Estudio de la prevalencia y la caracterización del dolor postoperatorio inmediato en la Unidad de Recuperación Postanestésica / Prevalence and characterization of postoperative pain in the Postanaesthesia Care Unit

Introducción. El dolor postoperatorio inmediato es aquel que se produce inmediatamente tras la cirugía, mientras el paciente permanece en la Unidad de Recuperación Postanestésica. Son pocos los estudios que evalúan y caracterizan el dolor postoperatorio en esta fase tan temprana. Objetivo. Estudio transversal de la prevalencia y las características del dolor postoperatorio inmediato. Material y métodos. Se analizaron 503 pacientes entre agosto de 2014 y febrero de 2015 que ingresaron en la Unidad de Recuperación Postanestésica. Se usó la escala visual analógica (EVA; rango 0-10) y se aplicó en 5 tiempos tras la cirugía, recogiéndose medidas procedentes del paciente y el investigador. Se analizaron los factores que influyen en la aparición y el mantenimiento del dolor (edad, sexo, tipo de cirugía, tipo de anestesia y analgesia), la variación de las constantes vitales y los efectos secundarios. Resultados. Globalmente, la media de la EVA valorada por el paciente fue 2,2±2,8. El tiempo de dolor más intenso fue a los 20min de llegar a la Unidad de Recuperación Postanestésica (p<0,001). Los valores de EVA del investigador (1,4±2,0) fueron inferiores a los del paciente, con buena correlación (R2=0,82; p<0,001) y distribución paralela aunque con concordancia moderada (kappa = 0,4). Cirugía plástica y neurocirugía fueron las especialidades con valores de EVA superiores. Las técnicas de bloqueo regional registraron valores más bajos de EVA. El sexo masculino y la edad avanzada registraron valores de EVA inferiores (p < 0,001). Conclusiones. El estudio de las características del dolor postoperatorio inmediato permitiría una mejor gestión en la prevención del dolor postoperatorio. Ayudaría a predecir, de acuerdo con el tipo de cirugía y anestesia utilizada, aquellos pacientes en los que pueden aparecer valores más altos de EVA para adaptar la analgesia (AU)

Introduction. Immediate postoperative pain occurs initially after surgery, while the patient is in the Post-Anaesthesia Recovery Unit. Very few studies assess this pain in this most immediate phase. Objective. Cross-sectional study of the prevalence and characteristics of immediate postoperative pain in patients after surgery. Material and methods. Between August 2014 and February 2015, a sample of 503 patients from the Post-Anaesthesia Recovery Unit was followed. Immediate postoperative pain was assessed (by the patient and the researcher) using the visual analogue scale (VAS; range 0-10) on 5 occasions after surgery. The impact of numerous factors (age, gender, type of surgery, type of anaesthesia and analgesic) on the pain, as well as variation in vital signs and the presence of side effects, were analysed. Results. Assessment of the pain showed overall VAS values of 2.2±2.8 on all occasions. Pain was reported to be of greatest intensity 20min after the patients’ arrival in the Post-Anaesthesia Recovery Unit (P<.001). The VAS values reported by the researcher (1.4±2.0) were lower than those reported by the patients. Although there was a very strong correlation (R2=0.82; P<.001) and they followed a parallel distribution, there was moderate concordance (kappa=0.4). Plastic surgery and neurosurgery were the specialties with the highest percentages of VAS values in the strong intensity range (8-10). Patients with regional block techniques (with or without general anaesthesia) had lower VAS values than other general anaesthesia groups. Male patients and older patients displayed less pain than female and young patients, respectively (P<.001). Conclusions. Studying the characteristics of postoperative pain at such an early stage allows for improved management. It helps to predict, according to the type of surgery and the anaesthesia used, those patients in which higher VAS values may be seen and to better adapt analgesic therapy (AU)

Prevalence and characterization of postoperative pain in the Postanaesthesia Care Unit. / Estudio de la prevalencia y la caracterización del dolor postoperatorio inmediato en la Unidad de Recuperación Postanestésica.

