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Introduction: The specialty of Anaesthesiology stands for evidence-based practice and meticulous training. In fact, the most recent change to the residency program was the addition of a two months internship at Group I hospitals, which was introduced in January 2020. Material and Methods: A descriptive cross-sectional observational study was carried out based on an online survey with the objective of defining, according to the perception of trainees, the quality, usefulness, and logistical resources of this internship. The survey consisted of 14 questions, divided in two groups: questions related to training and work and questions related to the logistical component of the internship. Results: From a universe of 160 trainees, 75 responses (46.9%) were obtained. Group I internships proved to be an asset for the Anaesthesiology residency. Most of the respondents had a high level of satisfaction with the internship, namely regarding autonomy and variety of functions performed, which culminate in a desire to work in district hospitals in the future. Discussion and Conclusions: This analysis of the first two years of Group I internship may serve as the basis for a wide-ranging discussion that may lead to a process of continuous improvement of the conditions and possible introduction of new elements into an internship that has already shown to be of value., Introdução: A especialidade de Anestesiologia prima pela prática baseada na evidência e cuidado com a formação. Os Estágios de Grupo I são a mais recente alteração ao programa formativo da especialidade, tendo-se realizado pela primeira vez em janeiro de 2020. Material e Métodos: Realizou-se um estudo observacional transversal descritivo com base num inquérito on-line com o objetivo de definir, segundo a perceção dos Médicos Internos, a qualidade, utilidade e recursos logísticos do estágio. O inquérito era composto por 14 questões, divididas em dois grupos: um bloco relativo à componente formativa e laboral e um bloco relativo à componente logística do estágio. Resultados: De um universo de 160 Internos de Formação Especializada em Anestesiologia foram obtidas 75 respostas (46,9%). Os Estágios de Grupo I demonstraram ser uma mais-valia no Internato de Anestesiologia. Os Médicos Internos, na sua grande maioria, apresentam um elevado grau de satisfação com o estágio, autonomia e variedade de funções desempenhadas, que culminam na vontade de exercer futuramente funções em hospitais distritais. Discussão e Conclusões: Esta análise dos dois primeiros anos do Estágio de Grupo I pode servir de base para uma discussão alargada que poderá conduzir a um processo de contínua melhoria de condições e eventual introdução de novos elementos num estágio que já demonstrou ser vantajoso para os elementos envolvidos.

Introduction: Due to the high contamination rate and number of cases of the SARS-Cov-2, local authorities decreed the closure of universities and schools, which has forced these institutions to come up with innovative solutions for the continuation of their activities. Objective: The aim of this study is to assess both the impact and level of satisfaction amongst undergraduate students of the online teaching of theoretical anesthesiology as an alternative method to the face-to-face teaching as the latter is currently impaired by the difficulties imposed by the pandemic. Methodology: The teaching method chosen consisted of conducting online classes taught by a specialist using the Microsoft Teams platform. The level of knowledge of the participants was assessed through the application of questionnaires before and after each term of the course. Results: A total of 812 questionnaires were completed, with a significant increase of 41.61% in the average of correct answers (3.94 vs 5.57; p

Purpose of review In this review, we want to collect all the adaptations that anaesthesiology training has faced because of the health crisis and social distancing measures resulting from coronavirus 2019 disease (COVID-19). We reviewed new teaching tools launched during the COVID-19 outbreak worldwide and particularly those implemented by the European Society of Anaesthesiology and Intensive Care (ESAIC) and the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC). Recent findings Globally, COVID-19 has interrupted health services and all aspects of training programmes. These unprecedented changes have led to teaching and trainee support innovation tools, focusing on online learning and simulation programmes. Airway management, critical care and regional anaesthesia, have been enhanced during the pandemic, while there were major obstacles in paediatrics, obstetrics and pain medicine. Summary The COVID-19 pandemic has altered profoundly the functioning of health systems worldwide. Anaesthesiologists and trainees have fought on the front lines of the battle against COVID-19. As a result, training in anaesthesiology during the last 2 years has focused on managing patients in intensive care. New training programmes have been designed to continue teaching residents of this speciality, focusing on e-learning and advanced simulation. It is necessary to present a review describing the impact that this turbulent period has had on the different subsections of anaesthesiology and to review the innovative measures that have been implemented to address these possible deficits in education and training. Sin financiación No data JCR 2021 0.566 Q2 SJR 2022 No data IDR 2021 UEV

Esta apresentação intitulada "Plano de integração do planejamento cirúrgico nas estratégias nacionais gerais de saúde" foi preparada para a Mesa Redonda de Cirurgia Global para o 35º Congresso Brasileiro de Cirurgia, ocorrida em 28 de julho de 2023. Apresentação preparada por Letícia Nunes Campos, acadêmica de medicina da Universidade de Pernambuco e pesquisadora colaborada 2022-2023 pelo Program in Global Surgery and Social Change (Harvard Medical School).

