Anestesia em pacientes de risco: um abordagem anestésica aos pacientes cardiopatas, nefropatas, hepatopatas, pediátricos e senis / Anesthesia in high-risk patients: an anesthetic approach to cardiac, nephropathic, hepatic, pediatric and senile patients

Este trabalho visa, por meio de levantamento de dados científicos, analisar a melhor abordagem anestésica para cada tipo de paciente de risco, mostrando um panorama geral e indicativo sobre os fármacos e sua funcionalidade para cada sistema. A revisão bibliográfica foi baseada na literatura encontrada em meios eletrônicos (plataformas PubMed, Scielo e Google Scholar) e físicos (livros de referência) nos últimos dez anos, dentro de artigos com relatos de caso, revisões de literatura e pesquisas inéditas. Dessa forma, obteve-se um levantamento amplo, abrangendo as principais classes farmacológicas utilizadas em procedimentos anestésicos em pacientes classificados como de risco, ou seja, cardiopatas, nefropatas, hepatopatas, pediátricos e senis, procurando determinar os que causam menor depressão cardiovascular e respiratória respeitando suas limitações. Sendo assim, para uma anestesia mais segura deve-se focar na prevenção de intercorrências anestésicas no transoperatório e pós-operatório. Observar, estudar, analisar o paciente e o protocolo a ser utilizado como um todo é necessário e indispensável na anestesiologia veterinária, associando a teoria com a prática.

This work aims, through research, with scientific data, to analyze the best anesthetic approach for each type of patient, showing a general and indicative overview about the drugs and their functionality for each system. The bibliographic review was based on the literature found in electronic media (PubMed, Scielo and Google Scholar platforms) and physical (reference books) in the last ten years, within articles with case reports, literature reviews and unpublished research. Thus, a broad survey was obtained, covering the main pharmacological classes used in anesthetic procedures in patients classified as at risk, that is, cardiopath, nephropath, liver disease, pediatric and senile patients, trying to determine those that cause less cardiovascular and respiratory depression respecting their limitations. Therefore, for safer anesthesia, focus must placed on preventing anesthetic complications in the intraoperative and postoperative periods. Observing, studying, analyzing the patient and the protocol to be used as a whole is necessary and indispensable in veterinary anesthesia, associating theory with practice.

Anestesia em pacientes de risco: um abordagem anestésica aos pacientes cardiopatas, nefropatas, hepatopatas, pediátricos e senis / Anesthesia in high-risk patients: an anesthetic approach to cardiac, nephropathic, hepatic, pediatric and senile patients

Este trabalho visa, por meio de levantamento de dados científicos, analisar a melhor abordagem anestésica para cada tipo de paciente de risco, mostrando um panorama geral e indicativo sobre os fármacos e sua funcionalidade para cada sistema. A revisão bibliográfica foi baseada na literatura encontrada em meios eletrônicos (plataformas PubMed, Scielo e Google Scholar) e físicos (livros de referência) nos últimos dez anos, dentro de artigos com relatos de caso, revisões de literatura e pesquisas inéditas. Dessa forma, obteve-se um levantamento amplo, abrangendo as principais classes farmacológicas utilizadas em procedimentos anestésicos em pacientes classificados como de risco, ou seja, cardiopatas, nefropatas, hepatopatas, pediátricos e senis, procurando determinar os que causam menor depressão cardiovascular e respiratória respeitando suas limitações. Sendo assim, para uma anestesia mais segura deve-se focar na prevenção de intercorrências anestésicas no transoperatório e pós-operatório. Observar, estudar, analisar o paciente e o protocolo a ser utilizado como um todo é necessário e indispensável na anestesiologia veterinária, associando a teoria com a prática.(AU)

This work aims, through research, with scientific data, to analyze the best anesthetic approach for each type of patient, showing a general and indicative overview about the drugs and their functionality for each system. The bibliographic review was based on the literature found in electronic media (PubMed, Scielo and Google Scholar platforms) and physical (reference books) in the last ten years, within articles with case reports, literature reviews and unpublished research. Thus, a broad survey was obtained, covering the main pharmacological classes used in anesthetic procedures in patients classified as at risk, that is, cardiopath, nephropath, liver disease, pediatric and senile patients, trying to determine those that cause less cardiovascular and respiratory depression respecting their limitations. Therefore, for safer anesthesia, focus must placed on preventing anesthetic complications in the intraoperative and postoperative periods. Observing, studying, analyzing the patient and the protocol to be used as a whole is necessary and indispensable in veterinary anesthesia, associating theory with practice.(AU)

Encuesta Nacional sobre la utilización de catéter venoso central en pacientes sometidos a neurocirugía electiva en Chile / Use of central venous catheter in patients undergoing elective neurosurgery in Chile: A national survey

