Anaesthesia praCtice for Caesarean dElivery Snapshot Study (ACCESS): Protocol and baseline characteristics of registered centres.

BACKGROUND: Specific guidelines to manage caesarean delivery anaesthesia are lacking. A European multicentre study, ACCESS investigates caesarean delivery anaesthesia management in European centres. In order to identify ACCESS participating centres, a registration survey was created. OBJECTIVE: The aim of the current report is to describe the characteristics of ACCESS study participating centres, the rationale for the ACCESS study and the study methodology. DESIGN AND SETTING: The ACCESS study is a European multicentre cross-sectional study to describe anaesthesia management for caesarean delivery (CD) using a snapshot (2-week) design. The ACCESS registration survey gathered: contact details for National Coordinators (NC); Lead Investigators (LI) per centre; centre annual CD volume; expected no. of CD during 2-week snapshot window; centre practice information; data collection language. The ACCESS registration survey was launched July 2022 (Google Forms, Google Inc., Mountain View, CA, USA) and distributed through personal connections, national and international societies, social media networks, during Euroanaesthesia 2023, through the European Society of Anaesthesiology and Intensive Care newsletter. RESULTS: The ACCESS registration survey identified Lead Investigators for 418 centres, in 32 countries, representing an anticipated number of 15,073 CD cases over the planned 12-month study period. A median (range) of 20 (2 to 400) CD cases are anticipated per centre during the 2-week snapshot window. Most 366/418 (87.6%) centres are small, ≤2000 annual CD cases, 42 are medium 2000-5000 cases and 10 are large, ≥5000 annual CD cases. Registered centres reported in 134 (32.0%) centres that anaesthesia for caesarean delivery is performed mostly by a specialist obstetric anaesthesiologist. CONCLUSION: The ACCESS registration survey revealed variability in volume and CD practice as well as training-levels and staffing among European countries. The ACCESS study (https://www.access-study.org/) aims to generate practice data to guide CD anaesthetic management strategies.

Obstetric anaesthesia manpower and service provision issues (introduction and European perspective).

Global health is an important and far-reaching concept in which health and access to surgical and anaesthetic care is crucial. Universal access to anaesthesia is a challenge in many countries. Manpower shortages are an important cause of difficulties and each European country has found different ways of facing a lack of healthcare professionals. In obstetric anaesthesia, the availability of competent anaesthesiologists has been related to the morbidity and mortality outcomes of patients. In this narrative review, authors from different European countries explain how manpower is managed in obstetric anaesthesia in delivery suites and obstetric operating rooms in different settings. To address manpower difficulties and issues, the goals are to achieve a minimum standard of care and at the same time, to promote clinical excellence through training, delegation to younger or less experienced colleagues, direct or at-a-distance supervision, or other means. The experience of sharing knowledge about the way in which manpower and service provision are organised in other healthcare settings is a significant opportunity to develop strategies for advancing tomorrow's obstetric anaesthesia in the world. While taking into account the level of socio-economic development in different countries, the aim is to standardise practice and workload organisation. Co-operative international projects in training and education in obstetric anaesthesia are ways in which better obstetric patient care can be achieved in the future.

On-Line Assessment (OLA) como preparación al Examen del Diploma Europeo de Anestesia y Cuidados Intensivos (EDAIC): estudio retrospectivo observacional sobre los resultados y el impacto sobre el examen Parte-I / On-Line Assessment (OLA) as a preparation for the European Diploma in Anaesthesiology and Intensive Care (EDAIC), a retrospective observational study on the results and the potential impact on the Part-I examination

