Estimación del dolor durante el perioperatorio: Una revisión narrativa de los dispositivos disponibles / Estimative pain measurement during perioperative period: a review of current available devices

Pain is a complex subjective organic function which is influenced by sensorial, emotional, cognitive and behavioral elements. Despite the wide offer of pain measurement devices in the perioperative period, none of them is completely validated for their transverse use in the anesthetic practice. The aim of this review is to present the existing devices for objective pain evaluation during the perioperative period along with the scientific evidence supporting each of them. Articles from the PubMed/MEDLINE literature search engine were reviewed. As result, 37 articles were selected due to its relevance, from which 13 pain assessment devices were described, regarding its clinical relevance as well as the amount of scientific evidence found. Among them are ANI, NOL, pupillometry, qNOX, and others. The nociceptive measurement performed by most of these is based mainly on the evaluation of the autonomic nervous system activity and variations of the electroencephalographic signal. However, it is not possible to recommend any particular device. This review aims to offer a broad overview of the available options in order to estimate the role that each of them could play in clinical anesthesiology practice.

El dolor es una experiencia subjetiva compleja en la que inciden elementos sensoriales, emocionales, cognitivos y conductua- les. A pesar de una amplia oferta de dispositivos para medir dolor en el perioperatorio, hoy no existe un instrumento de medición de analgesia validado y utilizado transversalmente en la práctica anestésica. El objetivo de esta revisión es presentar las actuales opciones disponibles para la medición del dolor agudo utilizadas en el período perioperatorio junto con la evidencia científica que respalda cada una de ellas. Se realizó una revisión de la literatura utilizando como fuente de búsqueda bibliográfica la base de datos MEDLINE/pubMed utilizando términos MESH. Como resultado, se seleccionaron 37 artículos de acuerdo a su importancia, a partir de los cuales se describen 13 dispositivos de valoración nociceptiva, a propósito de su relevancia clínica como también por la cantidad de evidencia científica encontrada. Entre ellos destacan ANI, NOL, pupilometría, qNOX, entre otros. La medición nociceptiva realizada por la mayoría de estos se basa principalmente en la evaluación de la actividad del sistema nervioso autónomo y variaciones de la señal electroencefalográfica. Sin embargo, no es posible recomendar algún dispositivo en particular. Esta revisión pretende ofrecer una visión amplia de las opciones disponibles con el fin de estimar el rol que cada uno de ellos podría desempeñar en la práctica clínica anestesiológica.

Percepción del dolor durante el trabajo de parto. Una revisión de los factores involucrados / Pain perception during labor. A review of factors

The pain experimented by women during the labor is considered as one of the most important, significative and stressing events in the life of a woman. It is widely known than labour is the caused of severe pain. Our purpose is to review the aspects related to the experience of acute pain of patients in labor, related to the normal physiology in this process and to describe different variables that can modify it. From the evidence we conclude that perception of pain is subjective and variable, and it is influenced or modified for multiple factors, by past living experiences or transmitted through generations, by socio-cultural environment and individual expectative in front of this event, also by psychological, clinical, biochemical and genetic factors that predispose to experience a different perception of its severity. This information seems relevant to us for a better comprehension of pain during the labor and for developing strategies that would allowed a relief in a more effective way helping the maternal-fetal welfare and a better experience of maternity, especially during labor.

El dolor experimentado por mujeres durante el trabajo de parto es considerado uno de los eventos más importantes, significativos e intensos en la vida de una mujer. Es ampliamente conocido que el trabajo de parto es causa de un dolor severo. Nuestro propósito es revisar los aspectos relacionados a la experiencia del dolor agudo en las pacientes en trabajo de parto, en cuanto a la fisiología normal de este proceso y describir diferentes variables que pueden modificarlo. Desde la revisión bibliográfica concluimos que la percepción del dolor es subjetiva y variable, y está influenciada o modificada por múltiples factores, por las experiencias pasadas vividas o transmitidas entre generaciones, por el entorno sociocultural y las expectativas individuales ante este evento, también por factores psicológicos, clínicos, bioquímicos y genéticos que predisponen a experimentar una percepción diferente en cuanto a su severidad y significado. Esta información nos parece relevante para una mejor compresión del dolor en el parto y para desarrollar estrategias que permitan su alivio de manera más efectiva, contribuyendo al bienestar materno-fetal y a una mejor experiencia de la maternidad, especialmente durante el trabajo de parto.

Huella de carbono en el Hospital Base de Puerto Montt / Measurement of the carbon footprint at a regional hospital

Background: Measuring the carbon footprint (CF) makes it possible to estimate the contribution of clinical activity to global warming. Aim: To measure the emitter components of CO2 equivalents (CO2e) at the Hospital Base, Puerto Montt (HBPM). Material and methods: Descriptive study with data collected retrospectively between January and December 2016 from the HBPM database. The data analyzes direct and indirect emissions as well as other indirect emissions beyond the organizational limits. Results: Of the 9,660.3 tons of CO2e emitted by the HBPM in 2016, 46% were derived from consumption of electricity, 29% derived from the generation of residues, and 10% from clinical gas consumption, of which Sevoflurane was the greatest contributor. Conclusions: Clinical gases are a significant source of CO2e emissions. Sevoflurane alone is in fourth place in CO2e emissions at the HBPM. Estimating the CF produced by HBPM is the first step in the discussion of measures to reduce the environmental impact of our activity.

