RÉSUMÉ
Paciente de 26 años afecto de ataxia de Friederich con una miocardiopatía hipertrófica no obstructiva sometido a una tiroidectomía total por una tirotoxicosis secundaria a amiodarona persistente (a pesar de elevadas dosis de antitiroideos y corticoides), que intraoperatoriamente presentó un episodio sugestivo de tormenta tiroidea.La tormenta tiroidea es una urgencia endocrinológica que asocia una elevada morbimortalidad. Para mejorar la supervivencia es de vital importancia un diagnóstico temprano y un tratamiento precoz que incluya: un tratamiento sintomático, el tratamiento de las manifestaciones cardiovasculares, neurológicas y/o hepáticas y de la tirotoxicosis, así como suprimir o evitar estímulos desencadenantes y practicar un tratamiento definitivo.(AU)
A 26-year-old patient with Friederich's ataxia with hypertrophic obstructive cardiomyopathy undergoing a total thyroidectomy due to persistent amiodarone-induced thyrotoxicosis (despite high doses of antithyroid drugs and corticosteroids), presented an intraoperative episode suggestive of thyroid storm.Thyroid storm is an endocrine emergency that is associated with high morbimortality. Early diagnosis and treatment, which is of vital importance to improve survival. Treatment includes: symptomatic treatment, treatment of cardiovascular, neurological, and/or hepatic manifestations and thyrotoxicosis, measures to suppress or avoid triggering stimuli, and definitive treatment.(AU)
Sujet(s)
Humains , Mâle , Adulte , Ataxie de Friedreich/complications , Ataxie de Friedreich/traitement médicamenteux , Crise thyréotoxique/complications , Crise thyréotoxique/traitement médicamenteux , Cardiomyopathie hypertrophique , Thyréotoxicose , Amiodarone , Anesthésie , Anesthésiologie , Résultat thérapeutique , Patients hospitalisés , Examen physique , Évaluation des symptômesRÉSUMÉ
A 26-year-old patient with Friederich's ataxia with hypertrophic obstructive cardiomyopathy undergoing total thyroidectomy due to persistent amiodarone-induced thyrotoxicosis (despite high doses of antithyroid drugs and corticosteroids), presented an intraoperative episode suggestive of thyroid storm. Thyroid storm is an endocrine emergency that is associated with high morbidity and mortality. Early diagnosis and treatment, which is of vital importance to improve survival, includes symptomatic treatment, treatment of cardiovascular, neurological, and/or hepatic manifestations and thyrotoxicosis, measures to suppress or avoid triggering stimuli, and definitive treatment.
Sujet(s)
Anesthésiques , Crise thyréotoxique , Thyréotoxicose , Humains , Adulte , Crise thyréotoxique/complications , Crise thyréotoxique/diagnostic , Crise thyréotoxique/traitement médicamenteux , Thyréotoxicose/complications , Thyréotoxicose/chirurgie , Thyréotoxicose/induit chimiquement , Ataxie/complications , Ataxie/traitement médicamenteux , Antithyroïdiens/effets indésirables , Anesthésiques/effets indésirablesRÉSUMÉ
OBJECTIVE: To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). MATERIAL AND METHODS: Prospective study conducted from January 2000 to January 2020 in which 3132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. RESULTS: No notable hemodynamic alterations were observed. The incidence of desaturation was .41%, awakening during the test was .16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of .73%. The P value in all cases was <.05%. CONCLUSIONS: Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.