Introducción: El Examen del Diploma Europeo de Anestesia y Cuidados Intensivos (EDAIC) es un diploma de la Sociedad Europea de Anestesia y Cuidados intensivos (ESAIC), obtenido tras aprobar dos exámenes, una primera parte escrita con preguntas de tipo test y una segunda parte oral estructurada. En 2011, otra prueba formativa en línea (el OnLine Assessment [OLA]) fue introducida para ayudar los candidatos a prepararse para el primer examen (EDAIC-I). Este estudio retrospectivo observacional fue diseñado para evaluar los resultados del OLA y su impacto sobre el EDAIC-I entre 2013 y 2019. Métodos: Después de obtener la autorización del comité examinador de la ESAIC, todos los resultados de los candidatos registrados para el OLA y/o el EDAIC-I entre 2013 y 2019 fueron incluidos. El número total de inscripciones y los resultados fueron analizados y comparados para ambas pruebas. Resultados: Más de 17.000 candidatos (17.401) presentaron cualquiera de los exámenes escritos del EDAIC. La tasa de aprobados en el EDAIC-I fue del 68,95%. La nota en el OLA aumentó de manera significativa en intentos sucesivos para el Paper A (Ciencias Básicas) (p = 0,006). La tasa global de aprobados en el EDAIC-I fue más alta en los candidatos que habían presentado el OLA antes (72,9 vs. 68,3%; OR: 1,25; IC 95% [1,12; 1,39]; p < 0,001). Los candidatos que fallaron en el primer intento al EDAIC-I repitieron más el examen si habían realizado el OLA (OR: 1.396, IC 95% [1.237; 1.574]; p < 0,001). Conclusión: El OLA fue asociado a un aumento de los resultados en ciencias básicas y de la tasa de aprobados en el EDAIC-I.(AU)

Background: The EDAIC is a diploma of the European Society of Anaesthesiology and Intensive Care (ESAIC). which is obtained after passing two a written MCQ-based (Part1) and a structured oral (part2) examinationIn 2011, a formative On-Line Assessment (OLA) was introduced to help candidates to prepare for EDAIC Part1 examination (EDAIC-I). This retrospective observational study evaluated the results of the OLA and its impact on the EDAIC-1 between 2013 and 2019. : Methods: After obtaining the authorisation from the ESAIC Examinations Committee, all the results of candidates registered to OLA and/or EDAIC-I between 2013 and 2019 were included. The total number of registrations and the results were analysed and compared for both. Results: Over 17,000 candidates (17,401) sat any of the written exams of the EDAIC. The overall pass-rate for the EDAIC-1 was 68.95%. The OLA score increased significantly with the number of attempts for Paper A (Basic Science) (p = 0.006). Overall success of the EDAIC-I was higher in candidates who took the OLA before (72.9% versus 68.3%; OR: 1.25; 95% CI [1.12; 1.39]; p< 0.001). Candidates who failed in their first attempt for EDAIC-I were more likely to sit the exam again if they had performed the OLA before (OR: 1.396, 95% CI [1.237; 1.574]; p< 0.001). Conclusion: The OLA was associated with an improvement of the results in basic science and success rate in the EDAIC-I.(AU)

On-Line Assessment (OLA) as a preparation for the European Diploma in Anaesthesiology and Intensive Care (EDAIC), a retrospective observational study on the results and the potential impact on the Part-I examination.

BACKGROUND: The EDAIC is a diploma of the European Society of Anaesthesiology and Intensive Care (ESAIC). which is obtained after passing two a written MCQ-based (Part1) and a structured oral (part2) examinationIn 2011, a formative On-Line Assessment (OLA) was introduced to help candidates to prepare for EDAIC Part1 examination (EDAIC-I). This retrospective observational study evaluated the results of the OLA and its impact on the EDAIC-1 between 2013 and 2019. METHODS: After obtaining the authorisation from the ESAIC Examinations Committee, all the results of candidates registered to OLA and/or EDAIC-I between 2013 and 2019 were included. The total number of registrations and the results were analysed and compared for both. RESULTS: Over 17,000 candidates (17,401) sat any of the written exams of the EDAIC. The overall pass-rate for the EDAIC-1 was 68.95%. The OLA score increased significantly with the number of attempts for Paper A (Basic Science) (p=0.006). Overall success of the EDAIC-I was higher in candidates who took the OLA before (72.9% versus 68.3%; OR: 1.25; 95% CI [1.12; 1.39]; p<0.001). Candidates who failed in their first attempt for EDAIC-I were more likely to sit the exam again if they had performed the OLA before (OR: 1.396, 95% CI [1.237; 1.574]; p<0.001). CONCLUSION: The OLA was associated with an improvement of the results in basic science and success rate in the EDAIC-I.