Libro que recoge en 16 capítulos temas como: Historia de la cirugía en Ecuador y en el mundo, Central de Esterilización, Valoración preoperatoria, Buenas prácticas quirúrgicas, Heridas y cicatrización, Infección quirúrgica y antibióticos en cirugía, Manejo de líquidos y electrolitos en pacientes quirúrgicos, Dolor agudo postoperatorio, Complicaciones postoperatorias, Equipo de anestesia, Historia de la anestesiología, Vigilancia del paciente anestesiado, Evaluación anestésica y premedicación e Interacciones farmacológicas en anestesia.

Multimodal analgesia in cardiac surgery sternotomy includes bilateral continuous erector spinae plane block (BC-ESPB). However, the effectiveness of the local anesthetic regimens is still uncertain. The purpose of this study was to assess pain control achieved with a multimodal analgesia regimen including BC-ESPB at the level of T5 with PCA with a 0.125 % bupivacaine infusion and rescue boluses. This is a descriptive case series study which recruited 11 adult patients undergoing cardiac surgery through sternotomy in whom multimodal analgesia including BC-ESPB was used, between February and April 2021, at a fourth level institution. All patients reported pain according to the numeric rating scale (NRS) ≤ 3 both at rest and in motion, at extubation and then 4 and 12 hours after surgery. After 24 hours the pain was NRS ≤ 3 in 100 % of the patients at rest and in 63.6 % in motion. At 48 h 81 % of the patients reported pain NRS ≤ 3 at rest and in motion. At 72h all patients reported pain NRS ≤ 3 at rest and 82 % in motion. The average intraoperative use of fentanyl was 2.35 µg/kg and postoperative hydromorphone was 5.3, 4.1 and 3.3 mg at 24, 48 and 72 hours, respectively. Hence, bilateral ESP block in continuous infusion plus rescue boluses allows for proper control of acute intra and post-operative pain. Resumen En cirugía cardiaca mediante esternotomía, la analgesia multimodal incluye el bloqueo bilateral continuo del plano erector de la espina (BBC-ESP). Sin embargo, existe incertidumbre sobre la efectividad de los esquemas de dosificación del anestésico local. Se busca evaluar el control del dolor proporcionado por un esquema de analgesia multimodal que incluye el BBC-ESP a la altura de T5 con ACP de bupivacaína 0,125 % en infusión y bolos de rescate. Se trata de un estudio descriptivo, serie de casos. Se reclutaron 11 pacientes adultos sometidos a cirugía cardiaca mediante esternotomía en quienes se usó analgesia multimodal que incluía BBC-ESP entre febrero y abril del 2021, en una institución de cuarto nivel. Todos los pacientes refirieron dolor, según la escala numérica (EN) ≤ 3 tanto en reposo como en movimiento, a la extubación, a las 4 y a las 12 horas. A las 24 horas el dolor fue EN ≤ 3 en el 100 % de los pacientes en reposo y en el 63,6 % en movimiento. A las 48 h el 81 % de los pacientes refirieron dolor EN ≤ 3 en reposo y en movimiento. A las 72 h todos los pacientes presentaron dolor EN ≤ 3 en reposo y 82 % en movimiento. El consumo intraoperatorio promedio de fentanilo fue de 2,35 ug/kg y de hidromorfona posoperatoria de 5,3, 4,1 y 3,3 mg a las 24, 48 y 72 horas. Así, el BBC-ESP en infusión continua más bolos de rescate permiten el control del dolor agudo intra y posoperatorio.

The technical standards in anesthesiology govern the professional practice and allow for the provision of safer anesthesia and surgery. This article gives a historical perspective on the creation, main content, and consequences of the implementation of the Peruvian standards in anesthesiology. Resumen Las normas técnicas de anestesiología rigen el ejercicio profesional y permiten ofrecer una anestesia y una cirugía más seguras. El presente artículo brinda una perspectiva histórica sobre la creación, el contenido principal y las consecuencias de la implementación de las normas de anestesiología peruanas.

Law 6 was enacted thirty years ago. Notwithstanding the fact that almost three decades have elapsed, with the exception of the regional and national leaders, many anesthesiologists are unaware of the existence of such law, of its contents or about which are the positive aspects for the specialty and for all anesthesia colleagues. There is a lack of awareness regarding the fact that the oversight committees are a valuable instrument to ensure excellence in the practice of anesthesia. This publication shall contribute to an share an overview of the efforts made to ensure the approval of the Law by the National Congress and of the Law among all anesthesiologists in the country. In this way, all practitioners will become acquainted with the information on the topic to take advantage of the provisions in the Law. Resumen La Ley 6 se promulgó hace treinta años. A pesar de que han pasado tres décadas, salvo los directivos regionales y nacionales, muchos anestesiólogos ignoran su existencia, su contenido o cuáles son los aspectos que han sido positivos para la especialidad y para los colegas. No se conoce que los comités para el control del ejercicio de la profesión sean una herramienta útil para velar por que se realice una práctica con excelencia. Esta publicación va a contribuir a que, ojalá, todos los anestesiólogos del país tengan un conocimiento somero del esfuerzo hecho para lograr su aprobación en el Congreso de la República y sobre la ley. Esto le aportará al gremio la información sobre el tema que les permita aprovechar lo que la ley ofrece.