Sujet(s)
Hydrate de chloral , Hypnotiques et sédatifs , Enfant , Enfant d'âge préscolaire , Hydrate de chloral/effets indésirables , Sédation consciente , Humains , Hypnotiques et sédatifs/effets indésirables , Nourrisson , Imagerie par résonance magnétique , Spectroscopie par résonance magnétique , Nausée/induit chimiquement , Études prospectives , Vomissement/induit chimiquementRÉSUMÉ
Objetivo: Valorar los tiempos medios de hipnosis, la estabilidad hemodinámica y la incidencia de complicaciones del uso de hidrato de cloral por vía oral en niños programados para exploraciones de resonancia magnética nuclear (RMN), a dosis de 70mg/kg. Material y métodos: Estudio prospectivo desde enero de 2000 a enero de 2020, en el que se realizaron 3.132 RMN a pacientes con edades comprendidas entre un día y 5 años, en régimen de anestesia ambulatoria. Se dividió a la población a estudio en 4 subgrupos: A) entre uno y 30 días; B) entre un mes y un año; C) entre uno y 3 años, y D) entre 3 y 5 años. Se registraron el sexo, la edad, el tipo de exploración, así como los tiempos medios de exploración y despertar, la frecuencia cardiaca previa a la RMN y al finalizar, la SatO2 y la incidencia de complicaciones del tipo de: depresión respiratoria (SatO2 inferior al 90%), agitación durante la RMN o al despertar (llanto intenso de más de 2min de duración), sedación prolongada valorada mediante el test de Steward y la aparición de náuseas y/o vómitos durante la RMN, al despertar o en su domicilio. Resultados: No se registraron alteraciones hemodinámicas reseñables. La incidencia de desaturaciones fue de un 0,41%. El despertar durante la prueba fue de un 0,16%, la sedación prolongada de un 1,08% y el despertar agitado apareció en un 1,46% de los casos. Las náuseas y vómitos al terminar la prueba tuvieron una incidencia de un 0,73%. Todos ellos con una p<0,05%. Conclusiones: El hidrato de cloral sigue siendo un fármaco que puede ser referente a dosis de 70mg/kg en sedaciones no superiores a una hora, en procedimientos no invasivos en niños y que asocia una estabilidad hemodinámica adecuada sin prácticamente efectos secundarios.(AU)
Objective: To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). Material and methods: Prospective study conducted from January 2000 to January 2020 in which 3,132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. Results: No notable hemodynamic alterations were observed. The incidence of desaturation was 0.41%, awakening during the test was 0.16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of 0.73%. The P value in all cases was<.05%. Conclusions: Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.(AU)
Sujet(s)
Humains , Nouveau-né , Enfant , Hydrate de chloral/usage thérapeutique , Hypnotiques et sédatifs , Spectroscopie par résonance magnétique , Anesthésie générale , Hypnose , Anesthésie hypnotique , Études prospectives , Anesthésiologie , EspagneRÉSUMÉ
OBJECTIVE: To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). MATERIAL AND METHODS: Prospective study conducted from January 2000 to January 2020 in which 3,132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. RESULTS: No notable hemodynamic alterations were observed. The incidence of desaturation was 0.41%, awakening during the test was 0.16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of 0.73%. The P value in all cases was<.05%. CONCLUSIONS: Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.
RÉSUMÉ
OBJECTIVES: To determine the current situation of the tutors in our specialty as regards resident/tutor ratios, times they have available to develop their work, the training that they have received to perform their function, and whether this is recognised by official bodies, other than by their own hospital. Furthermore, to determine the teaching and research work taught to the residents through the sessions, as well as their participation in publications per year. To find out their opinion of the tutors as regards unifying training contents, whether or not they have objective tests on finishing their residency, and their willingness to take part in the project promoted by the Teaching Section of SEDAR to carry out a common minimum theoretical-practical programme throughout the whole of Spain. MATERIAL AND METHODS: A questionnaire with the aforementioned questions was sent to Anaesthesiology Teach Units through the different regional coordinators, during the years 2008-2010. RESULTS: A total of 77/106 (72.6%) Teaching Units responded. The mean ratio of residents per tutor was 5.6±3.3. More than 60% of the tutors had not attended any training course or even how to join one in the two years of the study; 62.3% did not have specific time available to develop their role as tutors, and in 18.2%, their work was only recognised by health institutions. The number of teaching sessions for residents per year was 5.0±4.0 and the number of publications was 1.6±1.4. Almost all of them (98.7%) believe it was necessary to produce a programme that would ensure similar minimum theoretical-practical training plans and that on their own initiative had been carried out in 70% of Teaching Units, but without uniform criteria. Almost three-quarters (74%) had not presented any resident to the European Examination of Anaesthesia in the last few years, and 87% considered the system of evaluating residents as inadequate, with 79% in favour of having a final exam or test. CONCLUSIONS: The tutor/resident ratio should according to that stipulated. Time needs to be set aside for teaching, separate from care work, and our tutors, in general, lack specific training courses, and these are very disparate. There is a general demand to have a training programme of common minimum theoretical-practical skills. It is considered that the current evaluation system is inadequate, but there is no unanimity in whether or not to have an exam at the end of the residency, although the European Examination could be the model to consider in this regard.