Edgar Alexander Pask (1912-1966). Sus contribuciones científicas durante la segunda guerra mundial y en la Universidad De Newcastle Upon Tyne / Edgar Alexander Pask (1912-1966). His Scientific Contributions During The Second World War And In Newcastle Upon Tyne University

Edgar Alexander Pask Catedrático de Anestesiología de la Universidad de Newcastle upon Tyne realizó importantes auto-experimentos durante la Segunda Guerra Mundial. Aportamos datos biográficos y su currículo científico. Trabajó en el Departamento Nuffield de Anestesia de Oxford con el Profesor Sir Robert Macintosh. Permitió ser anestesiado en múltiples ocasiones con éter durantela realización de estas investigaciones en el Centro de Fisiología de la RAF en Farnborough. Estudio de los efectos de la hipoxia endescensos en paracaídas, estudio de la eficacia de las distintas técnica de ventilación artificial, estudio de la eficacia de los distintossalvavidas. Después de la Segunda Guerra Mundial sus contribuciones científicas estuvieron relacionadas con la fisiología respiratoria, la monitorización, mortalidad e infecciones. Desarrolló aparatos de ventilación artificial, monitores de determinación de gasesarteriales y anestésicos. En su honor, la Asociación de Anestesistas de Gran Bretaña e Irlanda creó la Medalla Pask. (AU)

Edgar Alexander Pask Professor of Anaesthesia at the University of Newcastle upon Tyne performed self-experiments during the Second World War. We describe his scientific curriculum vitae and biographical data. He worked in the Nuffield Department of Anaesthesia in Oxford with Professor sir Robert Macintosh. He allowed himself to be anaesthetized with ether on many occasions duringthese experiments in the Physiological Laboratory, RAF Research Station in Farnborough. His research was: Studies of breathingin high altitude descend with a parachute in hypoxemia, study of the efficacy of different methods of artificial respiration, testingof life jackets. After the Second World War his scientific reports were related with respiratory physiology, monitoring, mortality andinfections. He developed ventilators, monitoring equipment of arterial blood gases and anaesthetic drugs. In his honour Pask Medalof the Association of Anaesthetists of Great Britain and Ireland was established. (AU)

Historia de la administración de éter por vía intravenosa / History of intravenous ether administration

La anestesia con éter por vía intravenosa fue una técnica anestésica utilizada en los años iniciales del siglo XX. Tuvo una granaceptación en Alemania. En la década de los sesenta del siglo pasado fue usada en cirugía endoscópica. El éter ha sido utilizadocon éxito para estudiar los tiempos de la circulación portal. (AU)

Intravenous ether anesthesia was an anesthetic technique used in the initial years of the XX century. It was mostly used in Germany.In the sixties decade of the past century it was used for endoscopic surgery. Ether has been used successfully for the study of circulation time of portal circulation. (AU)

Fidel Pagés Miravé en el centenario de su publicación de 1921. Historia de la anestesia epidural / Fidel Pagés Miravé one hundred years after its publication in 1921. The history of epidural anaesthesia

Sicard y Cathelin en 1901, introducen de manera simultánea la administración sacra de fármacos. En 1919, Läwen fue un gran defensor de la anestesia regional. Gil-Vernet en 1917 describe los fundamentos anatómicos de la técnica de abordaje sacro al espacio epidural. Fidel Pagés Miravé es el verdadero introductor de la anestesia epidural. Su artículo publicado en 1921, Anestesia Metamérica, en la Revista Española de Cirugía, constituye un hito en la historia de la anestesia. Diez años más tarde Dogliotti publica sus resultados, sin citar la aportación de Pagés. La gran mayoría de los historiadores citan a Dogliotti en la bibliografía, ignorando a Pagés. Gutiérrez un cirujano argentino alertó del error histórico y revindicó la aportación original de Pagés. En la actualidad todos los libros de historia de la anestesia reseñan la publicación de Pagés. El anestesiólogo cubano Manuel Martínez Curbelo, introduce en la clínica la anestesia epidural continua. En esta publicación revisamos la historia del abordaje sacro, torácico y lumbar del espacio epidural. Describimos las distintas agujas y catéteres utilizados. En la práctica diaria anestésica la analgesia/anestesia epidural se utiliza en cirugía, analgesia del trabajo del parto, tratamiento del dolor agudo y crónico. (AU)