OBJECTIVES: To know, through an online survey, the usual clinical practice of Chilean anesthesiologists regarding central venous catheterization in patients undergoing elective neurosurgery. MATERIAL AND METHODS: An email was sent with a link to a questionnaire to anesthesiologists belonging to the Society of Anesthesiology of Chile (SACH). The questionnaire consisted of an anonymous questionnaire, with multiple-choice questions that included data referring to experience as an anesthesiologist, experience in neuroanesthesia, indication of central venous access in elective neurosurgery, access of choice, technique used, and immediate and late complications. RESULTS: A valid response was received to the online survey by 180 anesthesiologists, which represents a response rate of 50%. Only 14.4% of the respondents were classified as specialists in neuroanesthesia. The majority acces corresponded to the Internal Jugular. The main indication was the use of vasoactive drugs in 92.18%. Regarding clinical scenarios, 95.4% of respondents used a central venous route in posterior fossa surgery, while only 9.41% used it in minimally invasive surgery. 69.3% of the respondents indicated that they had presented an immediate complication related to the procedure, with arterial puncture being the most frequent with 72.1%. Protocols for perioperative management only existed in 17.8% of cases. There are no significant differences in the usual clinical practice among specialists in neuroanesthesia and general anesthesiologists in most of the items analyzed. CONCLUSIONS: From the data obtained, we observed that there is no uniform criterion in the indication, access and control of the central venous catheter in the context of elective neurosurgery. The foregoing could be explained by the scarce protocolization of anesthetic management in these surgeries. It is of interest to verify that there are no differences in clinical practice among anesthesiologists specialized in this area and those unusual in neurosurgical procedures.

OBJETIVOS: Conocer por medio de una encuesta online la práctica clínica habitual de los anestesiólogos chilenos respecto a la cateterización venosa central en pacientes sometidos a neurocirugía de carácter electivo. MATERIAL Y MÉTODOS: Se envió un correo electrónico con un enlace a un cuestionario a anestesiólogos pertenecientes a la Sociedad de Anestesiología de Chile (SACH). La encuesta consistía en un cuestionario de carácter anónimo, con preguntas de selección múltiple que incluía datos referidos a la experiencia como anestesiólogo, experiencia en neuroanestesia, indicación de vía venosa central en neurocirugía electiva, acceso de elección, técnica utilizada y complicaciones inmediatas y tardías. RESULTADOS: Se recibió respuesta válida a la encuesta online por parte de 180 anestesiólogos, lo que representa una tasa de respuesta del 50%. Sólo el 14,4% de los encuestados son catalogados como especialistas en neuroanestesia. La vía de acceso de elección corresponde a la Yugular Interna con un 66,8% de las preferencias. La principal indicación señalada para su utilización fue el uso de drogas vasoactivas en un 92,18% de los casos. Respecto a escenarios clínicos el 95,4% de los encuestados utiliza una vía venosa central en cirugía de fosa posterior, mientras que sólo el 9,41% la utiliza en cirugía mínimanente invasiva. El 69,3% de los encuestados indica haber presentado alguna vez una complicación inmediata relacionada al procedimiento, siendo la punción arterial la más frecuente con un 72,1%. Protocolos para el manejo perioperatorio sólo existían en 17,8% de los casos. No existen diferencias significativas en la práctica clínica habitual entre los especialistas en neuroanestesia y anestesiólogos poco habituados en neuroanestesia en la mayoría de los ítems analizados. CONCLUSIONES: A partir de los datos obtenidos por esta encuesta online, observamos que no existe un criterio uniforme en la indicación, vía de acceso y control del catéter venoso central en el contexto de la neurocirugía electiva. Lo anterior, podría explicarse por la escasa protocolización del manejo anestésico en estas cirugías. Es de interés comprobar que no existen grandes diferencias en la práctica clínica entre los anestesiólogos especialistas en esta área y aquellos poco habituales en procedimientos neuroquirúrgicos.

Profile of drug administration errors in anesthesia among anesthesiologists from Santa Catarina / Perfil de erros de administração de medicamentos em anestesia entre anestesiologistas catarinenses

INTRODUCTION: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. OBJECTIVE: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. MATERIALS AND METHODS: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors. RESULTS: Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%). CONCLUSION: Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity.

INTRODUÇÃO: A anestesiologia é a única especialidade médica que prescreve, dilui e administra os fármacos sem conferência de outro profissional. Somando-se a alta frequência de administração de fármacos, cria-se o cenário propício aos erros. OBJETIVO: Verificar a prevalência dos erros de administração de medicamentos durante anestesia, entre anestesiologistas catarinenses, as circunstâncias em que ocorreram e possíveis fatores associados. MATERIAIS E MÉTODOS: Um questionário eletrônico foi enviado a todos os anestesiologistas da Sociedade de Anestesiologia do Estado de Santa Catarina contendo respostas diretas ou de múltipla escolha sobre dados demográficos e perfil da prática anestésica do entrevistado; prevalência de erros, tipo e consequência do erro; e fatores que possivelmente contribuíram para os erros. RESULTADOS: Dos entrevistados, 91,8% afirmaram ter cometido erro de administração, somando total de erros de 274 e média de 4,7 (6,9) erros por entrevistado. O erro mais comum foi substituição (68,4%), seguido por erro de dose (49,1%) e omissão (35%). Apenas 7% dos entrevistados referiram erros de administração no neuroeixo. Quanto às circunstâncias dos erros, ocorreram principalmente no período matutino (32,7%), na manutenção da anestesia (49%), com 47,8% sem danos ao paciente e 1,75% com maior morbidade com dano irreversível e em 87,3% dos casos a identificação imediata. Quanto aos possíveis fatores contribuintes, os mais frequentes foram: distração e fadiga (64,9%) e leitura errada dos rótulos de ampolas ou seringas (54,4%). CONCLUSÃO: A maioria dos anestesiologistas entrevistados cometeu mais de um erro de administração em anestesia, principalmente justificado como distração ou fadiga, de baixa gravidade.