INTRODUCTION: Immediate postoperative pain occurs initially after surgery, while the patient is in the Post-Anaesthesia Recovery Unit. Very few studies assess this pain in this most immediate phase. OBJECTIVE: Cross-sectional study of the prevalence and characteristics of immediate postoperative pain in patients after surgery. MATERIAL AND METHODS: Between August 2014 and February 2015, a sample of 503 patients from the Post-Anaesthesia Recovery Unit was followed. Immediate postoperative pain was assessed (by the patient and the researcher) using the visual analogue scale (VAS; range 0-10) on 5 occasions after surgery. The impact of numerous factors (age, gender, type of surgery, type of anaesthesia and analgesic) on the pain, as well as variation in vital signs and the presence of side effects, were analysed. RESULTS: Assessment of the pain showed overall VAS values of 2.2±2.8 on all occasions. Pain was reported to be of greatest intensity 20min after the patients' arrival in the Post-Anaesthesia Recovery Unit (P<.001). The VAS values reported by the researcher (1.4±2.0) were lower than those reported by the patients. Although there was a very strong correlation (R2=0.82; P<.001) and they followed a parallel distribution, there was moderate concordance (kappa=0.4). Plastic surgery and neurosurgery were the specialties with the highest percentages of VAS values in the strong intensity range (8-10). Patients with regional block techniques (with or without general anaesthesia) had lower VAS values than other general anaesthesia groups. Male patients and older patients displayed less pain than female and young patients, respectively (P<.001). CONCLUSIONS: Studying the characteristics of postoperative pain at such an early stage allows for improved management. It helps to predict, according to the type of surgery and the anaesthesia used, those patients in which higher VAS values may be seen and to better adapt analgesic therapy.

Influence of oxygen transfer on Pseudomonas putida effects on growth rate and biodesulfurization capacity.

The growth rate and desulfurization capacity accumulated by the cells during the growth of Pseudomonas putida KTH2 under different oxygen transfer conditions in a stirred and sparged tank bioreactor have been studied. Hydrodynamic conditions were changed using different agitation conditions. During the culture, several magnitudes associated to growth, such as the specific growth rate, the dissolved oxygen concentration and the carbon source consumption have been measured. Experimental results indicate that cultures are influenced by the fluid dynamic conditions into the bioreactor. An increase in the stirrer speed from 400 to 700 rpm has a positive influence on the cell growth rate. Nevertheless, the increase of agitation from 700 to 2000 rpm hardly has any influence on the growth rate. The effect of fluid dynamics on the cells development of the biodesulfurization (BDS) capacity of the cells during growth is different. The activities of the intracellular enzymes involved in the 4S pathway change with dissolved oxygen concentration. The enzyme activities have been evaluated in cells at several growth time and different hydrodynamic conditions. An increase of the agitation from 100 to 300 rpm has a positive influence on the development of the overall BDS capacity of the cells during growth. This capacity shows a decrease for higher stirrer speeds and the activity of the enzymes monooxygenases DszC and DszA decreases dramatically. The highest value of the activity of DszB enzyme was obtained with cells cultured at 100 rpm, while this activity decreases when the stirrer speed was increased higher than this value.

The effect of hydrodynamic stress on the growth of Xanthomonas campestris cultures in a stirred and sparged tank bioreactor.

The specific growth and the xanthan production rates by the bacterium Xanthomonas campestris under different shear levels in shake flasks and in a stirred and sparged tank bioreactor have been studied. The shake flask has been used as a reference for studying the shear effects. An effectiveness factor expressed by the ratio of the observed growth rate and the growth rate without oxygen limitation or cell damage was calculated in both modes of cultures. It was observed that the effectiveness factor was strongly dependent on the operational conditions. A strong oxygen transfer limitation at low stirring rates, indicated by a 54 % decrease in the effectiveness factor was observed. In contrast, at higher stirrer speed, cell damage was caused by hydrodynamic stress in the turbulent bulk of the broth, yielding again a decrease in the effectiveness factor values for stirrer speeds higher than 500 rpm. Cell morphological changes were also observed depending on the agitation conditions, differences in morphology being evident at high shear stress.

