The delivery and challenges of Pediatric Anesthesia within the humanitarian sector: Médecins Sans Frontières and Mercy Ships.

Access to healthcare is inequitable. Poverty, natural disasters and war disproportionally effect those most vulnerable, including children. Non-governmental organizations (NGO) hold a vital role in providing pediatric care in these contexts. Here we describe the delivery and challenges of Pediatric Anesthesia with two such non-governmental organizations; Médecins Sans Frontières (MSF) and Mercy Ships. Descriptions of both are followed by case studies.

Wake Up Safe in the USA & International Patient Safety.

Patient safety is the most important aspect of anesthetic care. For both healthcare professionals and patients, the ideal would be no significant morbidity or mortality under anesthesia. Lessons from harm during healthcare can be shared to reduce harm and to increase safety. Many nations and individual institutions have developed robust safety systems to improve the quality and safety of patient care. Large registries that collect rare events, analyze them, and share findings have been developed. The approach, the funding, the included population, support from institutions and government and the methods of each vary. Wake Up Safe (WUS) is a patient safety organization accredited by Agency for Healthcare Research and Quality. Wake Up Safe was established in the United States in 2008 by the Society for Pediatric Anesthesia. The initiative aims to gather data on adverse events, analyze these incidents to gain insights, and apply this knowledge to ultimately reduce their occurrence. The purpose of this review is to describe the patient safety approaches in the USA. Through a national patient safety database WUS. Similar approaches either through WUS international or independent safety approaches have been described in Australia-New Zealand, India, and Singapore. We examine the patient safety processes across the four countries, evaluating their incident review process and the distribution of acquired knowledge. Our focus is on assessing the potential benefits of a WUS collaboration, identifying existing barriers, and determining how such a collaboration would integrate with current incident review databases or systems.

Advances in pediatric perioperative care using artificial intelligence.

PURPOSE OF THIS REVIEW: This article explores how artificial intelligence (AI) can be used to evaluate risks in pediatric perioperative care. It will also describe potential future applications of AI, such as models for airway device selection, controlling anesthetic depth and nociception during surgery, and contributing to the training of pediatric anesthesia providers. RECENT FINDINGS: The use of AI in healthcare has increased in recent years, largely due to the accessibility of large datasets, such as those gathered from electronic health records. Although there has been less focus on pediatric anesthesia compared to adult anesthesia, research is on- going, especially for applications focused on risk factor identification for adverse perioperative events. Despite these advances, the lack of formal external validation or feasibility testing results in uncertainty surrounding the clinical applicability of these tools. SUMMARY: The goal of using AI in pediatric anesthesia is to assist clinicians in providing safe and efficient care. Given that children are a vulnerable population, it is crucial to ensure that both clinicians and families have confidence in the clinical tools used to inform medical decision- making. While not yet a reality, the eventual incorporation of AI-based tools holds great potential to contribute to the safe and efficient care of our patients.

Society for Ambulatory Anesthesia Updated Consensus Statement on Perioperative Blood Glucose Management in Adult Patients With Diabetes Mellitus Undergoing Ambulatory Surgery.

This consensus statement is a comprehensive update of the 2010 Society for Ambulatory Anesthesia (SAMBA) Consensus Statement on perioperative blood glucose management in patients with diabetes mellitus (DM) undergoing ambulatory surgery. Since the original consensus guidelines in 2010, several novel therapeutic interventions have been introduced to treat DM, including new hypoglycemic agents and increasing prevalence of insulin pumps and continuous glucose monitors. The updated recommendations were developed by an expert task force under the provision of SAMBA and are based on a comprehensive review of the literature from 1980 to 2022. The task force included SAMBA members with expertise on this topic and those contributing to the primary literature regarding the management of DM in the perioperative period. The recommendations encompass preoperative evaluation of patients with DM presenting for ambulatory surgery, management of preoperative oral hypoglycemic agents and home insulins, intraoperative testing and treatment modalities, and blood glucose management in the postanesthesia care unit and transition to home after surgery. High-quality evidence pertaining to perioperative blood glucose management in patients with DM undergoing ambulatory surgery remains sparse. Recommendations are therefore based on recent guidelines and available literature, including general glucose management in patients with DM, data from inpatient surgical populations, drug pharmacology, and emerging treatment data. Areas in need of further research are also identified. Importantly, the benefits and risks of interventions and clinical practice information were considered to ensure that the recommendations maintain patient safety and are clinically valid and useful in the ambulatory setting. What Other Guidelines Are Available on This Topic? Since the publication of the SAMBA Consensus Statement for perioperative blood glucose management in the ambulatory setting in 2010, several recent guidelines have been issued by the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE), the Endocrine Society, the Centre for Perioperative Care (CPOC), and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) on DM care in hospitalized patients; however, none are specific to ambulatory surgery. How Does This Guideline Differ From the Previous Guidelines? Previously posed clinical questions that were outdated were revised to reflect current clinical practice. Additional questions were developed relating to the perioperative management of patients with DM to include the newer therapeutic interventions.

Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in adults.

Difficult airway management represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report with updated recommendations for the management of difficult airway in adults. These recommendations were developed based on the consensus of a group of expert anesthesiologists, aiming to provide strategies for managing difficulties during tracheal intubation. They are based on evidence published in international guidelines and opinions of experts. The report underlines the essential steps for proper difficult airway management, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and maintaining arterial oxygenation. Additional strategies for using advanced tools, such as video laryngoscopy, flexible bronchoscopy, and supraglottic devices, are discussed. The report considers recent advances in understanding crisis management, and the implementation seeks to further patient safety and improve clinical outcomes. The recommendations are outlined to be uncomplicated and easy to implement. The report underscores the importance of ongoing education, training in realistic simulations, and familiarity with the latest technologies available.

Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in pediatric care.

Difficult airway management in pediatrics during anesthesia represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report containing updated recommendations for the management of difficult airways in children and neonates. These recommendations have been developed based on the consensus of a panel of experts, with the objective of offering strategies to overcome challenges during airway management in pediatric patients. Grounded in evidence published in international guidelines and expert opinions, the report highlights crucial steps for the appropriate management of difficult airways in pediatrics, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and, paramountly, the maintenance of arterial oxygenation. The report also delves into additional strategies involving the use of advanced tools, such as video laryngoscopy, flexible intubating bronchoscopy, and supraglottic devices. Emphasis is placed on the simplicity of implementing the outlined recommendations, with a focus on the significance of continuous education, training through realistic simulations, and familiarity with the latest available technologies. These practices are deemed essential to ensure procedural safety and contribute to the enhancement of anesthesia outcomes in pediatrics.

Seguridad en anestesiología durante la pandemia por el nuevo coronavirus SARS-CoV-2 / Safety in anesthesiology during the pandemic due to the new SARS-CoV-2 coronavirus

La seguridad en anestesiología puede definirse como la reducción del riesgo de daño innecesario asociado a la atención anestésica a un mínimo aceptable, teniendo en cuenta los conocimientos vigentes, los recursos disponibles y el contexto donde se presenta la atención médica de dicha especialidad. A tales efectos, se describen las medidas de seguridad que se deben tomar en el periodo perioperatorio, elaboradas a partir de las recomendaciones internacionales sobre el tema en cuestión, las cuales resultan de gran utilidad debido a la rapidez con que se ha extendido esta pandemia.

Safety in anesthesiology can be defined as the risk reduction from the unnecessary damage associated with the anesthetic care to an acceptable minimum, taking into account the existing knowledge, the available resources and the context where the medical care of this specialty is presented. To such effects, the security measures that should be taken in the perioperative period are described, that were elaborated taking the international recommendations on the topic in question as a starting point, which are of great utility due to the speed with which this pandemic has expanded.

Deambulación precoz y cefalea pospunción dural en pacientes intervenidos bajo anestesia espinal subaracnoidea / Early ambulation and post-dural puncture headache in patients undergoing spinal anesthesia

Introducción: La historia de la raquianestesia, comenzó el 16 de agosto de 1898, la primera anestesia raquídea de la historia cimentó una de las piedras angulares de la Anestesiología. Más de cien años después y a pesar del desarrollo tecnológico que acompaña la especialidad, aún la anestesia regional es una técnica ampliamente utilizada a nivel mundial, no exenta de complicaciones, donde se destaca la cefalea pospunción dural. Objetivo: Describir la prevalencia y características de la cefalea pospunción dural en pacientes con deambulación, precoz o no, intervenidos bajo anestesia espinal subaracnoidea, para cirugía artroscópica de rodilla. Método: Se realizó un estudio observacional descriptivo en una serie de casos (100), atendidos en el Hospital Militar Central "Carlos J. Finlay", que fueron distribuidos en dos grupos. El grupo I formado por los que deambularon a las 4 horas de la intervención y el grupo II deambuló a las 14 horas. En ambos grupos se había utilizado anestesia raquídea con trocar 25 atraumático del tipo Whitacre. Resultados: En ambos grupos no se reportaron casos de cefalea pospunción dural. Conclusiones: No hubo casos de cefalea pospunción dural en pacientes con deambulación, precoz o no, intervenidos bajo anestesia espinal subaracnoidea para cirugía artroscópica de rodilla(AU)