Profile of drug administration errors in anesthesia among anesthesiologists from Santa Catarina.

INTRODUCTION: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. OBJECTIVE: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. MATERIALS AND METHODS: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors. RESULTS: Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%). CONCLUSION: Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity.

Utilidad de un método estadístico desimulación para evaluar la oferta y demanda de anestesiólogos en Uruguay (2011-2025): propuesta para prospección y planificación de necesidadde recursos humanos en Anestesiología / Usefulness of statistical simulation to assess supply and demand for anesthesiologists in Uruguay (2011-2025): a proposal for research and planning the need for human resources in Anesthesiology

Introducción: existe una crisis de recursos humanos en Anestesiología que afecta fundamentalmente al subsectorpúblico. Objetivos: el propósito del presente estudio fue estimar el déficit o superávit actual de anestesistas tomando como año base el 2011 y analizarlo en base a técnicas de simulación estadística hasta el 2025.Material y método: se caracterizó la oferta/demanda de anestesiólogos creando diferentes escenarios de acuerdo a los datos obtenidos por el Ministerio de Salud Pública en el año 2010 y por el Censo Nacional del 2011. Esta información se integró generando un modelo de simulación mediante lametodología de dinámica de sistemas. Esta permite realizar análisis de sensibilidad: incorporar diferentes escenarios y ver cómo impacta en la evolución del modelo año a año.Resultados: para un escenario de 11,28 anestesiólogos por cada 100.000 habitantes, el déficit se cerraría en el 2015. Manteniendo el número de residentes en 80, al finalizar el período se alcanzaría un excedente de 50 (12,7/100.000). Esto contemplaría las proyecciones del aumento de cirugías. Para una demanda mayor y superior a la media de los países desarrollados (15 cada 100.000) sería necesario incrementar la formación a 113 residentes. Una de las principales limitaciones en la aplicación del modelo fue la falta de organización apropiada del trabajo anestesiológico.Conclusión: el modelo permitió establecer proyecciones de las necesidades de recursos humanos año a año; estas estimaciones pueden adaptarse frente a situaciones cambiantes y de esta forma elaborar un plan de formación de recursos humanos en anestesia acorde a estos.

Introduction: there is a human resource shortage in Anesthesiology that mainly affects the public sub-sector.Objectives: the study aimed at estimating the current deficit or surplus of anesthesiologists. It considered 2011 as a baseline and used statistical simulation to analyse the situation until 2025.Method: the supply/demand of anesthesiologist was categorized by creating different scenarios according to the data collected from the Ministry of Public Health in 2010 and the National Census of 2011. This information was integrated and a simulation model wascreated by the system dynamics method. This method allows for the analysis of sensitivity: to incorporate different scenarios and study their impact on the modelÆs evolution every year.Results: deficit would disappear in a scenario with 11.28 anesthesiologists every 100,000 inhabitants. If the number of residents remains stable in 80, there would be a 50 surplus towards the end of the period (12.7 /100,000). These figures contemplate projectionsfor the increase of surgeries. In the event of a demand that is larger and greater than the average in developedcountries (15 every 100,000) it would be necessary to train as many as 113 residents. One of the main limitations for the application of the model was the absence of an appropriate organization of the practice of anesthesiology.Conclusion: the model enabled to project the need of human resources for every year. These estimates may be adapted to changing situations and thus, allows for the design of a plan to train human resources in anesthesiology to meet needs.