The importance of breastfeeding with its positive impact on the wellbeing of the mother-infant pair is well established. Anesthesiologists should encourage the promotion of lactation by being willing to give reassurance during the preoperative period and preparing a plan that does not interfere with safe breastfeeding. There is concern regarding the transfer of drugs into breast milk, which may lead to inconsistent advice from many health professionals and to early discontinuation. However, evidence shows that most anesthetic drugs are safe in terms of transfer into breast milk, and hence, compatible with breastfeeding, which should be resumed after anesthesia as soon as the mother is alert and feels well enough to hold her infant, without the need to "pump and dump". This review provides pharmacokinetic information on commonly used anesthesia drugs and their passage into breast milk, to help practitioners discuss risks and benefits with the mother, emphasizing that anesthesia should not interfere with the benefits of breastfeeding. Four practical clinical scenarios are presented: pregnant women concerned about the effect of epidural analgesia on subsequent breastfeeding, spinal anesthesia for c-section and lactation, patients who will receive general anesthesia during cesarean section, and finally women who are breastfeeding and require anesthesia for elective or urgent surgery. Neuraxial anesthesia allows for better pain control and immediate skin-to-skin contact at the time of childbirth. Also, it interferes the least with the woman's ability to care for her infant. Regional techniques, opioid-sparing techniques and outpatient surgery are preferred. Drugs such as opioids and longer-acting benzodiazepines should be administered cautiously, particularly in repeat doses. Resumen La lactancia materna tiene evidentes beneficios para el binomio maternofetal. El anestesiólogo debe ser un agente en la promoción de la lactancia, estar dispuesto a resolver dudas en el preoperatorio y elaborar un plan que no interfiera con su seguridad. Hay preocupación referente a la transferencia de los medicamentos (endovenosos y/o neuroaxiales) hacia la leche, que puede conducir a un consejo inconsistente de muchos profesionales de la salud, lo cual contribuye a la suspensión temprana de la lactancia materna. Sin embargo, existe evidencia de que la mayoría de los medicamentos que se utilizan en la anestesia (general y neuroaxial) son compatibles con la lactancia materna. Se debe iniciar la lactancia materna después de la anestesia tan pronto como la madre esté alerta y se sienta bien, sin necesidad de extraerla y eliminarla. Esta revisión entrega información farmacocinética sobre los medicamentos y técnicas anestésicas comúnmente utilizadas para que los profesionales realicen un balance riesgo-beneficio con la madre, enfatizando que la anestesia no debe interferir con los beneficios de la lactancia. Se presentan cuatro escenarios clínicos prácticos: embarazada preocupada por el efecto de la analgesia peridural en su lactancia posterior, anestesia raquídea para cesárea y efecto en lactancia, pacientes que requieren anestesia general para cesárea y, por último, paciente puérpera que requiere anestesia para cirugía. Las técnicas neuroaxiales permiten un mejor control del dolor y contacto piel con piel precoz en el parto vaginal o cesárea, lo que facilita que la madre inicie la lactancia más rápido. Si el escenario lo permite, se prefieren técnicas regionales, técnicas ahorradoras de opioides y cirugía ambulatoria, teniendo precaución con ciertos opioides y benzodiacepinas de acción larga especialmente ante dosis repetidas.

Introduction: Cognitive load determines working memory ability to store and retain information in long-term memory, thus conditioning learning. Objective: To compare cognitive loads among different simulation activities, including anesthesia and surgery simulation workshops in medical students. Methods: Cross-sectional analytical observational study. Two cognitive load measurement scales (Paas and NASA-TLX) were given to the students after each simulation workshop. Comparisons were made based on the scores derived from the scales. Results: Relevant differences were found in terms of the mental effort assessed by means of the Paas scale, as relates to student rotation order in the airway management workshop, with a greater effort being found in the group that rotated initially in surgery (6.19 vs. 5.53; p = 0.029). The workshop with the highest associated rate of frustration was the airway management workshop. Higher scores were obtained for this workshop in all the items of the NASA-TLX scale, reflecting a higher cognitive load when compared to the others. Conclusions: It was not possible to determine whether higher scores in some of the activities were associated with the inherent difficulty of airway management or the specific workshop design. Consequently, further studies are required to distinguish between those components in order to improve the way learning activities are designed. Resumen Introducción: La carga cognitiva determina la capacidad que tendrá la memoria de trabajo para almacenar y grabar información en la memoria a largo plazo, lo cual condiciona el aprendizaje. Objetivo: Comparar la carga cognitiva entre las distintas actividades de simulación, incluyendo talleres de simulación de anestesiología y cirugía en estudiantes de medicina. Métodos: Estudio observacional analítico tipo corte transversal. Se aplicaron dos escalas de medición de la carga cognitiva (Paas y NASA-TLX) a los estudiantes después de cada taller de simulación. Se realizaron comparaciones de los puntajes obtenidos mediante las escalas. Resultados: Se encontraron diferencias relevantes en cuanto al esfuerzo mental evaluado por la escala de Paas, en relación con el orden de rotación de los estudiantes en el taller de manejo de vía aérea; se encontró mayor esfuerzo en el grupo que rotó primero por cirugía (6,19 vs. 5,53; p = 0,029). El taller con mayores índices de frustración fue el de manejo de vía aérea. Este taller mostró los mayores puntajes en todos los ítems en la escala NASA-TLX, lo que indica una mayor carga cognitiva respecto a los demás. Conclusión: No fue posible diferenciar si los puntajes altos en algunas de las actividades se debieron a la dificultad natural del manejo de vía aérea, o al diseño específico del taller. Por lo que se requieren nuevos estudios que diferencien estos componentes para mejorar el diseño de actividades de aprendizaje.