Sicard and Cathelin in 1901 introduced independently the sacral injection of drugs. In 1910 Läwen was an enthusiastic defender of regional anaesthesia. Gil-Vernet in 1917 introduced new anatomical concepts in epidural sacral approach. Fidel Pagés Mirave was true pioneer of epidural anaesthesia. His publication in 1921, Metameric Anaesthesia, in the Spanish Journal of Surgery is a landmark in the history of world anaesthesia. Ten years later Dogliotti published his experiences with epidural anaesthesia, without anyreference to Pagés’ research. Most medical historians date the regular use of epidural anaesthesia from Dogliotti’s paper, published ten years later, and ignoring Pagés research. Gutierrez a surgeon born in Argentina, recognized the error and promoted the original scientific publication of Pages. Today all the important books of anaesthesia reference the first discoverer of epidural anaesthesia. The Cuban anaesthesiologist Manuel Martinez Curbelo, introduced into clinical practice continuous epidural anaesthesia. In this article we review the history of sacral and thoracic and lumbar approach to the epidural space, its different needles and catheters used in these techniques. Epidural analgesia/ anaesthesia are commonly used in daily practice in surgery, labour pain, and in the treatment of acute and chronic pain. (AU)

Recomendaciones prácticas en la paciente obstétrica con infección por COVID-19 / Practical recommendations in the obstetrical patient with a COVID-19 infection

La infección por COVID-19 afecta también a las pacientes obstétricas. La atención obstétrica habitual ha continuado a pesar de la pandemia. Existen series de casos de pacientes obstétricas. Parece que las técnicas neuroaxiales son seguras y es importante asegurarse que los bloqueos funcionen correctamente antes de una cesárea. Es por esto que se recomienda que los bloqueos sean realizados por anestesiólogos expertos. La protección y seguridad de los profesionales es un punto fundamental y, en caso de anestesia general, también se recomienda acudir al anestesiólogo más experto. Las pacientes gravemente enfermas deben reconocerse rápida y precozmente, para poder suministrarles el tratamiento adecuado lo antes posible. La susceptibilidad a las trombosis hace que la anticoagulación profiláctica sea prioritaria

COVID-19 infection also affects obstetric patients. Regular obstetric care has continued despite the pandemic. Case series of obstetric patients have been published. Neuroaxial techniques appear to be safe and it is important to obtain the highest possible rate of success of the blocks before a cesarean section. For this reason, it is recommended that the blocks be carried out by senior anesthesiologists. The protection and safety of professionals is a key point and in case of general anesthesia, so it is also recommended to call to the most expert anesthesiologist. Seriously ill patients should be recognized quickly and early, in order to provide them with the appropriate treatment as soon as possible. Susceptibility to thrombosis makes prophylactic anticoagulation a priority

Practical recommendations in the obstetrical patient with a COVID-19 infection. / Recomendaciones prácticas en la paciente obstétrica con infección por COVID-19.

COVID-19 infection also affects obstetric patients. Regular obstetric care has continued despite the pandemic. Case series of obstetric patients have been published. Neuroaxial techniques appear to be safe and it is important to obtain the highest possible rate of success of the blocks before a cesarean section. For this reason, it is recommended that the blocks be carried out by senior anesthesiologists. The protection and safety of professionals is a key point and in case of general anesthesia, so it is also recommended to call to the most expert anesthesiologist. Seriously ill patients should be recognized quickly and early, in order to provide them with the appropriate treatment as soon as possible. Susceptibility to thrombosis makes prophylactic anticoagulation a priority.

Diploma Europeo en Anestesiología y Cuidados Intensivos en España: resultados de los exámenes de las partes 1 y 2 de los últimos cinco años. ¿Vamos por el buen camino? / European Diploma in Anaesthesiology and Intensive Care in Spain: Results for the part 1 and part 2 exams in the last five years. Are we going in the right direction?