Seguridad en Anestesia. Un checklist entre los Anestesiólogos en Chile / Safety in Anesthesia. A checklist of Anesthesiologists in Chile

Aim: To describe the knowledge of the country's anesthesiologists about perioperative safety protocols in order to contribute information to the discussion of a general system for the registration and analysis of incidents as part of the implementation of the Helsinki Declaration on Patient Safety in Chile. Materials and Methods: The information was obtained through 100 surveys sent anonymously to members of the Chilean Society of Anesthesiology, which were answered voluntarily. Results: 89 anesthesiologists responded to the survey. 30% are familiar with the Helsinki Declaration. The most established protocols in their clinical centers were infection control (78%), malignant hyperthermia (72%) and drug monitoring (70%). By contrast, the protocols for massive hemorrhage, local anesthetic toxicity and anaphylaxis are observed to a lesser degree. The inclusion of an annual report on mortality and morbidity was recorded in 35% and an annual report on measures taken and outcomes obtained in the improvement of patient safety was only 23%. Conclusions: A low level of knowledge of the Helsinki Declaration is found among the anesthesiologists of the SACH. Not all its protocols are widely implemented, which makes it necessary to develop a policy to assess the development and impact of this Declaration in Chile. It is urgent to strengthen a national registration system to correct behaviors and thus strengthen perioperative safety to the benefit of our patients.

Objetivo: Describir el conocimiento de los anestesiólogos del país acerca de los protocolos de seguridad perioperatorios, para aportar información en la discusión de un sistema general de registro y análisis de incidentes, en el marco de la implementación de la declaración de Helsinki sobre la seguridad del paciente en nuestro país. Material y Método: La información se obtuvo a través de 100 encuestas enviadas de anónimamente a miembros de la sociedad chilena de anestesiología, la que fue respondida de forma voluntaria. Resultados: Contestaron la encuesta 89 anestesiólogos. Un 30% conoce la Declaración de Helsinki. Los protocolos más establecidos en sus centros clínicos fueron el control de infecciones (78%) Hipertermia maligna (72%) y control de fármacos (70%). Al contrario, los protocolos de hemorragia masiva, intoxicación por anestésicos locales y anafilaxia se observan en menor porcentaje. La realización de un informe anual de mortalidad y morbilidad se consignó en un 35% y un reporte anual de medidas tomadas y de resultados obtenidos en la mejora de la seguridad del paciente fue de sólo un 23%. Conclusiones: Se observa un bajo nivel de conocimiento de la declaración de Helsinki entre los anestesiólogos de la SACH. No todos sus protocolos están ampliamente implementados, lo que se hace necesario desarrollar una política de evaluación del desarrollo e impacto de esta declaración en nuestro país. Es imperioso fortalecer un sistema nacional de registro para corregir conductas, y de esta forma fortalecer la seguridad en el perioperatorio en beneficio de nuestros pacientes.

Función renal en cirugía cardíaca con circulación extracorpórea: Pacientes valvulares y coronarios / Renal function during cardiac surgery with extracorporeal circulation

Background: Patients with valvular heart disease are at high risk of acute renal failure after surgery with extracorporeal circulation. Aim: To describe changes in renal function parameters during surgery with extracorporeal circulation in patients with valvular heart disease and compare them with those found in patients undergoing elective coronary surgery Material and Methods: Two groups of patients were studied. Group 1 was composed by twelve patients undergoing elective coronary surgery and group 2 was composed by eleven patients undergoing surgery for heart valve replacement. Glomerular filtration rate and effective renal plasma now were estimated from inulin and the 131 I-hippuran clearance respectively, at five different times, during surgery and the postoperative period. Sodium filtration fraction and fractional excretion were calculated. Alpha and pi-glutathione s-transferase in urine were measured as markers of tubular damage in the pre and postoperative periods. Results: Effective renal plasma flow was reduced in both groups before induction of anesthesia, did not change during surgery and decreased significantly in patients with valvular disease in the postoperative period. Glomerular filtration rates were normal during all the study period. There was a non significant reduction of filtration fraction during extracorporeal circulation. Alpha and pi glutathione s-transferases were normal and did not change. Fractional excretion of sodium increased significantly postoperatively Conclusions: In patients with valvular disease undergoing surgery with extracorporeal circulation, renal function does not deteriorate. No significant difference was found when compared with patients undergoing coronary surgery. No evidence of functional and cellular renal disfunction or damage was found in both study groups.

Anestesia y cirugía en revascularización coronaria en un paciente trasplantado cardiaco: reporte de un caso / Anesthesia and coronary revascularization surgery in a cardiac transplanted patient: a case report

Dado el aumento de la sobrevida de los pacientes trasplantados cardiacos es cada vez más frecuente que se sometan a otras cirugías, tanto cardíacas, como no cardíacas. En este artículo se presenta un caso clínico de un paciente trasplantado cardíaco sometido a una cirugía de revascularización coronaria, y posteriormente una revisión de la literatura y discusión del caso.