Introduction: The history of spinal anesthesia, began on August 16, 1898, the first spinal anesthesia in history based one of the cornerstones of anesthesiology. More than a hundred years later and despite the technological development that accompanies the specialty, even regional anesthesia is a technique widely used worldwide, not free of complications, which highlights the dural post-puncture headache. Objective: To describe the prevalence and characteristics of dural post-puncture headache in patients with ambulation, early or not, undergoing subarachnoid spinal anesthesia, for arthroscopic knee surgery. Method: A descriptive observational study was conducted in a series of cases (100), attended at the Central Military Hospital "Carlos J. Finlay", which were divided into two groups. The group I formed by those who wandered at 4 hours after the intervention and group II wandered at 14 hours. In both groups, spinal anesthesia with atraumatic trocar of the Whitacre type was used. Results: In both groups there were no reported cases of dural post-puncture headache. Conclusions: There were no cases of dural post-puncture headache in patients with ambulation, early or not, undergoing subarachnoid spinal anesthesia for arthroscopic knee surgery(AU)

La hemorragia obstétrica en el servicio de Anestesiología del Hospital Dr. Agostinho Neto / Obstetric Hemorrhage in Anesthesia Service at Dr. Agostinho Neto Hospital

Introducción: La hemorragia obstétrica es una de las complicaciones más temidas y una de las principales causas de mortalidad materna. Objetivo: Caracterizar la hemorragia obstétrica en el servicio de Anestesiología y Reanimación del Hospital Dr. Agostinho Neto de Guantánamo. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo en el mencionado servicio de salud desde 2015 - hasta 2017. De un universo de 388 pacientes que tuvieron diagnóstico de morbilidad materna extremadamente grave, la muestra quedó constituida por las diagnosticadas con hemorragia obstétrica (n= 71). Para el procesamiento estadístico se utilizó el porcentaje, la media y la desviación estándar. Resultados: La hemorragia obstétrica se precisó en 18,2 por ciento de las pacientes; de ellas, 0,7 por ciento fallecieron. La edad media de las pacientes fue de 24,2 ± 6,2 años. La edad gestacional fue de 34,2 ± 6,2 años y la estadía en días fue de 5,9 ± 4,2 [IC 95 por ciento 5,3 - 6,5]. La atonía uterina (50,8 por ciento) fue la causa más común de la hemorragia. El 91,5 por ciento de las pacientes presentó inestabilidad hemodinámica, lo que condicionó el uso de altos volúmenes de fluidos y hemoderivados para su reanimación. La coagulación intravascular diseminada fue la causa de muerte fundamental. Conclusiones: La hemorragia obstétrica continúa una causa importante de morbilidad y mortalidad en el mencionado servicio de salud(AU)

Introduction: Obstetric hemorrhage is one of the feared complications and it is one of the main causes of maternal mortality. Objective: To characterize obstetric hemorrhage in the service of Anesthesiology and Reanimation at Dr. Agostinho Neto Hospital in Guantanamo, Cuba from 2015 to 2017. Methods: A descriptive, longitudinal and prospective study was carried out in the aforementioned health service from 2015 to 2017. Three hundred eighty eight (388) patients that had diagnostic of extremely serious maternal morbidity were the universe of this study. The sample was constituted by those diagnosed with obstetric hemorrhage (n = 71). Percentage, mean and standard deviation were used for the statistical analysis. Results: Obstetric hemorrhage occurred in 18.2 percent of the patients. 0.7 percent died. The mean age was of 24.2 ± 6.2 years; the pregnancies age was of 34.2 ± 6.2 years and hospital stay was of 5.9 ± 4.2 [IC 95 percentage 5.3 - 6.5]. Uterine atony (50.8 percent) was the most common cause of the hemorrhage. 91.5 percent of the patients had hemodynamic unsteadiness that conditioned the use of high volumes of fluids and hemoderivates for reanimation. Clotting intravascular was the main cause of death. Conclusions: Obstetric hemorrhage constitutes an important cause of morbidity and mortality in the mentioned health service(AU)