Antecedentes: El Diploma Europeo en Anestesiología y Cuidados Intensivos (EDAIC) se ha convertido en un estándar de calidad entre los anestesiólogos españoles. El objetivo de este estudio retrospectivo observacional fue valorar los resultados de los participantes españoles en los dos exámenes -parte1 y parte2- en un periodo reciente de 5años, entre 2012 y 2016 y entre 2013 y 2017, respectivamente. Material y métodos: Después de obtener la autorización de la European Society of Anaesthesiology, los resultados de los dos exámenes del EDAIC fueron analizados de manera anónima en un periodo de 5años. Analizamos el número de inscripciones, la tasa de aprobados, la causa de suspensos y la nota media en ciencias básicas (cuadernilloA de la parte1 del examen y las dos primeras mesas de la parte2 del examen) y en anestesiología clínica y cuidados intensivos (cuadernilloB de la parte1 del examen y las dos últimas mesas de la parte2 del examen). Las variables cuantitativas fueron analizadas con análisis de varianza y las variables cualitativas con test de chi-cuadrado para tendencias. El nivel de significación estadística fue establecido en p<0,05. Resultados: Para la parte 1 del examen escrito, 1.189 de un total de 10.954 candidatos (10,85%) fueron inscritos en centros españoles, reflejando el crecimiento global del examen (p=0,29). La tasa de aprobados fue del 62,1%, sin diferencias significativas con los demás países (p=0,38). Las ciencias básicas supusieron el 84,1% de los suspensos. La nota media fue de 71,74+/-5,98% para las ciencias básicas (cuadernilloA) y de 74,48+/-4,29% para la anestesiología clínica (cuadernilloB). En relación con la parte2 del examen, el 72,4% de los candidatos aprobados en la parte1 del examen se inscribieron en la parte2, con una tasa de aprobados del 62,7%, versus el 62,2% en el resto del mundo (p=0,91). Los suspensos en las mesas de ciencias básicas de la parte2 del examen supusieron el 93,8% de los candidatos suspensos en la parte2 del examen. Los suspensos eliminatorios en una mesa fueron registrados en 56 (31,5%) de los candidatos suspensos, de los que el 71,3% se produjeron en las mesas de ciencias básicas. Los suspensos eliminatorios aislados se produjeron solo en 7 (3,9%) de los candidatos. Conclusiones: La evolución del EDAIC en España ha sido muy similar a la del resto del mundo. En el futuro, los esfuerzos persistentes de los anestesiólogos españoles para mejorar sus conocimientos en ciencias básicas y preparar mejor la técnica del examen oral podrían mejorar la tasa de aprobados en el EDAIC en una cohorte de candidatos en constante aumento

Background: The European Diploma in Anaesthesiology and Intensive Care (EDAIC) has become a standard of quality among Spanish anaesthesiologists. The aim of this retrospective observational study was to assess the results of Spanish participants for the Part1 and Part2 exams over a recent five years period from 2012 to 2016 and 2013 to 2017, respectively. Material and methods: After obtaining the authorization from the European Society of Anaesthesiology, the results of both parts of the EDAIC exams were anonymously analysed for five years. We analysed the number of registrations, the pass rates, the cause for failure and the mean scores for basic sciences (paperA of part1 exam and the two first vivas of part2 exam) and clinical anaesthesia and intensive care (paperB of part1 exam and the two last vivas of part2 exam). Quantitative variables were analysed using the one-way analysis of variance, and qualitative variables using the chi-square test for trends. The level of statistical significance was set at P<.05. Results: For the written part1 exam, 1,189 of a total of 10,954 candidates (10.85%) were registered in Spanish centres, reflecting the global growth of the exam (P=.29). The pass rate was 62.1%, with no significant differences from other countries (P=.38). Basic sciences were involved in 84.1% of failing candidates. Mean scores were 71.74+/-5.98% for basic science (paperA) and 74.48+/-4.29% for clinical anaesthesiology (paperB). Regarding the part2 exam, 72.4% of the candidates who had passed the part1 exam registered for the oral part2, with a pass rate of 62.7% versus 62.2% in the rest of the world (P=.91). Failing in the basic sciences sections of the part2 resulted in 93.8% of candidates failing the part2 exam. Bad fails were registered in 56 (31.5%) of failing candidates, of which 71.3% occurred in the basic sciences vivas. Isolated bad fails only occurred in 7 (3.9%) cases. Conclusions: The evolution of the EDAIC in Spain has been very similar to evolution of the EDAIC in the rest of the world. Further efforts to improve knowledge in basic sciences and better preparation in the technique of oral examination should improve the pass rate of the EDAIC examinations from an ever-increasing cohort of candidates

European Diploma in Anaesthesiology and Intensive Care in Spain: Results for the part 1 and part 2 exams in the last five years. Are we going in the right direction? / Diploma Europeo en Anestesiología y Cuidados Intensivos en España: resultados de los exámenes de las partes 1 y 2 de los últimos cinco años. ¿Vamos por el buen camino?