Introdução: existe uma crise de recursos humanos em Anestesiologia que afeta fundamentalmente o subsetorpúblico.Objetivos: o propósito deste estudo é estimar o déficit ou superávit atual de anestesistas através de uma análise que utiliza técnicas de simulação estatística para fazer uma projeção até o ano 2025 considerando 2011 como ano base.Material e método: a oferta/demanda de anestesistas foi simulada criando diferentes situações de acordo com os dados obtidos pelo Ministério de Saúde Pública em 2010 e pelo Censo Nacional de 2011. Esta informação foi integrada gerando um modelo de simulação queutiliza dinâmica de sistemas. Dessa forma se pode fazer uma análise de sensibilidade: incorporar diferentes situações e conhecer seu impacto na evolução do modelo a cada ano.Resultados: considerando uma situação com 11,28 anestesistas por cada 100.000 habitantes, o déficit terminaria em 2015. Mantendo o número de residentes em 80, um excedente de 50 (12,7/100.000) seria alcançado nofim do período, considerando as projeções de aumento de cirurgias. Para uma demanda maior e superior à média dos países desenvolvidos (15 cada 100.000) seria necessário aumentar a formação a 113 residentes. Uma dasprincipais limitações da aplicação do modelo é a falta de uma organização apropriada do trabalho em anestesiologia.Conclusão: o modelo permitiu estabelecer projeções das necessidades de recursos humanos ano a ano; estas estimativas podem ser adaptadas para diferentes situações e dessa maneira elaborar um plano de formação de recursos humanos em anestesia de acordo com essas previsões.

Utilidad de un método estadístico desimulación para evaluar la oferta y demanda de anestesiólogos en Uruguay (2011-2025): propuesta para prospección y planificación de necesidadde recursos humanos en Anestesiología / Usefulness of statistical simulation to assess supply and demand for anesthesiologists in Uruguay (2011-2025): a proposal for research and planning the need for human resources in Anesthesiology

Introducción: existe una crisis de recursos humanos en Anestesiología que afecta fundamentalmente al subsectorpúblico. Objetivos: el propósito del presente estudio fue estimar el déficit o superávit actual de anestesistas tomando como año base el 2011 y analizarlo en base a técnicas de simulación estadística hasta el 2025.Material y método: se caracterizó la oferta/demanda de anestesiólogos creando diferentes escenarios de acuerdo a los datos obtenidos por el Ministerio de Salud Pública en el año 2010 y por el Censo Nacional del 2011. Esta información se integró generando un modelo de simulación mediante lametodología de dinámica de sistemas. Esta permite realizar análisis de sensibilidad: incorporar diferentes escenarios y ver cómo impacta en la evolución del modelo año a año.Resultados: para un escenario de 11,28 anestesiólogos por cada 100.000 habitantes, el déficit se cerraría en el 2015. Manteniendo el número de residentes en 80, al finalizar el período se alcanzaría un excedente de 50 (12,7/100.000). Esto contemplaría las proyecciones del aumento de cirugías. Para una demanda mayor y superior a la media de los países desarrollados (15 cada 100.000) sería necesario incrementar la formación a 113 residentes. Una de las principales limitaciones en la aplicación del modelo fue la falta de organización apropiada del trabajo anestesiológico.Conclusión: el modelo permitió establecer proyecciones de las necesidades de recursos humanos año a año; estas estimaciones pueden adaptarse frente a situaciones cambiantes y de esta forma elaborar un plan de formación de recursos humanos en anestesia acorde a estos. (AU)

Introduction: there is a human resource shortage in Anesthesiology that mainly affects the public sub-sector.Objectives: the study aimed at estimating the current deficit or surplus of anesthesiologists. It considered 2011 as a baseline and used statistical simulation to analyse the situation until 2025.Method: the supply/demand of anesthesiologist was categorized by creating different scenarios according to the data collected from the Ministry of Public Health in 2010 and the National Census of 2011. This information was integrated and a simulation model wascreated by the system dynamics method. This method allows for the analysis of sensitivity: to incorporate different scenarios and study their impact on the models evolution every year.Results: deficit would disappear in a scenario with 11.28 anesthesiologists every 100,000 inhabitants. If the number of residents remains stable in 80, there would be a 50 surplus towards the end of the period (12.7 /100,000). These figures contemplate projectionsfor the increase of surgeries. In the event of a demand that is larger and greater than the average in developedcountries (15 every 100,000) it would be necessary to train as many as 113 residents. One of the main limitations for the application of the model was the absence of an appropriate organization of the practice of anesthesiology.Conclusion: the model enabled to project the need of human resources for every year. These estimates may be adapted to changing situations and thus, allows for the design of a plan to train human resources in anesthesiology to meet needs.

Introduçäo: existe uma crise de recursos humanos em Anestesiologia que afeta fundamentalmente o subsetorpúblico.Objetivos: o propósito deste estudo é estimar o déficit ou superávit atual de anestesistas através de uma análise que utiliza técnicas de simulaçäo estatística para fazer uma projeçäo até o ano 2025 considerando 2011 como ano base.Material e método: a oferta/demanda de anestesistas foi simulada criando diferentes situações de acordo com os dados obtidos pelo Ministério de Saúde Pública em 2010 e pelo Censo Nacional de 2011. Esta informaçäo foi integrada gerando um modelo de simulaçäo queutiliza dinâmica de sistemas. Dessa forma se pode fazer uma análise de sensibilidade: incorporar diferentes situações e conhecer seu impacto na evoluçäo do modelo a cada ano.Resultados: considerando uma situaçäo com 11,28 anestesistas por cada 100.000 habitantes, o déficit terminaria em 2015. Mantendo o número de residentes em 80, um excedente de 50 (12,7/100.000) seria alcançado nofim do período, considerando as projeções de aumento de cirurgias. Para uma demanda maior e superior à média dos países desenvolvidos (15 cada 100.000) seria necessário aumentar a formaçäo a 113 residentes. Uma dasprincipais limitações da aplicaçäo do modelo é a falta de uma organizaçäo apropriada do trabalho em anestesiologia.Conclusäo: o modelo permitiu estabelecer projeções das necessidades de recursos humanos ano a ano; estas estimativas podem ser adaptadas para diferentes situações e dessa maneira elaborar um plano de formaçäo de recursos humanos em anestesia de acordo com essas previsões.