[Neuroanesthetic practice in Catalonia. Results of a survey done on 2003]. / Intervenciones neuroquirúrgicas en Cataluña. Resultados de una encuesta anestésica durante 2003.

INTRODUCTION: Health system planning requires the precise knowledge of the activity performed. We present the neuroanesthesic activity results in Catalonia during 2003. METHODS: A prospective and cross-sectional survey was performed for 14 randomised days during 2003. All hospitals practicing anaesthesia in Catalonia took part in the survey. Data on characteristics of patients, anaesthetic techniques and type of procedure were included. RESULTS: 6909 neuroanesthetic procedures performed in Catalonia in 2003 (95% IC 6022-7847), a 1.28% of total surgical activity. A 74% of procedures were done in the public hospitals and a 26% in private hospitals. Patients mean age was 48 years old (95% IC 45.5-50.6). Scheduled procedures were 79.7%. The most frequent interventions were: Spine surgery 40.1 %; craniotomies for tumour resection 24.1%, for haemorrhage o trauma 7.2% and for aneurysms or AVM surgery 2.3%; ventricular shunts 2.6%. Mean duration of craneotomies for tumour resection was 287 -/+95 min. All patients were distributed postoperatively in a conventional recovery room (55.8 %), in a monitored care unit (19.2%) or in an intensive care unit (24.9 %). Craniotomy patients were admitted to an intensive care unit (41.6%), a monitored care unit (33.7%) or a conventional recovery room (24.7%). CONCLUSIONS: About seven thousand Neurosurgical procedures were performed in Catalonia in 2003, in public (73.6%) and private (26.4%) hospitals. Spine surgery and craniotomies for tumour resection were the most frequently performed interventions. Craniotomy patients were mainly submitted to an ICU or a Monitored care unit.

Intervenciones neuroquirúrgicas en Cataluña. Resultados de una encuesta anestésica durante 2003 / Neuroanesthetic practice in Catalonia. Results of a survey done on 2003

Introducción. La planificación sanitaria requiere el conocimiento preciso de la actividad desarrollada. Presentamos los resultados de la actividad neuroanestésica en Cataluña en 2003.Material y métodos. Encuesta prospectiva y transversal realizada en 14 días aleatorizados del 2003. Participaron todos los hospitales que practicaban anestesia en Cataluña. Se incluyeron datos sobre las características de los pacientes, técnicas anestésicas y tipo de procedimiento. Resultados. Se recogieron un total de 265 procedimientos neuroanestésicos, representando el 1,28% del total de cirugías. Los datos permiten extrapolar que se realizaron 6.909 procedimientos neuroanestésicos en toda Cataluña durante el año 2003 (95% IC 6022-7847). El 74% de los procedimientos se realizaron en hospitales públicos y el 26% en hospitales privados. La edad media de los pacientes fue de 48 años (IC 95%45,5-50,6). Los procedimientos programados fueron el 79,7%. Las intervenciones más frecuentes fueron: cirugía de columna (40,1%), craneotomía para la resección de tumor (24,1%), craneotomía por hemorragia o trauma (7,2%), craneotomía para clipaje de aneurisma o cirugía de malformación arterio-venosa(MAV) (2,3%) y la derivación ventricular (2,6%). La duración media de las craneotomías para resección de tumor fue de 287± 95 min. Los pacientes fueron controlados postoperatoriamente en una sala de recuperación convencional (55,8%), en una unidad de cuidados monitorizado (19,2%) o en una unidad de cuidados intensivos (24,9%). Los pacientes tras craneotomía fueron admitidos principalmente en una unidad de cuidados intensivos (41,6%) o en una unidad de vigilancia monitorizada (33,7%).Conclusiones. Alrededor de siete mil procedimientos neuroanestésicos fueron realizados en Cataluña en el2003, el 74% de los cuales se realizaron en hospitales públicos y el 26% en hospitales privados. La cirugía de columna y la craneotomía para resección de tumores fueron las intervenciones más frecuentes. Los pacientes con craneotomía fueron remitidos principalmente a la UCI o a unidades de vigilancia monitorizada en el postoperatorio inmediato