BACKGROUND: The European Diploma in Anaesthesiology and Intensive Care (EDAIC) has become a standard of quality among Spanish anaesthesiologists. The aim of this retrospective observational study was to assess the results of Spanish participants for the Part1 and Part2 exams over a recent five years period from 2012 to 2016 and 2013 to 2017, respectively. MATERIAL AND METHODS: After obtaining the authorization from the European Society of Anaesthesiology, the results of both parts of the EDAIC exams were anonymously analysed for five years. We analysed the number of registrations, the pass rates, the cause for failure and the mean scores for basic sciences (paperA of part1 exam and the two first vivas of part2 exam) and clinical anaesthesia and intensive care (paperB of part1 exam and the two last vivas of part2 exam). Quantitative variables were analysed using the one-way analysis of variance, and qualitative variables using the chi-square test for trends. The level of statistical significance was set at P<.05. RESULTS: For the written part1 exam, 1,189 of a total of 10,954 candidates (10.85%) were registered in Spanish centres, reflecting the global growth of the exam (P=.29). The pass rate was 62.1%, with no significant differences from other countries (P=.38). Basic sciences were involved in 84.1% of failing candidates. Mean scores were 71.74±5.98% for basic science (paperA) and 74.48±4.29% for clinical anaesthesiology (paperB). Regarding the part2 exam, 72.4% of the candidates who had passed the part1 exam registered for the oral part2, with a pass rate of 62.7% versus 62.2% in the rest of the world (P=.91). Failing in the basic sciences sections of the part2 resulted in 93.8% of candidates failing the part2 exam. Bad fails were registered in 56 (31.5%) of failing candidates, of which 71.3% occurred in the basic sciences vivas. Isolated bad fails only occurred in 7 (3.9%) cases. CONCLUSIONS: The evolution of the EDAIC in Spain has been very similar to evolution of the EDAIC in the rest of the world. Further efforts to improve knowledge in basic sciences and better preparation in the technique of oral examination should improve the pass rate of the EDAIC examinations from an ever-increasing cohort of candidates.

Método de suma acumulada (CUSUM) para evaluar las curvas de aprendizaje del bloqueo femoral continuo guiado por ecografía / Use of the cumulative sum method (CUSUM) to assess the learning curves of ultrasound-guided continuous femoral nerve block

Introducción. Aunque la ecografía es una competencia básica de los residentes de anestesia (RA) hay pocos datos disponibles sobre su proceso de aprendizaje. Este estudio prospectivo observacional tiene como objetivo evaluar el proceso de aprendizaje del bloqueo del nervio femoral continuo guiado por ecografía y determinar el número de procedimientos necesarios que un RA debe realizar para ser exitoso, utilizando el método de suma acumulada (CUSUM). Método. Reclutamos 19 RA sin experiencia previa. Construimos las curvas de aprendizaje utilizando la metodología CUSUM para el bloqueo del nervio femoral continuo guiado por ecografía considerando 2 criterios de éxito: disminución del dolor>2 puntos en una escala numérica [0-10] tras 15min y el tiempo necesario para realizar la técnica. Resultados. Analizamos los datos de 17 RA, que realizaron un total de 237 bloqueos del nervio femoral continuo guiados por ecografía. Ocho de 17 RA tuvieron éxito en cuanto a la disminución del dolor, y asimismo aquellos RA que realizaron>12 bloqueos (8/8) lo consiguieron. En cuanto al tiempo de realización, 5/17 RA alcanzaron el objetivo en 12min; y todos los RA que realizaron>20 procedimientos (4/4) lo alcanzaron. Conclusiones. El número de procedimientos necesarios para alcanzar el éxito parece ser 12, sin embargo es necesario realizar un número mayor para reducir el tiempo de realización del mismo. La metodología CUSUM podría ser útil en programas de formación, permitiendo intervenciones precoces en casos de fallos repetidos, y realizar un currículo basado principalmente en las competencias (AU)

Background. Although ultrasound is a basic competence for anaesthesia residents (AR) there is few data available on the learning process. This prospective observational study aims to assess the learning process of ultrasound-guided continuous femoral nerve block and to determine the number of procedures that a resident would need to perform in order to reach proficiency using the cumulative sum (CUSUM) method. Methods. We recruited 19 AR without previous experience. Learning curves were constructed using the CUSUM method for ultrasound-guided continuous femoral nerve block considering 2 success criteria: a decrease of pain score>2 in a [0-10] scale after 15minutes, and time required to perform it. Results. We analyse data from 17 AR for a total of 237 ultrasound-guided continuous femoral nerve blocks. 8/17 AR became proficient for pain relief, however all the AR who did more than 12 blocks (8/8) became proficient. As for time of performance 5/17 of AR achieved the objective of 12minutes, however all the AR who did more than 20 blocks (4/4) achieved it. Conclusions. The number of procedures needed to achieve proficiency seems to be 12, however it takes more procedures to reduce performance time. The CUSUM methodology could be useful in training programs to allow early interventions in case of repeated failures, and develop competence-based curriculum (AU)