Surgical and anesthesia capacity in Bolivian public hospitals: results from a national hospital survey.

BACKGROUND: Underdeveloped nations suffer from significant deficiencies in surgical and anesthesia care. Although surgical inequities are a pressing issue internationally, the extent of these inequities is unknown due to a lack of data. The aim of this study was to assess surgical and anesthesia capacity in Bolivia as part of a multinational study assessing surgical and anesthesia infrastructure in Africa, Latin America, and South Asia. METHODS: A standardized survey tool was used to obtain national-level health-care data at the Bolivian Ministry of Health. Hospital-specific data were obtained through interviews with key administrators and providers at 18 public basic and general hospitals in Bolivia. RESULTS: There are 1,270 obstetrician/gynecologists and 1,807 surgeons in Bolivia. In contrast, there are 500 anesthesiologists, placing a large anesthesia burden on the country. Basic hospitals and general hospitals performed an average of 730 and 2,858 operations per year, respectively. One basic hospital was unable to perform any surgeries due to a lack of surgical manpower. All but two hospitals reported some lack of infrastructure, equipment, or pharmaceutical capacity. The ability to collect health outcomes was inconsistent in most hospitals. CONCLUSIONS: Surgical capacity varies throughout Bolivia. There are relatively large numbers of surgery providers but an insufficient number of anesthesiologists, suggesting a specific need for further development in anesthesia. Though there are many areas of strength within the Bolivian public health-care system, this survey identified several areas to which national policy and international collaboration can contribute in order to more adequately address major causes of surgical morbidity and mortality.

Evaluation of the interest in the academic career of physicians specializing in anesthesiology.

BACKGROUND AND OBJECTIVES: A trend toward the lack of interest in academic careers has been observed in Medicine, including in the area of Anesthesiology. The objective of the present study was to research the interest of physicians specializing in Anesthesiology in following an academic career, as well as identify the determinant factors of this choice. METHOD: The present was a prospective and cross-sectional study. A simple probabilistic sample of physicians specializing in Anesthesiology was selected and a questionnaire was sent to each participant. The answers were submitted to uni and multivariate analyses to determine the frequency of academic predisposition in the sample and to determine the independent predictive factors of academic predisposition. RESULTS: A total of 155 questionnaires were analyzed (rate of response = 38.7%). Sixty-nine participants (44.5%) manifested their interest in following an academic career. The multivariate analysis identified the following as independent predictive factors of academic predisposition: attending the first year of specialization (OR = 2.52; 95% CI = 1.19 - 5.38); presenting a scientific work at medical event (OR = 3.78; 95% CI = 1.84 - 7.78) and being located in the southeast region (OR = 2.66; 95% CI = 1.31 - 5.39). CONCLUSIONS: A significant number of Brazilian physicians attending a specialization course demonstrated interest in following an academic career after the end of the course. In comparison with the probability of not manifesting academic predisposition, the physicians attending the first-year specialization course presented a 2.5-fold higher chance of manifesting interest in an academic career; those presenting a scientific work at a medical event had a 3.78-fold higher chance; those associated to Teaching Centers in the southeast region had a 2.66-fold higher chance of manifesting academic interest.

Avaliação do interesse na carreira acadêmica dos médicos em especialização em Anestesiologia / Evaluation of the interest in the academic career of physicians specializing in anesthesiology / Evaluación del interés en la carrera académica de los médicos en especialización en anestesiología

