Propuesta de metodología docente en vía aérea difícil. Presentación de un modelo interactivo de cadáver fresco congelado / Proposed difficult airway teaching methodology. Presentation of an interactive fresh frozen cadaver model

Antecedentes y objetivo. El objetivo del trabajo es presentar una metodología basada en el empleo de los cadáveres frescos congelados para el entrenamiento de las habilidades en el tratamiento de la vía aérea y presentar el grado de satisfacción entre los alumnos. Material y métodos. Sobre 6 cadáveres frescos congelados se estructuraron 14 estaciones de trabajo en las que los alumnos entrenaron las diferentes habilidades necesarias para el tratamiento de la vía aérea. Se explican los detalles de preparación de los cadáveres que resultan fundamentales para un adecuado trabajo. Se evaluó el grado de satisfacción de los alumnos mediante la escala de evaluación de Likert de 5 puntos sobre las 14 estaciones, la valoración global y la utilidad clínica del curso. Resultados. La valoración global y la utilidad media del curso fueron de 4,75 y 4,9 sobre 5, respectivamente. Todas las partes del curso fueron valoradas por encima de 4 sobre 5. La elevada satisfacción sobre el curso se mantuvo homogénea en las 2 ediciones analizadas. La satisfacción global del curso no fue definitiva e unívocamente determinada por ninguna de sus partes en especial. Conclusión. El modelo de cadáver fresco para el entrenamiento de los médicos en técnicas de manejo de la vía aérea constituye una propuesta docente satisfactoria para el alumno, y con un realismo que se aproxima al paciente vivo (AU)

Background and objective. The aim of this paper is to present a methodology based on the use of fresh-frozen cadavers for training in the management of the airway, and to evaluate the degree of satisfaction among learning physicians. Material and methods. About 6 fresh-frozen cadavers and 14 workstations were prepared where participants were trained in the different skills needed for airway management. The details of preparation of the cadavers are described. The level of satisfaction of the participant was determined using a Likert rating scale of 5 points, at each of the 14 stations, as well as the overall assessment and clinical usefulness of the course. Results. The mean overall evaluation of the course and its usefulness was 4.75 and 4.9, out of 5, respectively. All parts of the course were rated above 4 out of 5. The high level of satisfaction of the course remained homogeneous in the 2 editions analysed. The overall satisfaction of the course was not finally and uniquely determined by any of its particular parts. Conclusion. The fresh cadaver model for training physicians in techniques of airway management is a proposal satisfactory to the participant, and with a realism that approaches the live patient (AU)

Gestante con hemólisis, enzimas hepáticas elevadas y trombocitopenia: diagnóstico diferencial / Haemolysis, elevated liver enzymes and low platelet count in pregnancy: Differential diagnosis

No disponible

[Proposed difficult airway teaching methodology. Presentation of an interactive fresh frozen cadaver model]. / Propuesta de metodología docente en vía aérea difícil. Presentación de un modelo interactivo de cadáver fresco congelado.

BACKGROUND AND OBJECTIVE: The aim of this paper is to present a methodology based on the use of fresh-frozen cadavers for training in the management of the airway, and to evaluate the degree of satisfaction among learning physicians. MATERIAL AND METHODS: About 6 fresh-frozen cadavers and 14 workstations were prepared where participants were trained in the different skills needed for airway management. The details of preparation of the cadavers are described. The level of satisfaction of the participant was determined using a Likert rating scale of 5 points, at each of the 14 stations, as well as the overall assessment and clinical usefulness of the course. RESULTS: The mean overall evaluation of the course and its usefulness was 4.75 and 4.9, out of 5, respectively. All parts of the course were rated above 4 out of 5. The high level of satisfaction of the course remained homogeneous in the 2 editions analysed. The overall satisfaction of the course was not finally and uniquely determined by any of its particular parts. CONCLUSION: The fresh cadaver model for training physicians in techniques of airway management is a proposal satisfactory to the participant, and with a realism that approaches the live patient.