Visión moderna sobre una técnica antigua: revisión narrativa de técnicas de localización del espacio epidural / Modern approach to an old technique: narrative revision of techniques used to locate the epidural space

Desde la primera descripción de la técnica epidural en los años 1920, el progreso continuo en el conocimiento de la anatomía y de la fisiología del espacio epidural ha permitido desarrollar diferentes técnicas de localización de este espacio para aumentar tanto la seguridad como la eficacia del procedimiento. Las técnicas más utilizadas hoy en día se basan en las 2 principales propiedades descritas del espacio epidural: la diferencia de distensibilidad entre el ligamento amarillo y el espacio epidural y la existencia de una presión negativa en el espacio epidural. Sin embargo, en los últimos años, la evolución tecnológica ha permitido desarrollar nuevas técnicas de localización basadas en otras propiedades físicas de los tejidos. Algunas de ellas están todavía en una fase experimental, pero otras como las técnicas con ultrasonidos han alcanzado una fase clínica y se está expandiendo su uso en la práctica diaria (AU)

Since the first description of the epidural technique during the 1920s, the continuous progress of knowledge of the anatomy and physiology of the epidural space has allowed the development of different techniques to locate this space while increasing both the safety and efficacy of the procedure. The most common techniques used today are based on the two main characteristics of the epidural space: the difference in distensibility between the ligamentum flavum and the epidural space, and the existence of negative pressure within the epidural space. However, over recent years, technological advances have allowed the development of new techniques to locate the epidural space based on other physical properties of tissues. Some are still in the experimental phase, but others, like ultrasound-location have reached a clinical phase and are being used increasingly in daily practice (AU)

Modern approach to an old technique: Narrative revision of techniques used to locate the epidural space. / Visión moderna sobre una técnica antigua: revisión narrativa de técnicas de localización del espacio epidural.

Since the first description of the epidural technique during the 1920s, the continuous progress of knowledge of the anatomy and physiology of the epidural space has allowed the development of different techniques to locate this space while increasing both the safety and efficacy of the procedure. The most common techniques used today are based on the two main characteristics of the epidural space: the difference in distensibility between the ligamentum flavum and the epidural space, and the existence of negative pressure within the epidural space. However, over recent years, technological advances have allowed the development of new techniques to locate the epidural space based on other physical properties of tissues. Some are still in the experimental phase, but others, like ultrasound-location have reached a clinical phase and are being used increasingly in daily practice.

Use of the cumulative sum method (CUSUM) to assess the learning curves of ultrasound-guided continuous femoral nerve block. / Método de suma acumulada (CUSUM) para evaluar las curvas de aprendizaje del bloqueo femoral continuo guiado por ecografía.

BACKGROUND: Although ultrasound is a basic competence for anaesthesia residents (AR) there is few data available on the learning process. This prospective observational study aims to assess the learning process of ultrasound-guided continuous femoral nerve block and to determine the number of procedures that a resident would need to perform in order to reach proficiency using the cumulative sum (CUSUM) method. METHODS: We recruited 19 AR without previous experience. Learning curves were constructed using the CUSUM method for ultrasound-guided continuous femoral nerve block considering 2 success criteria: a decrease of pain score>2 in a [0-10] scale after 15minutes, and time required to perform it. RESULTS: We analyse data from 17 AR for a total of 237 ultrasound-guided continuous femoral nerve blocks. 8/17 AR became proficient for pain relief, however all the AR who did more than 12 blocks (8/8) became proficient. As for time of performance 5/17 of AR achieved the objective of 12minutes, however all the AR who did more than 20 blocks (4/4) achieved it. CONCLUSIONS: The number of procedures needed to achieve proficiency seems to be 12, however it takes more procedures to reduce performance time. The CUSUM methodology could be useful in training programs to allow early interventions in case of repeated failures, and develop competence-based curriculum.