Competencias docentes en entornos virtuales: un reto para la anestesiología cubana / Teaching competences in virtual environments: A challenge for cuban anesthesiology

Introducción: La educación virtual es el proceso de formación desarrollado mediante la incorporación de las tecnologías de la información y las comunicaciones, a través de internet. Para un adecuado desarrollo de este nuevo método pedagógico se necesitan profesores preparados y motivados en ese sentido. Objetivos: Describir los principales aspectos relacionados con el desarrollo de las competencias docentes en los entornos virtuales de aprendizaje. Método: Se realizó un resumen de la información extraída de diferentes fuentes bibliográficas. Desarrollo: El nivel de competencias docentes en los entornos virtuales de aprendizaje se ve afectado por el escaso conocimiento y dominio de las herramientas tecnológicas y la poca motivación. Conclusiones: La presente revisión aporta elementos para trazar una estrategia destinada a mantener una superación profesoral continua en la que se incluya el uso de las de las tecnologías de la información y las comunicaciones(AU)

Introduction: Virtual education is the training process developed through the usage of information and communication technologies, through the Internet. For an adequate development of this new pedagogical method, teachers are needed who are qualified and motivated in that respect. Objectives: To describe the main aspects related to the development of teaching competences in virtual learning environments. Method: A summary was made of the information extracted from different bibliographic sources. Development: The level of teaching competences in virtual learning environments is affected by poor knowledge and mastery of technological tools, as well as by low motivation. Conclusions: This review provides elements to design a strategy aimed at maintaining the continuous improvement of professors including the use of information communication technologies(AU)

Consenso sobre Ecocardiografia transesofágica perioperatória da Sociedade Brasileira de Anestiologia e do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia / Consensus on perioperative transesophageal echocardiography of the Brazilian Society of Anesthesiology and the Department of Cardiovascular Image of the Brazilian Society of Cardiology

A Sociedade Brasileira de Anestesiologia, pelo Núcleo Vida de Ecocardiografia Transesofágica Intraoperatória (ETTI/SBA) juntamente com o Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), fez uma força-tarefa para normatizar a feitura da ecocardiografia transesofágica intraoperatória para os anestesiologistas e ecocardiografistas brasileiros com base nas evidências científicas da Sociedade dos Anestesiologistas Cardiovasculares/Sociedade Americana de Ecocardiografia (SCA/ASE) e da Sociedade Brasileira de Cardiologia

Twitter como herramienta académica en anestesiología / Twitter as an academic tool in anesthesiology

Twitter is a social network that allows, through the construction of an academic profile, to access updated information in anesthesia, interact with world leaders in the field, participate in academic events at distance through the impressions of the attendees, follow the most important journals, be aware of local and national issues, do surveys and publish personal opinions among other utilities.OBJECTIVE: Publicize the social network Twitter as an academic tool in anesthesiology in times where information is within the reach of a mobile phone. MATERIALS AND METHODS: Essay based on information from Pubmed, Google Scholar and unconventional literature. CONCLUSIONS: Twitter is a social network for digital immigrants with academic interest in anesthesia. Turns anesthesiologists into members of a global village based on networking.

Twitter es una red social que permite mediante la construcción de un perfil académico, acceder a información actualizada en anestesia, interactuar con referentes mundiales de la especialidad, participar de eventos académicos a distancia por medio de las impresiones de los asistentes, seguir revistas de impacto, estar al tanto de información gremial tanto local como nacional, hacer encuestas, publicar opiniones y experiencias personales. OBJETIVOS: Dar a conocer la red social Twitter como herramienta académica en anestesiología en tiempos en los que la información está al alcance de un teléfono móvil. METODOLOGÍA: Ensayo basado en información de bases de datos Pubmed y Google Scholar, y en literatura no convencional. CONCLUSIONES: Twitter es una red social para inmigrantes digitales con interés académico en anestesia. Convierte a los anestesiólogos en miembros de una red de trabajo, basado en el aprendizaje colaborativo.