Introduction. Health system planning requires the precise knowledge of the activity performed. We present the neuroanesthesic activity results in Catalonia during 2003.Methods. A prospective and cross-sectional survey was performed for 14 randomised days during 2003.All hospitals practicing anaesthesia in Catalonia took part in the survey. Data on characteristics of patients, anaesthetic techniques and type of procedure were included. Results. 6909 neuroanesthetic procedures performed in Catalonia in 2003 (95% IC 6022-7847), a 1.28% of total surgical activity. A 74% of procedures were done in the public hospitals and a 26% in private hospitals. Patients mean age was 48 years old (95% IC 45.5-50.6).Scheduled procedures were 79.7%. The most frequent interventions were: Spine surgery 40.1 %; craniotomies for tumour resection 24.1%, for haemorrhage o trauma 7.2% and for aneurysms or AVM surgery 2.3%; ventricular shunts 2.6%. Mean duration of craniotomies for tumour resection was 287 ± 95 min. All patients were distributed postoperatively in a conventional recovery room (55.8 %), in a monitored care unit (19.2%) or in an intensive care unit (24.9 %). Craniotomy patients were admitted to an intensive care unit (41.6%), a monitored care unit (33.7%) or a conventional recovery room (24.7%).Conclusions. About seven thousand Neurosurgical procedures were performed in Catalonia in 2003, in public (73.6%) and private (26.4%) hospitals. Spine surgery and craniotomies for tumour resection were the most frequently performed interventions. Craniotomy patients were mainly submitted to an ICU or a Monitored care unit

Reflexión sobre la situación actual de los tutores docentes y la docencia de anestesiología y reanimación en nuestro país / No disponible

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[Anaphylaxis and anaphylactic shock]. / Anafilaxia y choque anafiláctico.

Term anaphylaxis means an immediate hypersensitivity reaction mediated by IgE that produces a clinical syndrome with systemic affection of variable severity. Its prevalence varies according to the habits of each region and of the studied population from 3.2 to 7.6 cases per 100,000 inhabitants per year. Anaphylaxis secondary to the food ingestion accounts for 30-50% of the cases. Some risk factors have been defined, among them the most important are asthma, food allergy and previous reactions to the same food. Biphasic anaphylactic reactions are those presenting a recurrence of anaphylactic symptoms, after the initial remission of them. Success of treatment is based on the early recognition of signs and symptoms and the instauration of treatment with adrenaline.

Noninvasive versus invasive microbial investigation in ventilator-associated pneumonia: evaluation of outcome.