Control de la temperatura perioperatoria: encuesta sobre las prácticas actuales / Perioperative temperature control: survey on current practices

Introducción. La prevención de la hipotermia perioperatoria disminuye la morbimortalidad y el coste hospitalario. Este estudio evaluó su nivel de aplicación en 3 hospitales universitarios españoles de tercer nivel. Material y métodos. Una encuesta entre anestesiólogos evaluó la importancia estimada y la práctica clínica en materias de prevención de la hipotermia perioperatoria. Los resultados se compararon en función de la experiencia. Una p < 0,05 fue considerada significativa. Resultados. Ciento dieciséis anestesiólogos contestaron a la encuesta, 48 (41,3%) residentes, 32 (27,6%) adjuntos de menos de 10 años de experiencia, y 36 (31,1%) adjuntos de 10 o más años de experiencia. La prevención de la hipotermia fue evaluada con 7,49 ± 1,79 puntos en una escala de importancia de 0 a 10, sin diferencias entre grupos (p = 0,58). Los adjuntos recién graduados valoraban la temperatura al final de la intervención más que el resto de anestesiólogos (p = 0,02). El calentador de sueros, junto con una manta convectiva fue la medida de prevención más habitual (47%). Solo un 20% de los encuestados monitorizaban la temperatura intra-operatoria, aunque un 75% lo consideraban un parámetro importante. Ninguna unidad disponía de un protocolo de prevención de hipotermia. Discusión y conclusión. A pesar de no existir protocolos de prevención, los anestesiólogos son conscientes de la importancia de la normotermia perioperatoria, pero aún no influye suficiente en su manejo peri-operatorio para diagnosticar y prevenir la hipotermia. Una armonización a nivel local, regional y nacional podría mejorar estas prácticas en el futuro (AU)

Introduction. Prevention of perioperative hypothermia decreases morbidity and mortality, as well as hospital costs. This study was conducted to evaluate the level of implementation of protocols in 3 tertiary Spanish University Hospitals. Material and methods. A survey among anaesthesiologists assessed estimated importance and clinical practice in terms of prevention of perioperative hypothermia. Results were compared depending on their experience. P<.05 was considered significant. Results. A total of 116 anaesthesiologists answered the survey, of whom 48 (41.3%) were residents, 32 (27.6%) were staff with less than 10 years of experience, and 36 (31.1%) staff with 10 years or more of experience, In a 0-10 importance scale, prevention of hypothermia was scored 7.49±1,79, with no difference between groups (P=.58). Younger staff were more concerned of the end surgery temperature than other colleagues (P=.02). The most usual practice was a combination warming the intravenous fluids and an electric blanket (55%). Only 20% of the anaesthesiologists monitored temperature intra-operatively, even though 75% considered it an important parameter. No unit had a written protocol for prevention of perioperative hypothermia. Discussion and conclusion. Despite the absence of prevention protocols, the anaesthesiologists were aware of the importance maintaining a normal peri-operative temperature, but this awareness is still not enough to influence their perioperative management to diagnose and prevent hypothermia. A harmonisation of practice at local, regional and national level could improve this practice in the future (AU)

Perioperative temperature control: Survey on current practices.

INTRODUCTION: Prevention of perioperative hypothermia decreases morbidity and mortality, as well as hospital costs. This study was conducted to evaluate the level of implementation of protocols in 3 tertiary Spanish University Hospitals. MATERIAL AND METHODS: A survey among anaesthesiologists assessed estimated importance and clinical practice in terms of prevention of perioperative hypothermia. Results were compared depending on their experience. P<.05 was considered significant. RESULTS: A total of 116 anaesthesiologists answered the survey, of whom 48 (41.3%) were residents, 32 (27.6%) were staff with less than 10 years of experience, and 36 (31.1%) staff with 10 years or more of experience, In a 0-10 importance scale, prevention of hypothermia was scored 7.49±1,79, with no difference between groups (P=.58). Younger staff were more concerned of the end surgery temperature than other colleagues (P=.02). The most usual practice was a combination warming the intravenous fluids and an electric blanket (55%). Only 20% of the anaesthesiologists monitored temperature intra-operatively, even though 75% considered it an important parameter. No unit had a written protocol for prevention of perioperative hypothermia. DISCUSSION AND CONCLUSION: Despite the absence of prevention protocols, the anaesthesiologists were aware of the importance maintaining a normal peri-operative temperature, but this awareness is still not enough to influence their perioperative management to diagnose and prevent hypothermia. A harmonisation of practice at local, regional and national level could improve this practice in the future.