[Intraoperative complications of corticosubcortical mapping]. / Complicaciones intraoperatorias del mapeo corticosubcortical.

By looking through our cases and literature, an analysis of the surgical complications derived from direct cerebral stimulation under general anesthesia and local anesthesia and sedation was made. A retrospective descriptive study was performed including patients who were intervened in our centre from 2004 to 2008 and had the cortico-subcortical mapping technique. Common pre-operation variables were as follow: Age, sex, tumor localization and tumor's pathology; On patients intervened while awake, we collected the ASA, BMI and duration of the intervention. Afterwards, variable like epileptic attacks and cerebral edema were included in two groups. In addition, on those awake, respiratory and circulatory complications, local anesthesia toxicity, poor level of sedation, nausea and vomiting, pain and feeling uncomfortable with body posture were collected as well. A total of 20 patients had surgery. 10 of them were operated under local anesthesia and sedation with a mean age of 41 years, mean BMI of 26.8 and a pre-operatory ASA score of I or II ( except one patient with ASA III). The mean time duration of the surgical procedure was 5 hours and 20 minutes. On the other side, 10 patients were intervened with general anesthesia with a mean age of 55 years. There were no cases of cerebral edema in either group, although in 4 patients had epileptic attacks which resolved with cold saline irrigation. Five patients with local anesthesia and sedation did not have any complication, 2 patients showed desaturation episodes without further complications, three manifested hypertension episodes and two signs of feeling uncomfortable with body posture. None of the intra-operatory complications registered interfered wit the overall surgical procedure. This is a safe technique if performed following recommended indications and parameters. Regarding complications, respiratory complications are the most common and the most dangerous, as they can influence in the surgical procedure for difficult cases.

Complicaciones intraoperatorias del mapeo corticosubcortical / Intraoperative complications of corticosubcortical mapping

Mediante una revisión de nuestra casuística y dela literatura analizamos las complicaciones intraoperatoriasderivadas del uso de las estimulaciones cerebralesdirectas bajo anestesia general y anestesialocal y sedación. Se realizó un estudio retrospectivodescriptivo de los pacientes intervenidos (2004-2008)en que se utilizó la técnica del mapeo corticosubcortical.Se determinaron como variables preoperatoriascomunes: edad, sexo, localización tumoral, anatomíapatológica, y en los pacientes operados despiertos, seregistró el ASA, IMC y duración de la intervención.En los dos grupos se constataron la aparición de edemacerebral o crisis comiciales. En los pacientes despiertosse registró además las complicaciones respiratorias,hemodinámicas, toxicidad por anestésico local, nivelinadecuado de sedación, náuseas/vómitos, dolor eincomodidad postural. Bajo anestesia local y sedaciónse operaron 10, de 41 años de edad media, IMC mediode 26,8 y un ASA preoperatorio de I o II . La duraciónmedia de la intervención fue de 5 horas y 20 minutos.Mediante anestesia general se intervinieron 10 pacientes,de 55 años de media. En ningún caso de los dosgrupos se constató edema cerebral, 4 pacientes presentaroncrisis comiciales (autolimitadas con irrigación desuero frío). En 5 pacientes con anestesia local y sedaciónno registramos ninguna complicación, 2 pacientes episodiosde desaturación sin complicaciones, 3 episodiosde hipertensión y 2 incomodidad postural. Ninguna delas complicaciones intraoperatorias que registramosinterfirió en el desarrollo de la cirugía. Es una técnicasegura si se realiza siguiendo las indicaciones y losparámetros recomendados. Las crisis y complicacionesrespiratorias son las complicaciones más frecuentes ya su vez las más temidas, puesto que pueden influir encasos problemáticos en el proceso de la cirugía (AU)

By looking through our cases and literature, ananalysis of the surgical complications derived fromdirect cerebral stimulation under general anesthesiaand local anesthesia and sedation was made. A retrospectivedescriptive study was performed includingpatients who were intervened in our centre from 2004to 2008 and had the cortico-subcortical mapping technique.Common pre-operation variables were as follow:Age, sex, tumor localization and tumor’s pathology; Onpatients intervened while awake, we collected the ASA,BMI and duration of the intervention. Afterwards,variable like epileptic attacks and cerebral edema wereincluded in two groups. In addition, on those awake,respiratory and circulatory complications, local anesthesiatoxicity, poor level of sedation, nausea and vomiting,pain and feeling uncomfortable with body posturewere collected as well. A total of 20 patients had surgery.10 of them were operated under local anesthesia andsedation with a mean age of 41 years, mean BMI of 26.8and a pre-operatory ASA score of I or II ( except onepatient with ASA III). The mean time duration of thesurgical procedure was 5 hours and 20 minutes. On theother side, 10 patients were intervened with generalanesthesia with a mean age of 55 years. There were nocases of cerebral edema in either group, although in 4patients had epileptic attacks which resolved with coldsaline irrigation. Five patients with local anesthesiaand sedation did not have any complication, 2 patientsshowed desaturation episodes without further complications,three manifested hypertension episodes and (..) (AU)

