Retrospective observational study on safety of sedation for colonoscopies in ASA I and II patients performed by a nurse and under the supervision of anesthesiology.

INTRODUCTION: Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol: NAAP) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. OBJECTIVE: The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion (TCI) of propofol in colonoscopies supervised by anaesthesiologists. MATERIAL AND METHODS: Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1-5, and pain was assessed on a numerical verbal scale of 1-5. RESULTS: A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. CONCLUSION: Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.

Estudio observacional retrospectivo sobre la seguridad de la sedación para colonoscopias en pacientes ASA I y II realizada por enfermería y tutelada por anestesiología / Retrospective observational study on safety of sedation for colonoscopies in ASA I and II patients performed by a nurse and under the supervision of anesthesiology

Introducción: La sedación con propofol por no anestesiólogos es una práctica creciente en áreas fuera de quirófano resultado del incremento de procedimientos diagnóstico-terapéuticos mínimamente invasivos que precisan sedación y de la dificultad de los servicios de anestesiología para responder adecuadamente a esta demanda. Objetivo: El objetivo principal de este estudio es valorar la seguridad de un programa de sedación para colonoscopias administrada por enfermería formada y tutelada por anestesiólogos, aplicando un protocolo de sedación con sistemas Target Controlled Infusion. Material y métodos: Durante un periodo de 6 meses se incluyeron en el estudio todos los pacientes ASA I y II que precisaron la realización de una colonoscopia programada y cumplían los criterios de inclusión. Se realizaron 381 colonoscopias. En el procedimiento se analizaron los episodios de desaturación, hipo- o hipertensión, bradicardia o taquiarritmia y la necesidad de asistencia por anestesiología. Tras el procedimiento se evaluó en una escala de 1 a 5 el nivel de satisfacción y el dolor mediante escala verbal numérica de 0 a 10. Resultados: El 5% de los pacientes presentó una saturación de oxígeno menor del 90% sin requerir ventilación con máscara; el 7,35% presentó hipotensión, el 3,94% bradicardia y fue necesario consultar al anestesiólogo responsable en el 22% de los casos. El grado de satisfacción alcanzado por los pacientes al final del proceso fue de 4,27 sobre 5. Conclusión: La sedación durante colonoscopias, en pacientes ASA I y II, siguiendo un protocolo consensuado puede ser administrada de forma segura por personal de enfermería tutelado por anestesiología.(AU)

Introduction: Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. Objective: The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion of propofol in colonoscopies supervised by anaesthesiologists. Material and methods: Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1 to 5, and pain was assessed on a numerical verbal scale of 1 to 5. Results: A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. Conclusion: Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.(AU)

Efectos adversos y complicaciones de la infusión intestinal continua de levodopa-carbidopa en una cohorte de pacientes con enfermedad de Parkinson de un hospital terciario / Adverse effects and complications of continuous intestinal infusion of levodopa-carbidopa in a cohort of patients with Parkinsons disease in a tertiary hospital

Introducción: La infusión intestinal continua de levodopa/carbidopa (IICLC) es un tratamiento de segunda línea indicado en fases avanzadas de la enfermedad de Parkinson (EP). Para su implantación se debe realizar una gastrostomía endoscópica percutánea. Objetivos: El objetivo principal ha sido describir la frecuencia y las características de los efectos secundarios asociados a este tratamiento. Como objetivo secundario se han analizado las características epidemiológicas y clínicas de pacientes afectos de EP que han recibido o reciben tratamiento con IICLC. Pacientes y métodos: Estudio descriptivo, unicéntrico y retrospectivo para una muestra consecutiva de pacientes con EP tratados con IICLC desde principios de 2006 hasta finales de agosto de 2021. Resultados: Se han analizado 81 planificaciones. El éxito del tratamiento (duración mayor de 12 meses) se alcanzó en el 78,1% (n = 50) de los pacientes en los que se disponía de ese período de seguimiento. La duración media del tratamiento fue de 35 meses. El 58,6% de los pacientes presentó algún tipo de complicación. Se notificaron 43 complicaciones leves y 16 complicaciones graves. Conclusión: La constitución de un equipo multidisciplinar experimentado es fundamental para garantizar un manejo y seguimiento adecuado de estos pacientes.(AU)

Introduction: Continuous intestinal infusion of levodopa/carbidopa is a second-line treatment indicated in advanced stages of Parkinson’s disease (PD). For its implantation, a percutaneous endoscopic gastrostomy must be performed. Objectives: The main objective has been to describe the frequency and characteristics of the side effects associated with this treatment. As a secondary objective, we have analyzed the epidemiological and clinical characteristics of the PD patients who have received this treatment in our hospital. Patients and methods: Descriptive, single-center, retrospective study for a consecutive sample of PD patients treated with Continuous intestinal infusion of Levodopa/Carbidopa from the beginning of 2006 to the end of August 2021. Results: 81 treatment planifications have been analyzed. Treatment success (duration greater than 12 months) was achieved in 78.1% (n = 50) of the patients in whom this follow-up period was available. The median duration of treatment was 35 months. 58.6% of the patients presented some type of complication. A total of 43 minor complications and 16 serious adverse events were reported. Conclusion: The constitution of an experienced multidisciplinary team is essential to guarantee the adequate management and follow-up of these patients.(AU)

[Adverse effects and complications of continuous intestinal infusion of levodopa-carbidopa in a cohort of patients with Parkinson's disease in a tertiary hospital]. / Efectos adversos y complicaciones de la infusión intestinal continua de levodopa-carbidopa en una cohorte de pacientes con enfermedad de Parkinson de un hospital terciario.