Sujet(s)
Anesthésiologie/enseignement et éducation , Corps enseignant et administratif en médecine , Internat et résidence , Réanimation/enseignement et éducation , Enseignement/méthodes , Agrément/statistiques et données numériques , Programme d'études , Évaluation des acquis scolaires , Corps enseignant et administratif en médecine/normes , Hôpitaux d'enseignement/statistiques et données numériques , Humains , Internat et résidence/législation et jurisprudence , Internat et résidence/normes , Gestion de la douleur , Évaluation de programme , Amélioration de la qualité , Espagne , Enseignement/normesRÉSUMÉ
OBJECTIVE: To assess training in blind intubation with the Fastrach laryngeal mask in a simulation model by applying the cumulative sums (CuSum) method. MATERIAL AND METHODS: Six anaesthesiology resident doctors, with no previous experience of the technique, participated, three in their first year, and three in the second. The study was conducted with the help of the SimMan Universal Simulator. Fifty attempts by each one of them over a four month period, divided into two stages: the first 20 with minimum airway difficulty, and the next 30 with limitations of flexion-extension movements to <80°. An unacceptable failure rate was set at 10% after a second failed attempt. The time limit set to be considered a success was 60seconds. RESULTS: A total of 120 attempts in the first stages, and the remaining 180 in the second were analysed individually, all managing to achieve acceptable success rates of 90%: 84% in the first attempt and 13.33% in the second. A total of 2.66% failures were recorded. The learning curve showed that the residents began to achieve an acceptable 90% success rate in case number 25±11.76 of the 50 attempts. CONCLUSIONS: This statistical method and the SimMan simulator, used together, have demonstrated to be very useful tools in assessing learning curves in this technique.
Sujet(s)
Anesthésiologie/enseignement et éducation , Masques laryngés , Courbe d'apprentissage , Mannequins , Humains , Internat et résidenceRÉSUMÉ
Objetivos: Evaluar el aprendizaje de intubación a ciegas a través de mascarilla laríngea Fastrach en un modelo de simulación, mediante la aplicación del método de sumas acumulativas CuSum. Material y métodos: Participaron seis médicos residentes de Anestesiología, tres en su primer año y tres en el segundo, sin experiencia previa en la técnica. El estudio se realizó con la ayuda del Simulador Universal SimMan. A lo largo de 4 meses, se registraron 50 intentos en cada uno de ellos, divididos en dos etapas: los primeros 20 con mínima dificultad de vía aérea y los siguientes 30 con limitación a los movimientos de flexoextensión a < 80°. Se aceptó como índice inaceptable de fallo el 10% tras un segundo intento fallido. El límite temporal fijado para considerarlo éxito fue de 60 s. Resultados: Se analizaron 120 intentos en la primera etapa y los 180 restantes en la segunda, individualmente; todos lograron unos índices aceptables de éxito del 90%: el 84% en el primer intento y el 13,33% en el segundo. Se registró un 2,66% de fallos del total. La curva de aprendizaje mostró que los residentes lograron alcanzar el índice aceptable de éxito del 90% como media en el caso número 25 ± 11,76, de 50 casos. Conclusiones: Se ha demostrado que este método estadístico y el simulador SimMan utilizados conjuntamente son unas herramientas muy útiles en la evaluación del aprendizaje de esta técnica(AU)