[Problem-based learning in an undergraduate medical school course on anesthesiology, recovery care, and pain management]. / El aprendizaje basado en problemas aplicado a la asignatura de pregrado de anestesiología, reanimación y terapéutica del dolor.

INTRODUCTION: We describe our experience with problem-based learning (PBL) in an undergraduate course in anesthesiology and recovery care. MATERIAL AND METHODS: The study was carried out over 5 consecutive academic years from 2000 through 2005. In total, 168 students took part. PBL was started in seminars in the first 3 years the course was given. In the last 2 years, PBL was used throughout the entire course, which consisted of 12 seminars. At the end, each student evaluated the activities overall, the tutor's intervention, the student's own participation, and the time invested in searching for information and preparing for discussions. RESULTS: In the first 3 years, most students considered they had better assimilated the knowledge presented and that they had participated more. In the last 2 years, assessment of the course overall reached a score of 8.47 (SD, 1.24); of the instructor, 8.84 (0.98); and of student participation, 7.38 (1.29). The students used 2.11 (1.43) hours to search for information and 1.74 (1.14) hours to prepare for discussion. CONCLUSIONS: The medical students' level of satisfaction with and acceptance of PBL in this anesthesiology course were high. The instructor's intervention and student participation were assessed highly. A large amount of time was used for study.

El aprendizaje basado en problemas aplicado a la asignatura de pregrado de Anestesiología, Reanimación y Terapéutica del Dolor / Problem-based learning in an undergraduate medical school course on anesthesiology, recovery care, and pain management

INTRODUCCIÓN: El objetivo de este trabajo es presentarnuestra experiencia con el método de “Aprendizajebasado en problemas” (ABP) en la enseñanza universitariade Anestesiología y Reanimación.MATERIAL Y MÉTODOS: El estudio se realizó durante 5cursos consecutivos desde el 2000 hasta el 2005, y en élparticiparon 168 estudiantes. En los 3 primeros años seinició el ABP con tres seminarios. En los dos últimos elsistema se utilizó para toda la asignatura y consistió en12 seminarios al final de los cuales el alumno tenía queevaluar globalmente la actividad, la intervención deltutor, su propia participación y el tiempo empleado en labúsqueda de la información y en la preparación de ladiscusión.RESULTADOS: En los tres primeros años, la mayor partede los estudiantes consideraron tener una mayor asimilaciónde conocimientos y una mayor participación enclase. En los dos últimos, la valoración global de la asignaturafue de 8,47 ± 1,24 (x ± DS), el papel del tutor 8,84± 0,98 y la participación del alumno de 7,38 ± 1,29. Elnúmero de horas/alumno empleadas en la búsqueda dela información fue de 2,11 ± 1,43 y en la preparación deltema de 1,74 ± 1,14.CONCLUSIONES: El grado de satisfacción y la aceptacióndel ABP por parte de los alumnos de pregrado deAnestesiología son altos. La intervención del tutor y laparticipación del alumno fueron elevadas. El tiempoempleado en el proceso es largo

INTRODUCTION:We describe our experience with problem-based learning (PBL) in an undergraduate course inanesthesiology and recovery care.MATERIAL AND METHODS: The study was carried outover 5 consecutive academic years from 2000 through2005. In total, 168 students took part. PBL was startedin seminars in the first 3 years the course was given. Inthe last 2 years, PBL was used throughout the entirecourse, which consisted of 12 seminars. At the end, eachstudent evaluated the activities overall, the tutor's intervention,the student's own participation, and the timeinvested in searching for information and preparing fordiscussions.RESULTS: In the first 3 years, most students consideredthey had better assimilated the knowledge presentedand that they had participated more. In the last 2years, assessment of the course overall reached a score of8.47 (SD, 1.24); of the instructor, 8.84 (0.98); and of studentparticipation, 7.38 (1.29). The students used 2.11(1.43) hours to search for information and 1.74 (1.14)hours to prepare for discussion.CONCLUSIONS: The medical students' level of satisfactionwith and acceptance of PBL in this anesthesiologycourse were high. The instructor's intervention and studentparticipation were assessed highly. A large amountof time was used for study