INTRODUCTION: Continuous intestinal infusion of levodopa/carbidopa is a second-line treatment indicated in advanced stages of Parkinson's disease (PD). For its implantation, a percutaneous endoscopic gastrostomy must be performed. OBJECTIVES: The main objective has been to describe the frequency and characteristics of the side effects associated with this treatment. As a secondary objective, we have analyzed the epidemiological and clinical characteristics of the PD patients who have received this treatment in our hospital. PATIENTS AND METHODS: Descriptive, single-center, retrospective study for a consecutive sample of PD patients treated with Continuous intestinal infusion of Levodopa/Carbidopa from the beginning of 2006 to the end of August 2021. RESULTS: 81 treatment planifications have been analyzed. Treatment success (duration greater than 12 months) was achieved in 78.1% (n = 50) of the patients in whom this follow-up period was available. The median duration of treatment was 35 months. 58.6% of the patients presented some type of complication. A total of 43 minor complications and 16 serious adverse events were reported. CONCLUSION: The constitution of an experienced multidisciplinary team is essential to guarantee the adequate management and follow-up of these patients.

TITLE: Efectos adversos y complicaciones de la infusión intestinal continua de levodopa-carbidopa en una cohorte de pacientes con enfermedad de Parkinson de un hospital terciario.Introducción. La infusión intestinal continua de levodopa/carbidopa (IICLC) es un tratamiento de segunda línea indicado en fases avanzadas de la enfermedad de Parkinson (EP). Para su implantación se debe realizar una gastrostomía endoscópica percutánea. Objetivos. El objetivo principal ha sido describir la frecuencia y las características de los efectos secundarios asociados a este tratamiento. Como objetivo secundario se han analizado las características epidemiológicas y clínicas de pacientes afectos de EP que han recibido o reciben tratamiento con IICLC. Pacientes y métodos. Estudio descriptivo, unicéntrico y retrospectivo para una muestra consecutiva de pacientes con EP tratados con IICLC desde principios de 2006 hasta finales de agosto de 2021. Resultados. Se han analizado 81 planificaciones. El éxito del tratamiento (duración mayor de 12 meses) se alcanzó en el 78,1% (n = 50) de los pacientes en los que se disponía de ese período de seguimiento. La duración media del tratamiento fue de 35 meses. El 58,6% de los pacientes presentó algún tipo de complicación. Se notificaron 43 complicaciones leves y 16 complicaciones graves. Conclusión. La constitución de un equipo multidisciplinar experimentado es fundamental para garantizar un manejo y seguimiento adecuado de estos pacientes.

Dielectric characterization of healthy and malignant colon tissues in the 0.5-18 GHz frequency band.

Several reports over the last few decades have shown that the dielectric properties of healthy and malignant tissues of the same body organ usually show different values. However, no intensive dielectric studies of human colon tissue have been performed, despite colon cancer's being one of the most common types of cancer in the world. In order to provide information regarding this matter, a dielectric characterization of healthy and malignant colon tissues is presented. Measurements are performed on ex vivo surgery samples obtained from 20 patients, using an open-ended coaxial probe in the 0.5-18 GHz frequency band. Results show that the dielectric constant of colon cancerous tissue is 8.8% higher than that of healthy tissues (p = 0.002). Besides, conductivity is about 10.6% higher, but in this case measurements do not have statistical significance (p = 0.038). Performing an analysis per patient, the differences in dielectric constant between healthy and malignant tissues appear systematically. Particularized results for specific frequencies (500 MHz, 900 MHz, 2.45 GHz, 5 GHz, 8.5 GHz and 15 GHz) are also reported. The findings have potential application in early-stage cancer detection and diagnosis, and can be useful in developing new tools for hyperthermia treatments as well as creating electromagnetic models of healthy and cancerous tissues.

Insertion of self-expanding metal stent for treatment of malignant obstruction in a pregnant woman.

Colorectal cancer (CRC) is the second most frequent cancer both in incidence and mortality in women, especially in those over 60 years of age. Diagnosis in women at gestational age is rare, so its incidence during pregnancy is low. However, an increase in its diagnosis is expected during the next years because of the raise in the average age of pregnancy.In most cases, the diagnosis is delayed because symptoms related to CRC can be attributed to pregnancy itself. Up to 30 % of CRC cases may present as an intestinal obstruction. In this situation, the main objective is to solve the clinical emergency in the safest way for mother and fetus, together with performing an accurate diagnostic approach to offer the best possible therapeutic management knowing the limitations and difficulties related to pregnancy. The self-expanding metallic stent (SEMS) can be particularly useful in colon obstruction in a pregnant patient with CRC because it allows solving the acute condition providing time to perform a more accurate staging study and to prepare the patient for surgery, thus reducing both post-surgical morbidity and mortality.We report on the case of a patient who early in the second trimester of pregnancy presented with an acute colonic obstruction due to CRC which was successfully managed with the placement of a self-expanding metal stent.