Objetivo:evaluar la efectividad de la oxigenación suplementaria con FiO2elevada en comparación con la FiO2 convencional para prevenir la infección del sitio quirúrgico.Método:revisión sistemática de eficacia con metaanálisis en cinco bases de datos y portales internacionales. La investigación se guio por la pregunta: ¿Qué tan eficaz es la oxigenación suplementaria con FiO2alta (más del 80%) en comparación con la FiO2 convencional (del 30 al 35%) para prevenir la infección del sitio quirúrgico en adultos?Resultados:se incluyeron quince ensayos clínicos aleatorizados. Aunque todos los subgrupos mostraron un efecto general a favor de la intervención, en las cirugías colorrectales esa relación tenía significancia estadística (I2=10%;X²=4,42; p=0,352).Conclusión:una fracción inspirada de oxígeno superior al 80% durante el perioperatorio en cirugías colorrectales ha demostrado ser eficaz en la prevención de la infección del sitio quirúrgico, reduciendo su incidencia hasta en un 27% (p=0,006). Se sugiere realizar más estudios en grupos de pacientes sometidos a cirugías en otras especialidades, como cardiaca y vascular. Registro PROSPERO: 178453. Objective:to assess the effectiveness of supplemental oxygenation with high FiO2when compared to conventional FiO2 in the prevention of surgical site infection.Method:an effectiveness systematic review with meta-analysis conducted in five international databases and portals. The research was guided by the following question: Which is the effectiveness of supplemental oxygenation with high FiO2(greater than 80%) when compared to conventional FiO2 (from 30% to 35%) in the prevention of surgical site infections in adults? Results:fifteen randomized clinical trials were included. Although all the subgroups presented a general effect in favor of the intervention, colorectal surgeries had this relationship evidenced with statistical significance (I2=10%;X2=4.42; p=0.352). Conclusion:inspired oxygen fractions greater than 80% during the perioperative period in colorectal surgeries have proved to be effective to prevent surgical site infections, reducing their incidence by up to 27% (p=0.006). It is suggested to conduct new studies in groups of patients subjected to surgeries from other specialties, such as cardiac and vascular. PROSPERO registration No.: 178,453. Objetivo:avaliar a efetividade da oxigenação suplementar com FiO2elevada comparada com FiO2 convencional na prevenção de infecção de sítio cirúrgico.Método:revisão sistemática de efetividade com metanálise em cinco bases de dados e portais internacionais. A pesquisa foi norteada pela pergunta: Qual a efetividade da oxigenação suplementar com FiO2elevada (maior que 80%) comparada com FiO2 convencional (de 30 a 35%) na prevenção de infecção de sítio cirúrgico em adultos?Resultados:foram incluídos quinze ensaios clínicos randomizados. Embora todos os subgrupos tenham apresentado um efeito geral a favor da intervenção, as cirurgias colorretais tiveram essa relação evidenciada com significância estatística (I2=10%;X2=4,42; p=0,352).Conclusão:uma fração inspirada de oxigênio maior que 80% durante o período perioperatório em cirurgias colorretais tem se mostrado efetiva para prevenir a infecção de sítio cirúrgico, reduzindo sua incidência em até 27% (p=0,006). Sugere-se a realização de novos estudos em grupos de pacientes submetidos a cirurgias de outras especialidades, tais como cardíacas e vasculares. Registro PROSPERO: 178453.