JUSTIFICATIVA E OBJETIVOS: Tem-se observado certa tendência à perda pelo interesse acadêmico nas diversas áreas da Medicina, inclusive Anestesiologia. O objetivo deste estudo foi pesquisar o interesse de médicos em especialização (ME) em Anestesiologia em seguir uma carreira acadêmica, bem como identificar os fatores determinantes dessa escolha. MÉTODO: O estudo foi prospectivo e transversal. Selecionou-se uma amostra probabilística simples de médicos em especialização em Anestesiologia. Um questionário foi enviado a cada participante. As respostas foram submetidas a análises uni e multivariadas para determinar a frequência de predisposição acadêmica na amostra e determinação dos fatores preditivos independentes de predisposição acadêmica. RESULTADOS: Foram analisados 155 questionários (taxa de resposta = 38,7 por cento). Sessenta e nove participantes (44,5 por cento) manifestaram interesse em seguir uma carreira acadêmica. A análise multivariada identificou como fatores independentes de previsão da predisposição acadêmica: estar cursando o primeiro ano do curso de especialização (razão de chances [RC] = 2,52; intervalo de 95 por cento de confiança [IC 95 por cento] = 1,19 - 5,38), ter apresentado trabalho científico em evento médico (RC = 3,78; IC 95 por cento = 1,84 - 7,78) e pertencer à região sudeste (RC = 2,66; IC 95 por cento = 1,31 - 5,39). CONCLUSÕES: Uma parcela significativa dos ME brasileiros demonstrou interesse em seguir carreira acadêmica após o término do curso de especialização. Em comparação com a probabilidade de não manifestar predisposição acadêmica, os médicos do primeiro ano do curso de especialização apresentam chances 2,5 vezes maiores de se manifestarem interessados em uma carreira acadêmica; apresentação de trabalho científico em eventos médicos aumentou essa chance em 3,78 vezes; pertencer a CETs da região sudeste aumentou em 2,66 vezes a chance manifestar interesse acadêmico.

BACKGROUND AND OBJECTIVES: A trend toward the lack of interest in academic careers has been observed in Medicine, including in the area of Anesthesiology. The objective of the present study was to research the interest of physicians specializing in Anesthesiology in following an academic career, as well as identify the determinant factors of this choice. METHOD: The present was a prospective and cross-sectional study. A simple probabilistic sample of physicians specializing in Anesthesiology was selected and a questionnaire was sent to each participant. The answers were submitted to uni and multivariate analyses to determine the frequency of academic predisposition in the sample and to determine the independent predictive factors of academic predisposition. RESULTS: A total of 155 questionnaires were analyzed (rate of response = 38.7 percent). Sixty-nine participants (44.5 percent) manifested their interest in following an academic career. The multivariate analysis identified the following as independent predictive factors of academic predisposition: attending the first year of specialization (OR = 2.52; 95 percent CI = 1.19 - 5.38); presenting a scientific work at medical event (OR = 3.78; 95 percent CI = 1.84 - 7.78) and being located in the southeast region (OR = 2.66; 95 percent CI = 1.31 - 5.39). CONCLUSIONS: A significant number of Brazilian physicians attending a specialization course demonstrated interest in following an academic career after the end of the course. In comparison with the probability of not manifesting academic predisposition, the physicians attending the firstyear specialization course presented a 2.5-fold higher chance of manifesting interest in an academic career; those presenting a scientific work at a medical event had a 3.78-fold higher chance; those associated to Teaching Centers in the southeast region had a 2.66-fold higher chance of manifesting academic interest.

JUSTIFICATIVA Y OBJETIVOS: Se ha venido observando una cierta tendencia a la pérdida del interés académico en las diversas áreas de la Medicina, incluso en la Anestesiología. El objetivo de este estudio fue investigar el interés de los médicos en especialización (ME) en Anestesiología, para continuar una carrera académica, como también identificar los factores determinantes de esa elección. MÉTODO: El estudio fue prospectivo y transversal. Se seleccionó una muestra probabilística sencilla de médicos en proceso de especialización en Anestesiología. Un cuestionario fue enviado a cada participante. Las respuestas se sometieron al análisis uni y multivariado para determinar la frecuencia de la predisposición académica en la muestra y determinar los factores predictivos independientes de predisposición académica. RESULTADOS: Fueron analizados 155 cuestionarios (tasa de respuesta = 38,7 por ciento). Sesenta y nueve participantes (un 44,5 por ciento), manifestaron interés en seguir una carrera académica. El análisis multivariado identificó como factores independientes de previsión de la predisposición académica: estar cursando el primer año del curso de especialización (razón de chances [RC] = 2,52; intervalo de un 95 por ciento de confianza [IC 95 por ciento] = 1,19 - 5,38), haber presentado un trabajo científico en un evento médico (RC = 3,78; IC 95 por ciento = 1,84 - 7,78) y pertenecer a la región sudeste (RC = 2,66; IC 95 por ciento = 1,31 - 5,39). CONCLUSIONES: Una parte significativa de los MEs brasileños demostró interés en seguir una carrera académica después del término del curso de especialización. En comparación con la probabilidad de no manifestar predisposición académica, los médicos del primer año del curso de especialización presentan chances 2,5 veces mayores de manifestarse interesados en una carrera académica. La presentación de un trabajo científico en eventos médicos aumentó esa chance en 3,78 veces. Pertenecer a CETs de la región sudeste aumentó en 2,66 veces el chance de manifestar interés académico.

[Use of nitrous oxide in Uruguay]. / Utilización de oxido nitroso en Uruguay.

