 respuestas. La reutilización de viales de propofol en más de un paciente y la reutilización de jeringas con propofol en más de un paciente fueron referidas como prácticas frecuentes en el 37,9% (251/662) y el 6,2% (41/662) de los encuestados, respectivamente. El análisis multivariado mostró que un bajo número de quirófanos (< 9), la percepción de escasez de propofol, el uso infrecuente de guantes y la reutilización de jeringas son factores significativamente relacionados a la reutilización de viales de propofol. Conclusiones: A pesar de las condiciones económicas, la tasa de reutilización de propofol en Colombia es similar en comparación con la de países desarrollados. Se requiere mayor investigación dirigida a estudiar la influencia de factores externos tales como condiciones económicas, administrativas y formativas.

De la farmacocinética a la farmacodinámica, ¿estamos listos para los software 3D? / From pharmacokinetics to pharmacodynamics -Are we ready for 3D software?

Abstract The relationship between the dose and plasma concentration of a drug is determined by pharmacokinetics. However, difficulties arise when more than one drug is administered simultaneously. There is currently a gap in the teaching model when trying to convey the significance of pharmacodynamic interactions. In this article the authors reflect on the importance of developing a software that simplifies the pharmacokinetic concepts of two drugs, turning them into one single variable in space as a function of time. Together with depth of anesthesia monitoring and the pain control variables, this model will bring pharmacokinetics and pharmacodynamics together and provide a teaching tool for improved understanding of these concepts.

Resumen La relación entre la dosis y la concentración plasmática de un fármaco está determinada por la farmacocinética. Sin embargo, se presentan dificultades cuando hay más de un medicamento administrado de forma simultánea. En la actualidad hay un vacío en el modelo de enseñanza cuando se pretende difundir la importancia de las interacciones farmacodinámicas. En el presente artículo los autores hacen una reflexión sobre la importancia de poder construir un software que simplifique los conceptos farmacocinéticos de dos medicamentos, convirtiéndolos en una sola variable de espacio en función del tiempo. Este modelo permitiría, junto con la monitorización de la profundidad anestésica y las variables de control del dolor, acoplar la farmacocinética a la farmacodinámica, y brindaría una herramienta de educación para la comprensión de estos conceptos.

Anesthesia recovery comparison between remifentanil-propofol and remifentanil-desflurane guided by Bispectral Index® monitoring / Comparação da recuperação pós-anestésica entre remifentanil-propofol e remifentanil-desflurano guiada pela monitoração do Índice Bispectral®

Abstract Background and objectives There is a strong demand for fast and predictable anesthesia recovery with few side effects. Choice of the hypnotic agent could impact on that. This study investigated the differences between recoveries after remifentanil-propofol and remifentanil-desflurane anesthesias guided by bispectral index (BIS®). Methods Forty patients were randomly assigned into 2 groups according to the anesthesia technique applied: remifentanil-propofol (REM-PRO) and remifentanil-desflurane (REM-DES). After the discontinuation of the anesthetics, the times to extubation, to obey commands and to recover the airway protection reflex were recorted. In the post-anesthetic recovery room (PACU) it was recorded the occurrence of nausea and vomiting (PONV), scores of Ramsay sedation scale and of numeric pain scale (NPS), morphine dose and length of stay in the unit. Results Data from 38 patients were analyzed: 18 from REM-PRO and 20 from REM-DES group. Anesthesia times were similar (REM-PRO = 193 min, SD 79.9 vs. 175.7 min, SD 87.9 REM-DES; p = 0.5). REM-DES had shorter times than REM-PRO group: time to follow command (8.5 min; SD 3.0 vs. 5.6 min; SD 2.5; p = 0.0) and extubation time (6.2 min; 3.1-8.5 vs. 9.5 min; 4.9-14.4; p = 0.0). Times to recover airway protective reflex were similar: 16 patients from REM-PRO (88.9%) restored the airway protective reflex 2 min after extubation vs. 17 from REM-DES (89.5%); and 2 patients from REM-PRO (11.1%) vs. 2 from REM-DES (10.5%) 6 min after extubation, p = 1. Ramsay sedation score, NPS, PONV incidents, morphine dose and PACU stay of length PACU were also similar. Conclusion Remifentanil-desflurane-based anesthesia has a faster extubation time and to follow command than remifentanil-propofol-based anesthesia when both guided by BIS®.

Resumo Justificativa e objetivos Há uma forte demanda por recuperação pós-anestésica rápida e previsível com poucos efeitos adversos. A escolha do agente hipnótico pode influenciar isso. Este estudo investigou as diferenças da recuperação no pós-operatório entre as técnicas anestésicas com remifentanil-propofol e com remifentanil-desflurano ambas com monitoração guiada pelo índice bispectral (BIS ®). Métodos Foram randomicamente distribuídos 40 pacientes em dois grupos de acordo com a técnica anestésica aplicada: remifentanil-propofol (REM-PRO) e remifentanil-desflurano (REM-DES). Após a descontinuação dos anestésicos foram registrados os tempos para extubação, obedecer a comandos e recuperar o reflexo de proteção das vias aéreas. Na sala de recuperação pós-anestésica (SRPA) foi registrado a ocorrência de náuseas e vômitos (NVPO), os escores na escala de sedação de Ramsay e na escala numérica de dor (END), a dose de morfina utilizada e o tempo de permanência nesta unidade. Resultados Os dados de 38 pacientes foram analisados: 18 do grupo REM-PRO e 20 do grupo REM-DES. Os tempos de anestesia foram semelhantes (REM-PRO = 193 minutos, DP 79,9 vs. 175,7 minutos, DP 87,9 REM-DES; p = 0,5). O grupo REM-DES apresentou tempos mais curtos do que o grupo REM-PRO: tempo para obedecer a comandos (8,5 minutos; DP 3,0 vs. 5,6 minutos; DP 2,5; p = 0,0) e tempo de extubação (6,2 minutos; 3,1-8,5 vs. 9,5 minutos; 4,9-14,4; p = 0,0). Os tempos para recuperação do reflexo de proteção das vias aéreas foram semelhantes: 16 pacientes do grupo REM-PRO (88,9%) recuperaram o reflexo de proteção das vias aéreas dois minutos após a extubação vs. 17 do grupo REM-DES (89,5%) e dois pacientes do grupo REM-PRO (11,1%) vs. dois do REM-DES (10,5%) seis minutos após a extubação, p = 1. Os escores de Ramsay, NPS, a incidência de NVPO, a dose de morfina e o tempo de permanência na SRPA também foram semelhantes. Conclusão A anestesia com remifentanil-desflurano tem um perfil de recuperação da anestesia pós-anestésica mais rápido do que o da anestesia com remifentanil-propofol quando ambas guiadas pelo BIS®.