139 p. Objetivo: Evaluar si existe diferencia en la eficacia del Mesilato de Fentolamina (MF) al usarlo en combinación con diferentes anestésicos locales con vasoconstrictor. De esta manera se pretende evitar los traumas en lengua y labios que con frecuencia se presentan tras el tratamiento bucodental, así como mejorar el confort del paciente al acortar el tiempo de recuperación de los efectos desagradables que provoca la propia anestesia. Material y métodos: Se llevó a cabo un estudio a doble ciego aleatorizado con 90 pacientes divididos en tres grupos correspondientes a tres tipos de anestésicos locales diferentes: lidocaína 2% 1/80000, articaína 4% 1/200000 y bupivacaína 0,5% 1:200000. Se seleccionaron tratamientos a realizar en el maxilar inferior mediante bloqueo anestésico del nervio dentario inferior. Tras la terminación del tratamiento (

Introduction: Spinal anesthesia, one of the main tools in the surgical context, provides great advantages in its use, however, some considerations about possible side effects and complications should be taken into account. Objective: The present study aimed to evaluate the use of spinal anesthesia in several surgical situations, elucidating positive and negative points. Materials and Methods: This is a literature review about the use of spinal anesthesia as an anesthetic procedure. The PICO strategy was used to develop the guiding question. Furthermore, the descriptors "Spinal anesthesia"; "Anesthesia"; "Anesthesiology" were cross-referenced with the National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (SCIELO), Ebscohost, Google Scholar, and Virtual Health Library (VHL) databases. Results and Discussion: A significant portion of the articles indicated a correlation between spinal anesthesia, its positive points, and some possible complications. In addition, other articles addressed general aspects of the theme, such as the use of digital media to obtain information and the correlation between perioperative factors and surgical prognosis. Conclusion: It was possible to see that spinal anesthesia, even with some reservations, is a safe and beneficial procedure to perform surgeries and, consequently, to offer a quality and safe service to the patient. Introducción: La raquianestesia, uno de los principales instrumentos en el contexto quirúrgico, ofrece grandes ventajas en su uso, sin embargo, algunas reflexiones sobre los posibles efectos colaterales y las complicaciones deben tenerse en cuenta. Objetivo: El presente estudio tiene como objetivo evaluar la utilización de la raquianestesia en situaciones quirúrgicas diversas, dilucidando los aspectos positivos y negativos. Materiales y métodos: Se trata de una revisión bibliográfica sobre el uso de la anestesia espinal como procedimiento anestésico. Se utilizó la estrategia PICO para desarrollar la pregunta guía. Además, se utilizaron los descriptores "Spinal anesthesia"; "Anesthesia"; "Anesthesiology" en las bases de datos National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (SCIELO), Ebscohost, Google Scholar y Biblioteca Virtual de Saúde (BVS). Resultados y discusión: Una parte significativa de los artículos indicaba una correlación entre la anestesia espinal, sus aspectos positivos y algunas posibles complicaciones. Además, otros artículos abordaron aspectos generales del tema, como el uso de medios digitales para obtener información y la correlación entre los factores perioperatorios y el pronóstico quirúrgico. Conclusión: Se pudo percibir que la raquianestesia, aunque con algunos resaltados, es un procedimiento seguro y benéfico para la realización de cirugías y, por consiguiente, en la oferta de un servicio de calidad y seguro para el paciente. Introdução: A raquianestesia, uma das principais ferramentas no contexto cirúrgico, fornece grandes vantagens na sua utilização, contudo, algumas ponderações acerca de possíveis efeitos colaterais e complicações devem ser levadas em conta. Objetivo: O presente estudo teve como objetivo avaliar a utilização da raquianestesia em situações cirúrgicas diversas, elucidando pontos positivos e negativos. Materiais e Métodos: Trata-se de uma revisão de literatura acerca do uso da raquianestesia como procedimento anestésico. Utilizou-se a estratégia PICO para a elaboração da pergunta norteadora. Ademais, realizou-se o cruzamento dos descritores “Raquianestesia”; “Anestesia”; “Anestesiologia”, nas bases de dados National Library of Medicine (PubMed MEDLINE), Scientific Eletronic Library Online (SCIELO), Ebscohost, Google Scholar e Biblioteca Virtual de Saúde (BVS). Resultados e Discussão: Uma parcela significativa dos artigos indicou uma correlação entre a raquianestesia, seus pontos positivos e algumas possíveis complicações. Além disso, outros artigos abordaram aspectos gerais sobre a temática, como o uso de mídias digitais para obtenção de informações e a correlação entre fatores perioperatórios com o prognóstico cirúrgico. Conclusão: Foi possível perceber que a raquianestesia, ainda que com algumas ressalvas, é um procedimento seguro e benéfico para a realização de cirurgias e, por consequência, na oferta de um serviço de qualidade e seguro para o paciente.