[Comparative study of two methods for salvaging red blood cells: centrifugation techniques (cell-saver) versus filtration through a 100,000-dalton filter]. / Estudio comparativo de dos métodos de recuperación de hematíes: técnicas de centrifugación (cell-saver) frente a filtración con filtro de 100,000 daltons.

OBJECTIVES: Some loss of blood occurs during blood salvage. We hypothesized that plasmapheresis filtering would damage blood much less than centrifugation techniques do, thereby allowing more red blood cells to be transfused. MATERIAL AND METHODS: Laboratory study in which 16 units of whole donor blood were distributed randomly in two groups and processed either by a conventional "cell-saver" method or by hemofiltration using recirculation through a 100,000 dalton filter. We analysed hemoglobin, hematocrit, free hemoglobin, extracellular potassium, platelets, leukocytes, protein and albumin in whole blood before and after processing, and in the waste bag in each group. RESULTS: The recovery of hemoglobin and red blood cell volume was about 80% with both methods. More free plasma hemoglobin was found in the waste bag with the filtration technique. Hemolysis in processed blood was low, less than 0.1% in both groups. Platelet recovery with conventional centrifugation and filtration was 11 and 49%, respectively. Albumin, total protein and extra-cellular potassium were recovered at a rate of about 20% with the filtration technique, whereas recovery of these elements was minimal with the cell saver method. CONCLUSIONS: Both methods of autotransfusion caused moderate loss of red blood cells and low plasma levels of free hemoglobin in processed blood. Recovery of platelets, albumin, total protein and potassium was better with filtration than with the "cell-saver" method.

[Intramucosal intraoperative gastric pH (pHi) during cardiac surgery] surgery]. / pH intramucoso gástrico (pHi) durante el intraoperatorio de cirugía cardíaca.

OBJECTIVE: To evaluate the monitoring of intramucosal pH (pHi) and standard pH (pHs) during heart surgery with extracorporeal circulation (ECC) and moderate hypothermia. The correlations of pHi and pHs and the postoperative APACHE III score after surgery were analyzed. PATIENTS AND METHODS: Sixteen patients with cardiac output > 0.4 scheduled for coronary bypass surgery, or aortic or mitral valve replacement were studied. Arterial pH (pHa), pHi and pHs were measured and the difference between pHa and pHi was calculated before starting ECC (T0), during ECC and hypothermia (T1) and after termination of ECC (T2). The APACHE III score was recorded 18 h after surgery. RESULTS: No significant differences between the pHi and pHs were observed in these patients. pHi was significantly higher during ECC with hypothermia (T1) than at baseline (T0). pHi and pHs were significantly correlated during the study period. There was no correlation between the APACHE III score in the immediate postoperative period and either pHi or pHs during surgery. CONCLUSION: Periods of splanchnic hypoxia (pHi < 7.32) during heart surgery with moderate hypothermia were not seen in patients with cardiac output > 0.4. pHs is a reliable measurement of pHi. There is no relation between APACHE III scores in the early postoperative period and pHi or pHs levels during surgery.

[Comparative study between thiopental and propofol in short-duration anesthesia]. / Estudio comparativo entre tiopental y propofol en anestesias de corta duración.

In a randomized study, 80 healthy unpremedicated female patients were included. For short gynaecological procedures (curettage) they were anaesthetized with either propofol 2 mg/kg (n = 40) or thiopentone 5 mg/kg (n = 40) in combination with nitrous oxide/oxygen (1/1). Supplementary doses of propofol (25 mg) or thiopentone (50 mg) were given when necessary during the procedure. Propofol caused a significant fall in arterial blood pressure (greater than thiopentone in diastolic pressure) and a decrease in heart rate (thiopentone did not change heart rate). Discomfort on injection was similar in both groups. Recovery times were shorter in propofol group: Patients opened their eyes at 1.3 minutes, were awake at 2.2 minutes and could seat with no help at 5.2 minutes. In the thiopentone group, there was a greater incidence of nausea. Propofol was associated with euphoria, "clear-headedness" and pleasant dreams more than thiopentone. We conclude that propofol is a good alternative to thiopentone in short operative procedures.