Anestesia y manejo peri-operatorio del paciente quemado / Anesthesia and perioperative handling of burned patients / Anestesia e manejo perioperatório do paciente queimado

Introducción: Los pacientes quemados son un reto para el anestesiólogo, el cirujano plástico y el médico general, quien es el primer implicado en su atención. El manejo especializado y cuidadoso de los pacientes mejora su morbi- lidad y disminuye su mortalidad. Objetivo: El articulo revisa los retos que enfrenta el anestesiólogo en el paciente con quemaduras como la dificultad para el monitoreo, la vía aérea difícil, las grandes pérdidas sanguíneas, el manejo del dolor y el trabajo en equipo. Se hace una actualización de la literatura y se presenta la experiencia de la Unidad de quemados del Hospital Simón Bolívar de Bogotá. Método: Se hizo una búsqueda bibliográfica no sistemática de la literatura actual en las bases de datos de Pubmed, Lilacs y Bireme y se consultaron las estadísticas del servicio de quemados del Hospital. Resultados: Se presentan los datos estadísticos de los últimos 20 años del servicio y se desarrolla el contenido de la revisión en varios apartes incluyendo fisiopatología, resucitación inicial, monitoreo, manejo intraoperatorio y manejo del dolor. Conclusión: El manejo anestésico y peri-operatorio del paciente quemado es un reto para el anestesiólogo, el cirujano y el médico tratante, requiriendo un conocimiento básico sobre la fisiopatología y el manejo inicial del paciente. Igualmente debemos tener las habilidades necesarias en el manejo de la vía aérea complicada y la hemorragia intra- operatoria. El manejo de estos pacientes en unidades especializadas mejora su mortalidad.

Introduction: Burned patients are a challenge for anesthe- siologists, plastic surgeon and general practitioner, who is the first involved in your care. The specialized and careful management of patients improves morbidity and mortality decreases. Objective: The article reviews the challenges facing the anesthesiologist in patients with burns as difficulty monitoring, difficult airway, large blood loss, pain management and teamwork. an update of the literature is made and the experience of the burn unit of Simon Bolivar Hospital in Bogota is presented. Method: It was a non-systematic literature search of current lite- rature in the databases PubMed, Lilacs and Bireme and service statistics burned Hospital was consulted. Results: The statistical data of the last 20 years of service are presented and the content of the review is carried out in several asides including pathophysiology, initial resus- citation, monitoring, intraoperative management and pain management. Conclusion: The anesthetic manage- ment and perioperative burn patient is a challenge for the anesthesiologist, surgeon and physician, requiring a basic understanding of the pathophysiology and initial mana- gement of the patient. We must also have the necessary skills in handling the difficult airway and intra-operative bleeding. The management of these patients in specia- lized units improves mortality.

Introdução: Os pacientes queimados são um grande desafio para o anestesista, o cirurgião plástico e o médico geral, primeiro em fazer o atendimento. O manejo especializado e cuidadoso dos pacientes melhora a morbilidade e diminui a mortalidade. Objetivo: O artigo faz uma revisão dos desafios que enfrenta o anestesista no atendimento do paciente com queimaduras, tais como a dificuldade para o controle, a difícil via aérea, as grandes perdas sanguíneas, alivio da dor e trabalho em equipe. Apresenta-se uma atualização na literatura a este respeito e se descreve a experiência da Unidade de Queimados do Hospital Simón Bolivar de Bogotá. Método: Realizou-se a busca bibliográfica da literatura atualizada nas seguintes bases de dados: Pubmed, Lilacs e Bireme, além disso foram consultadas as estadísticas do serviço de queimados do mencionado Hospital em Bogotá. Resultado: Apresentam-se dados estadísticos dos últimos vinte anos do serviço, como também a literatura incluindo fisiopatologia, ressuscitação inicial, monito-reio, manejo intraoperatório e alivio da dor. Conclusão: O manejo anestésico e perioperatório do paciente com queimaduras nas unidades especializadas é importante para diminuir mortalidade. A apresenta grandes desafios o manejo inicial do paciente para o anestesista, cirurgião e médico tratante, pois requer conhecimentos básicos da fisiopatologia e manejo inicial do paciente. Especial-mente cuidadoso deve ser o manejo da via aérea difícil e hemorragia intra operatória.

Perioperative anaphylaxis / Anafilaxia perioperatória / Anafilaxia perioperatoria

Anaphylaxis remains one of the potential causes of perioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed.

A anafilaxia continua sendo uma das causas potenciais de morte perioperatória, pois geralmente não é prevista e evolui rapidamente para uma situação ameaçadora da vida. Uma revisão da anafilaxia perioperatória é feita.

La anafilaxia sigue siendo una de las causas potenciales de muerte perioperatoria por ser generalmente no anticipada, y progresar rápidamente a una situación amenazante de la vida. Se realiza una revisión de la anafilaxia perioperatoria.