BACKGROUND: Nitrous oxide (N2O) is a medicinal gas that has been used for anesthesia for over a century and a half. As evidence of the adverse effects of N2O have been contrasted with the good safety profiles of new anesthetic agents, use of the older gas has declined. OBJECTIVE: To describe and analyze the use of N2O for anesthesia in the Eastern Republic of Uruguay. To describe the use of other drugs for general anesthesia. METHODS: The study had 2 phases. In the first phase, information on the use of N2O and other drugs for general anesthesia was obtained from the medical records of a sample of patients who underwent surgery between November 2007 and November 2008 at nationally important hospitals. In the second phase 80 physician anesthesiologists were surveyed to obtain information on their reported use of N2O for general anesthesia. The respondents were found working during the first half of 2008. RESULTS: A total of 104 patients' records were read and 80 anesthesiologists were surveyed. We found that 31 (29.8%) patients received N2O during anesthesia. The survey showed that 62 (77.5%) of the anesthesiologists had used N2O in the last 6 months. Nine (50%) of the anesthesiologists who had not used N2O said their reason was that it was unavailable. The other 9 referred either to the risk of postoperative nausea and/or vomiting (n = 6) or the fact of having better alternatives (n = 9). CONCLUSION: This study shows that N2O is little used in current anesthesia practice. The tendency in Uruguay continues to be toward declining use.

[Anesthesiologist's aptitude for peri-operative detection and treatment of latex allergy]. / Aptitud del anestesiólogo para la detección y tratamiento perioperatorios de la alergia al látex.

BACKGROUND: Latex allergy is the second cause of perioperative anaphylaxis. Anesthesiologists play a key role in opportune identification of risk factors, as well as clinical diagnosis and therapeutic management. OBJECTIVE: To evaluate the anesthesiologists aptitude to identify and treat latex allergy. PARTICIPANTS AND METHODS: Sixty-six anesthesiologists from five general hospitals located at Guadalajara, Jalisco, Mexico, were evaluated. Aptitude was determined by applying a validated structured instrument. Aptitude levels were measured by using an ordinal scale. Comparisons were performed using Mann Whitney U test. RESULTS: Anesthesiologist's global aptitude ranged from -2 to 27 with a median of 8 (from a maximum value in the scale of 40); frequencies by each category of the scale were: Random 48 (72.7%), Very bad 11 (16.7%), Bad 4 (6.1%) and Medium only 3 (4.5%). Both Good and Very good categories registered no anesthesiologist. The relationship of this indicator with other variables did not reach statistical significance (KW 6.478; p = 0.16617). CONCLUSIONS: A suboptimal aptitude was identified among anesthesiologists regarding identification of latex allergy. A need to establish new strategies for educative intervention in order to improve this issue was identified.

Nivel sensitivo calculado vs. observado en anestesia peridural con bupivacaína.Estudio de concordancia / Sensitive level calculated versus. observed in peridural anesthesia with bupivacaína. Study of agreement

Objetivos: Este estudio fue diseñado para evaluar la concordancia entre nivel sensitivo esperado y observado, después de anestesia peridural con bupivacaína 0.5 por ciento y validar la ecuación que se usa rutinariamente para calcular la dosis (volumen) a administrar. Métodos: Estudio prospectivo de concordancia - conformidad. Participantes: 77 pacientes de ambos sexos, mayores de 17 años, programados para cirugía abdominal y de miembros inferiores, en el Hospital Universitario de San Ignacio, bajo anestesia peridural con bupivacaína 0.5 por ciento. El volumen total de dosis para obtener un nivel sensitivo determinado, se calculó con la fórmula (7.8 menos (edad Multiplicando por 0.03) Multiplicando por No. metámeras) Dividido entre 5 y después de 30 minutos de administrada esta dosis se verificó el nivel sensitivo obtenido en el paciente. Resultados: Los límites de concordancia del 95 por ciento fueron evaluados, encontrando una diferencia promedio de 2.23 metámeras con límites de (Negativo)2.39 y 6.84. 50 por ciento El de los pacientes tuvieron una desviación de al menos 2 metámeras por encima del nivel esperado y algunos pacientes tuvieron una desviación de hasta 9 metámeras. Conclusión: La concordancia entre nivel esperado y nivel observado es muy pobre cuando se calcula el volumen de dosis de bupivacaína 0.5 por ciento...

Performance of a pediatric ambulatory anesthesia program--a developing country experience.

BACKGROUND: The aim of this study was to evaluate the performance of a pediatric ambulatory anesthesia program in a tertiary care teaching hospital in a developing country. METHODS: Data on all pediatric patients (<16 years of age) scheduled to have elective day-care surgery during a 1 year period from January 1999 to December 1999 were collected retrospectively. An audit form was used to determine the specialty of the procedures, anesthesia techniques, postoperative analgesia, perioperative complications, unplanned admissions and outcomes with respect to morbidity and mortality. RESULTS: A total of 763 pediatric ambulatory surgical procedures were performed during the year of 1999. The procedures included general surgery, ENT, orthopedic and plastic surgery. The most common procedure was inguinal hernia repair followed by umbilical hernia repair, adenotonsillectomy and circumcision and 96% of the patients had general anesthesia. There were only three unplanned admissions (0.4%); one for a surgical reason and two for anesthetic reasons. There was no serious morbidity or mortality in any patient. CONCLUSIONS: Performance of pediatric day-care anesthesia has been good in our day-care unit and we have a successful ambulatory surgery program, despite the limitations of a developing country.