By November 2021, at the time of preparing this article, the disease caused by the new coronavirus (Coronavirus Disease 2019 - COVID-19), declared as a pandemic by the World Health Organization (WHO) on March 11, 2020, had affected more than 128 million people and claimed upwards of 5 million lives. Many of the patients who suffered from this disease will need elective procedures, and this will require knowledge on how to perform the surgery, what tests to order and the extent of preoperative optimization. The objective of this work was to conduct a narrative review of the current evidence regarding time to the performance of an elective procedure in a patient who suffered from COVID-19, the preoperative tests that need to be ordered, and the degree of clinical optimization required according to the complexity of the surgery and individual patient clinical condition. A search was conducted in the Pubmed/Medline, Science Direct, OVID and SciELO databases, as well as in the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) web-based platforms. Although the evidence is still limited, different scientific societies have issued relevant guidelines pertaining to the timing of an elective procedure after COVID-19 infection. For patients who were asymptomatic, the time is 4 weeks after the initial diagnosis of SARS-CoV-2, whereas for symptomatic patients with a mild to moderate course, the time is at least 7 weeks, and 12 weeks if ICU admission was required. There are no guidelines pertaining to preoperative tests or the degree of clinical optimization, although institutional protocols have been developed based on expert consensus on the topic. Resumen La enfermedad por el nuevo coronavirus COVID-19 (Coronavirus Disease 2019) declarada pandemia por la Organización Mundial de la Salud (OMS) el 11 de marzo de 2020, ha registrado más de 128 millones de casos a escala mundial, con más de cinco millones de muertes a noviembre de 2021, fecha de elaboración de este artículo. Muchos de los pacientes que tuvieron esta enfermedad se someterán a procedimientos electivos, y es necesario saber realizar la cirugía, los exámenes por solicitar y el grado de optimización preoperatoria. El objetivo de este trabajo es elaborar una revisión narrativa de la evidencia actual respecto al tiempo de realización de un procedimiento electivo en un paciente que tuvo COVID-19, los exámenes preoperatorios que se deben solicitar y el grado de optimización clínica según la complejidad de la cirugía y el estado clínico del paciente. Para ello, se realizó una búsqueda en bases de datos (Pubmed/Medline, Science Direct, OVID, SciELO), así como en plataformas web de la Organización Mundial de la Salud (OMS) y los Centers for Diseases Control and Prevention (CDC). Aunque la evidencia aún es limitada, diferentes sociedades científicas han dado pautas relevantes respecto al tiempo de realización de un procedimiento electivo despues de sufrir COVID-19. Para el caso de pacientes que fueron asintomáticos es de 4 semanas después del diagnóstico de infección por SARS-CoV-2, mientras que para pacientes sintomáticos con un curso de la enfermedad leve a moderado es de mínimo 7 semanas, y de 12 semanas si requirió ingreso a cuidados intensivos. No hay guías que orienten en cuanto a la solicitud de exámenes preoperatorios y el grado de optimización clínica, pero sí protocolos institucionales basados en consenso de expertos que abordan esta temática.

Introduction: The methods most frequently used at the present time in Colombia for the administration of general anesthesia are based on halogenated and intravenous drugs. However, in view of the lack of differential clinical outcomes, the existence of cost variations between the two is not clear. Objective: To determine the expected cost of the use of both techniques in patients taken to surgery, within the framework of the Colombian national health system. Methods: A cost minimization study was carried out using the decision tree as the analytical model. A time frame of 6 postoperative hours was used as the assumption. Only direct healthcare-related costs were included using a case study approach. An econometric model was used based on the frequency with which each technology is applied and the type of drug used, and a deterministic and probabilistic sensitivity analysis was performed. Results: For the case study, total intravenous anesthesia (TIVA) is more costly than the inhalational technique, with an incremental cost of $102,718 per patient. The deterministic analysis shows that both the incidence of postoperative nausea and vomiting (PONV) as well as the use of target controlled infusion (TCI) techniques are the main cost determinants. The probabilistic analysis shows that the cost difference can even be nil in more than 50% of the simulated settings, when the difference in the risk of PONV is higher. Conclusions: Although the total intravenous technique can be more costly than the inhalational technique, this difference is offset by a lower cost of the postanesthesia care unit, given the lower risk of postoperative nausea and vomiting. Resumen Introducción: Actualmente, los métodos más usados en Colombia para la administración de anestesia general son las técnicas basadas en halogenados y en medicamentos intravenosos. No obstante, y ante la falta de desenlaces clínicos diferenciales, no es claro si existe una variación en los costos. Objetivo: Determinar el costo esperado del uso de ambas técnicas en pacientes llevados a cirugía bajo la perspectiva del sistema nacional de salud colombiano. Métodos: Se realizó un estudio de minimización de costos. Se empleó el árbol de decisión como modelo analítico. Se asumió un horizonte temporal de 6 horas postoperatorio. Se incluyeron solo los costos sanitarios directos mediante un caso tipo. Se empleó un modelo econométrico basado en la frecuencia de uso de cada tecnología y medicamento empleado y se realizó análisis de sensibilidad determinístico y probabilístico. Resultados: Para el caso tipo, la técnica total endovenosa es más costosa que la técnica basada en halogenados, con un costo incremental de $102.718 por paciente. El análisis determinístico muestra que tanto la incidencia de náuseas y vómito postoperatorio como el uso de tecnologías TCI (targetcontrolled infution) son los principales determinantes de estos costos. El análisis probabilístico muestra que la diferencia de costos puede ser incluso de cero pesos en más del 50 % de los escenarios simulados cuando se tiene una mayor diferencia del riesgo de náuseas y vómito postoperatorio. Conclusiones: Aunque la técnica total endovenosa puede ser más costosa que la basada en halogenados, esto se compensa con un costo inferior en la unidad de recuperación postanestésica debido a un menor riesgo de náuseas y vómito postoperatorio.