Objective: To assess training in blind intubation with the Fastrach laryngeal mask in a simulation model by applying the cumulative sums (CuSum) method. Material and methods: Six anaesthesiology resident doctors, with no previous experience of the technique, participated, three in their first year, and three in the second. The study was conducted with the help of the SimMan Universal Simulator. Fifty attempts by each one of them over a four month period, divided into two stages: the first 20 with minimum airway difficulty, and the next 30 with limitations of flexion-extension movements to <80°. An unacceptable failure rate was set at 10% after a second failed attempt. The time limit set to be considered a success was 60 seconds. Results: A total of 120 attempts in the first stages, and the remaining 180 in the second were analysed individually, all managing to achieve acceptable success rates of 90%: 84% in the first attempt and 13.33% in the second. A total of 2.66% failures were recorded. The learning curve showed that the residents began to achieve an acceptable 90% success rate in case number 25±11.76 of the 50 attempts. Conclusions: This statistical method and the SimMan simulator, used together, have demonstrated to be very useful tools in assessing learning curves in this technique(AU)
Sujet(s)
Humains , Mâle , Femelle , Intubation trachéale/instrumentation , Intubation trachéale , Études d'évaluation comme sujet , Anesthésiologie/enseignement et éducation , Anesthésiologie/méthodes , Anesthésiologie/éthique , Anesthésiologie , Anesthésiologie/tendances , Formation médicale continue comme sujet/organisation et administration , Formation médicale continue comme sujet/normesRÉSUMÉ
The recent publication of guidelines for postgraduate training in anesthesiology, pain, and intensive care issued by the European Board of Anaesthesia (EBA) and the European Union of Medical Specialists (UEMS) (http://www.sedar.es/revistasedar/uems.pdf) specifies directions we must take with our residents. The training section of the Sociedad Española de Anestesiología y Reanimación (SEDAR) has decided to make the guidelines available on the association's website so that the UEMS/EBA proposals can be compared to the training program drafted by the Spanish national board for our specialty. Our aim is to identify points of convergence between the two proposals and to target gaps where improvements can be made so that Spanish residency training in this specialty is in harmony with the European framework.
Sujet(s)
Anesthésiologie/enseignement et éducation , Recommandations comme sujet , Internat et résidence/normes , Anesthésie obstétricale/normes , Compétence clinique/normes , Soins de réanimation , Programme d'études/normes , Évaluation des acquis scolaires/normes , Union européenne , Professions de santé/législation et jurisprudence , Humains , Médecine/organisation et administration , Gestion de la douleur/normes , Sociétés médicales/normes , Espagne , Organismes de certification/normesSujet(s)
Anesthésie générale , Syndrome du QT long/congénital , Adulte , Anesthésie générale/méthodes , Humains , MâleRÉSUMÉ
No disponible
Sujet(s)
Humains , Mâle , Adulte , Anesthésie générale/méthodes , Anesthésie générale , Syndrome du QT long/complications , Syndrome du QT long/traitement médicamenteux , Procédures de chirurgie maxillofaciale et buccodentaire/méthodes , Syndrome du QT long/congénital , Rythme cardiaque , Rythme cardiaque/physiologie , Électrocardiographie , Chirurgie stomatologique (spécialité)/instrumentation , Midazolam/usage thérapeutique , Sulfate de magnésium/usage thérapeutiqueSujet(s)
Anesthésiologie/enseignement et éducation , Programme d'études/normes , Enseignement spécialisé en médecine/normes , Soins postopératoires/enseignement et éducation , Agrément , Rendez-vous et plannings , Enseignement spécialisé en médecine/législation et jurisprudence , Europe , Sociétés médicales , EspagneRÉSUMÉ
No disponible