[Prevalence of latex hypersensitivity in operating room workers of the University of Chile Clinical Hospital]. / Prevalencia de sensibilización a látex en personal de pabellones quirúrgicos del Hospital Clínico de la Universidad de Chile.

BACKGROUND: Health care workers (HCW) are a high risk group for developing natural rubber latex (NRL) hypersensitivity and allergy. Some studies showed a correlation between time and frequency of exposure to NRL gloves and hypersensitivity, but a recent meta-analysis showed no clear evidences for such assumption. AIM: To determine the prevalence of NRL hypersensitivity and allergy in a group of HCW at the University of Chile Clinical Hospital. MATERIALS AND METHODS: Ninety five HCW (aged 37+/-10 years, 59 females) were interviewed about time of exposure, atopic diseases and latex-related allergy symptoms. Different NRL extracts and seven NRL gloves brands were tested by the prick test method. RESULTS: Twenty four workers (25%, 95% CI = 16.9%-35.2%) were sensitized. No gender differences were found. No symptomatic cases were found in the sensitized group. In the workplace, six and two non sensitized subjects had respiratory symptoms or contact urticaria, respectively. Sensitivity to bananas, avocadoes, kiwi and chestnut was not significantly more common among latex sensitive individuals. No differences between sensitized and non sensitized subjects were observed for the presence of atopic diseases or the mean number of years at the workplace. The sensitization rate to NRL increased along with years of work, from 18.6% in patients working less than 10 years, to 28.1% in the group between 10 and 20 years and to 35% in those working more than 21 years (p=0.693). Sensitization was also related to the weekly hours of exposure: 1-10 hours, 17%; 11-20 hours, 23.5%; 21-30 hours, 50% and 31-40 hours, 28.5% (p=0.036). CONCLUSIONS: Sensitization increased proportionally to the years and weekly hours wearing NLR gloves. We did not find symptomatic patients in the sensitized group.

Prevalencia de sensibilización a látex en personal de pabellones quirúrgicos del Hospital Clínico de la Universidad de Chile / Prevalence of latex hypersensitivity in operating room workers of the University of Chile Clinical Hospital

Background: Health care workers (HCW) are a high risk group for developing natural rubber latex (NRL) hypersensitivity and allergy. Some studies showed a correlation between time and frequency of exposure to NRL gloves and hypersensitivity, but a recent meta-analysis showed no clear evidences for such assumption. Aim: To determine the prevalence of NRL hypersensitivity and allergy in a group of HCW at the University of Chile Clinical Hospital. Materials and Methods: Ninety five HCW (aged 37±10 years, 59 females) were interviewed about time of exposure, atopic diseases and latex-related allergy symptoms. Different NRL extracts and seven NRL gloves brands were tested by the prick test method. Results: Twenty four workers (25%, 95% CI = 16.9%-35.2%) were sensitized. No gender differences were found. No symptomatic cases were found in the sensitized group. In the workplace, six and two non sensitized subjects had respiratory symptoms or contact urticaria, respectively. Sensitivity to bananas, avocadoes, kiwi and chestnut was not significantly more common among latex sensitive individuals. No differences between sensitized and non sensitized subjects were observed for the presence of atopic diseases or the mean number of years at the workplace. The sensitization rate to NRL increased along with years of work, from 18.6% in patients working less than 10 years, to 28.1% in the group between 10 and 20 years and to 35% in those working more than 21 years (p=0.693). Sensitization was also related to the weekly hours of exposure: 1-10 hours, 17%; 11-20 hours, 23.5%; 21-30 hours, 50% and 31-40 hours, 28.5% (p=0.036). Conclusions: Sensitization increased proportionally to the years and weekly hours wearing NLR gloves. We did not find symptomatic patients in the sensitized group.

La utilidad de la escala de ASA y de la radiografía de tórax como indicadores de riesgo cardiovascular perioperatorio / The uselfuness of the ASA Scala and Chest X-ray As indicators of perioperative cardiovascular risk

El objetivo del presente trabajo es evaluar la utilidad de las escalas más utilizadas en el riesgo peroperatorio, sin considerar a la gasometría arterial. Con los resultados obtenidos en este estudio, proponemos conjuntar la escala de la Asociación Americana de Anestesiología (ASA), el diagnóstico radiográfico de EPOC con el índice de riesgo multifactorial de Goldman. Esta estrategia incrmenta lacerteza diagnóstica propia del índice de Goldman, es práctica, no implica mayor costo y permite obtener una mayor graduación del riesgo de morbilidad cardiovascular perioperatoria