Introduction The risk of suicide among anesthesiologists seems to be higher than in other areas of specialization, probably because of the significant stress associated with this specialty, easy access to strong medications and the profound knowledge about the use of these drugs. There is a poor knowledge about the impact of suicide on anesthesiologists in Colombia and the resources available to deal with this situation are limited. Objective This survey is intended to indirectly identify the frequency of suicide among the Colombian anesthesiologists and the experiences associated with the suicide of a colleague. Methods Observational, cross-sectional study based on a survey administered to all the anesthesiologists members of the Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.), at a national scale. Results 403 anesthesiologists completed the survey. Eighty (19.8 %) of the respondents said they were aware of the death of at least one colleague that committed suicide. Most of them are male anesthesiologists or intensivists, and the age group with the highest rate of reports is between 25 - 29 years old in males. The primary causal mechanism was opioid overdose (58.5 %). Conclusions In an indirect characterization of suicide among Colombian anesthesiologists, 99 suicide reports were identified corresponding to 80 anesthesiologists. Suicide is preventable and the worksite should provide the support mechanisms required to identify occupational stress, drug dependence, depression and suicide. Resumen Introducción: El riesgo de suicidio entre anestesiólogos parece ser mayor que el que se presenta en otras especialidades, posiblemente debido al elevado estrés asociado con la especialidad, al fácil acceso a medicamentos potentes y al conocimiento íntimo de cómo usarlos. En Colombia poco se sabe sobre el impacto del suicidio de un colega en un departamento de anestesia y los recursos disponibles para afrontar esta situación. Objetivo: Con esta encuesta se buscó identificar de manera indirecta la frecuencia de suicidio entre anestesiólogos colombianos y las experiencias relacionadas con el suicidio de un colega. Métodos: Estudio observacional de corte transversal de tipo encuesta aplicada a todos los anestesiólogos afiliados a la Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) a escala nacional. Resultados: Se obtuvo respuesta de 403 anestesiólogos. Ochenta (19,8 %) participantes indicaron tener conocimiento de la muerte por suicidio de al menos un colega. La mayoría corresponden a anestesiólogos o intensivistas de sexo masculino, y el grupo etario con mayor número de reportes es el de 25 a 29 años para el sexo masculino. El principal mecanismo causal identificado fue la intoxicación por opioides (58,5 %). Conclusiones: En una caracterización indirecta del suicidio en anestesiólogos colombianos se encontraron 99 informes de suicidio reportados por 80 anestesiólogos. El suicidio es prevenible, en los sitios de trabajo deben existir los mecanismos de apoyo para la identificación del estrés laboral, la farmacodependencia, la depresión y el suicidio.

Este artigo foi redigido como reflexão do atual estado da formação em Anestesiologia em Portugal, assim como possíveis perspetivas para o futuro.&nbsp

Aim: to define the competencies of nurse anaesthetists in the hospitals of Catalonia on the basis of their clinical practice through a consensus-building process. Design: we used the Delphi method to determine consensus among a group of 16 nurse anaesthetists. Methods: between February and June 2020, we administered a questionnaire of 142 questions distributed among seven domains: expert, communicator, collaborator, manager, health advocate, scholar and professional. Two rounds were conducted. Results: in round 1, 18 competencies were discarded and nine had inconclusive results. Eighteen competencies were proposed by participants. The nine competencies with inconclusive results and the 18 newly proposed competencies were considered in round 2. In round 2, three of these 27 competencies tested were discarded, and consensus was reached on the other 24. Conclusion: health education and the empowerment of the patient and family are fundamental pillars in the practice of nurse anaesthetists in Spain, especially in pre-anaesthetic assessment and pain care. These areas of practice can help define competencies in other countries where the profession of nurse anaesthetist is less developed. Impact: the lack of regulation of the competencies of nurse anaesthetists leads to great variability in training and practice. The results can help in their standardization in Spain and in other countries lacking regulation. Our approach can also help policymakers and hospital administrators in health systems that are undergoing the process of regulation. The regulation of the competencies of nurse anaesthetists will allow them to contribute their expertise to the health-illness continuum, increasing safety and improving the quality of care.

Introduction: The SARS-CoV-2 pandemic has led to the cancellation of non-emergent surgeries in order to optimize the use of resources. Once the elective medical services are restored, a technical and ethical strategy becomes critical to select candidate patients for elective surgery. Objective: To describe the results from the implementation of MeNTS (Medically Necessary Time-sensitive Procedures), FI-CGA, and survey on COVID-19 symptoms Scales, as methods for the selection of patients who were candidates for elective surgery during the SARS-CoV-2 pandemic, in a third level institution in Cali, Colombia. Methods: The databases of the results on the administration of MeNTS, frailty index (FI-CGA) and COVID 19 symptoms scales in patients who were candidates for elective surgery in a third level clinic in Cali city, between March 1st and August 31st, 2020 were reviewed. Results: A total of 1,044 patients were included, of which 647 (62.0 %) were females, with a median age of52 years (interquartile range [IQR] 38-62). 98 % of the patients were asymptomatic, the overall median score for MeNTS was 48 (IQR 44-52) and the average for FI-CGA was 0.0 (standard deviation 0.1). Conclusions: MeNTS, FI-CGA and the Symptoms Survey are easily accessible scales amidst the pandemic and are helpful to select patients with intermediate and low risk of perioperative morbidity in elective surgery during the SARS-CoV-2 pandemic. Further studies are required to confirm these findings and to clarify the potential of these tools in the selection of patients that meet the high-risk criteria. Resumen Introducción: La pandemia por SARS-CoV-2 ha ocasionado la suspensión de cirugías no urgentes con el fin de optimizar los recursos. Una vez los servicios médicos electivos son restablecidos, es fundamental disponer de una estrategia técnica y ética para la selección de los pacientes candidatos a cirugía electiva. Objetivo: Describir los resultados observados durante la implementación de las escalas MeNTS (Medically Necessary Time-sensitive Procedures), IF-VIG y Encuesta de síntomas para COVID-19, como métodos de selección de pacientes candidatos a cirugía electiva durante la pandemia por SARS-CoV-2 en una institución de nivel tres en la ciudad de Cali, Colombia. Metodología: Se revisaron las bases de datos de los resultados de la aplicación de escalas de MeNTS, índice de fragilidad (IF-VIG) y los síntomas para COVID 19, en pacientes candidatos a cirugía electiva en una clínica de tercer nivel en la ciudad de Cali, entre marzo 1 y agosto 31 del 2020. Resultados: En total 1.044 pacientes fueron incluidos, de los cuales 647 (62,0 %) fueron mujeres con una mediana de edad de 52 años (rango intercuartil [RIC] 38-62). El 98 % de los pacientes estuvieron asintomáticos, la mediana general de la puntuación total de MeNTS fue 48 (RIC 44-52) y el promedio para IF-VIG fue de 0,0 (desviación estándar 0,1). Conclusiones: MeNTS, IF-VIG y Encuesta de síntomas, son escalas fácilmente accesibles durante tiempos de pandemia y son de utilidad para seleccionar pacientes de riesgo intermedio y bajo de morbilidad perioperatoria en cirugía electiva durante la pandemia por SARS-CoV-2. Se requieren futuros estudios para confirmar estos hallazgos y para clarificar su potencial en la selección de pacientes con criterios que los definan como de riesgo alto.

The deadly triad concept represented a dogma in the definition of poor outcomes and death associated with major bleeding in trauma. This model of end-stage disease was then rapidly transferred to other major bleeding scenarios. However, and notwithstanding the fact that it represented a severe scenario, the original triad fails to establish a sequence, which would be relevant when defining the objectives during the initial treatment of severe bleeding. Likewise, this model admits only one scenario where all the conditions shall co-exist, knowing that each one of them contributes with a different risk burden. Based on a structured review, we propose a pentad model that includes a natural pattern of events occurring with hypoxemia as the main trigger for the development of hypocalcemia, hyperglycemia, acidosis and hypothermia, as surrogates of multi-organ impairment. This severity model of major bleeding considers coagulopathy as a result of the failure to restore the initial components of damage. Resumen El concepto de la tríada mortal significó un dogma en la definición de malos desenlaces y muerte asociados al sangrado mayor en trauma. Este modelo de afectación terminal fue luego rápidamente trasladado a otros escenarios de sangrado mayor. Sin embargo y a pesar de significar un escenario de gravedad, la tríada original falla en adjudicar una secuencialidad, lo cual sería importante a la hora de definir los objetivos durante el tratamiento inicial de la hemorragia grave. De igual forma, solo admite un único escenario en donde deben coexistir todas las condiciones, cuando se sabe que cada una atribuye una carga diferencial de riesgo. A partir de una revisión estructurada proponemos un modelo de pentada que incluye un patrón natural de eventos que se implantan sobre la hipoxemia como principal detonante para el desarrollo de hipocalcemia, hiperglucemia, acidosis e hipotermia como representantes del deterioro en múltiples sistemas. Este modelo de gravedad del sangrado mayor culmina con la coagulopatía como resultante de la falla en la resolución de los demás componentes previos.

Um grupo de investigadores Dinamarqueses testaram um modelo de inteligência artificial (IA) para reconhecer a presença de paragem cardiorrespiratória (PCR) em chamadas de emergência médica direcionadas a uma central de emergência médica de Copenhaga.Mais de 600 000 pessoas por ano sofrem uma paragem cardiorrespiratória (PCR) na Europa e E.U.A..O reconhecimento rápido deste evento, quer seja por uma testemunha presencial ou pelo profissional da central telefónica de emergência médica é um prérequisito para que se possa iniciar Suporte Básico de Vida (SBV), prestar o melhor atendimento, triagem,aconselhamento, selecção e envio de meios de socorro apropriados. info:eu-repo/semantics/publishedVersion