Noninvasive and invasive diagnostic techniques have been shown to achieve comparable performances in the evaluation of suspected ventilator-associated pneumonia (VAP). We studied the impact of both approaches on outcome in a prospective, open, and randomized study in three intensive care units (ICUs) of a 1,000-bed tertiary care university hospital. Patients with suspected VAP were randomly assigned to noninvasive (Group 1) versus invasive (Group 2) investigation (tracheobronchial aspirates [TBAS] versus bronchoscopically retrieved protected specimen brush [PSB] and bronchoalveolar lavage [BAL]. Samples were cultured quantitatively, and BAL fluid (BALF) was examined for intracellular organisms (ICO) additionally. Initial empiric antimicrobial treatment was administered following the guidelines of the American Thoracic Society (ATS) and adjusted according to culture results (and ICO counts in Group 2). Outcome variables included length of ICU stay and mechanical ventilation as well as mortality. Overall, 76 patients (39 noninvasive, 37 invasive) were investigated. VAP was microbiologically confirmed in 23 of 39 (59%) and 23 of 37 (62%) (p = 0.78). There were no differences with regard to the frequencies of community-acquired and potentially drug-resistant microorganisms (PDRM). Antimicrobial treatment was changed in seven patients (18%) of Group 1 and 10 patients (27%) of Group 2 because of etiologic findings (including five of 17 with ICO = 2% (p = not significant [NS]). Length of ICU stay and mechanical ventilation were also not significantly different in both groups. Crude 30-d mortality was 31 of 76 (41%), and 18 of 39 (46%) in Group 1 and 14 of 37 (38%) in Group 2 (p = 0.46). Adjusted mortality was 16% versus 11% (p = 0.53), and mortality of microbiologically confirmed pneumonia 10 of 23 (44%) in both groups (p = 1.0). We conclude that the outcome of VAP was not influenced by the techniques used for microbial investigation.

Enfermedad herniaria en el ámbito sociolaboral marítimo / Impact of hernias on the activities of recreational and professional seamen

Introducción. Las hernias de la pared abdominal son muy frecuentes y su relación laboral y con el ejercicio físico importantes. En nuestro cupo atendemos a pacientes relacionados con el ámbito sociolaboral marítimo, lo que nos ha permitido estudiar la enfermedad herniaria en este tipo especial de población que desarrolla un esfuerzo físico importante. Pacientes y método. Seleccionamos a 122 pacientes laboralmente activos o cuya hernia apareció durante su vida laboral y que eran portadores de 132 hernias. Todos eran varones con una edad media de 53,5 años y el 46 por ciento de ellos era portador de alguna enfermedad asociada. La distribución de las 132 hernias intervenidas fue la siguiente: 76 por ciento hernias inguinales, 14 por ciento hernias umbilicales, 6 por ciento hernias incisionales, 2 por ciento hernias epigástricas y 2 por ciento hernias crurales. El 100 por ciento de los casos fueron intervenidos de forma reglada. A los 26 primeros casos se les realizó herniorrafia directa sin utilizar material protésico, efectuando herniorrafia sin tensión con malla de polipropileno en todos los restantes. Se realizó un seguimiento de un año. Resultados. De los 122 pacientes, el 74 por ciento desempeñaba su puesto de trabajo en la marina pesquera (40 por ciento en la pesca de bajura y 30 por ciento en la pesca de altura), el 14 por ciento en la marina mercante (13 por ciento navegación de cabotaje y 1 por ciento navegación oceánica) y el 16 por ciento restante en otros puestos relacionados con el ámbito marítimo. En lo que se refiere al puesto de trabajo dentro del buque, el 57 por ciento pertenecía a la marinería, el 20 por ciento trabajaban en la sala de máquinas, el 5 por ciento en el puente y el 18 por ciento realizaban otras funciones. No se presentaron complicaciones intraoperatorias en ningún caso, la mortalidad fue del 0 por ciento y la morbilidad del 9,8 por ciento. En los 20 pacientes a los que se les aplicó la técnica de Bassini se observaron molestias postoperatorias y una recidiva. En los pacientes a los que se les aplicó herniorrafia sin tensión con malla de polipropileno se apreció poco dolor postoperatorio, una reincorporación laboral sin incidencias al mes de la intervención y ninguna recidiva. Conclusiones. La enfermedad herniaria es la más frecuente en nuestro medio, y dentro de ella la hernia inguinal. La máxima frecuencia de aparición herniaria se relaciona con el grupo que realiza un trabajo físico más duro (marinería de cubierta de la pesca de bajura). La herniorrafia sin tensión con malla de polipropileno es una buena técnica para el tratamiento de la enfermedad herniaria en pacientes laboralmente activos (AU)

[The recognition of AIDS as a disabling pathology among the members of the Special Regime of the Sea in the province of Cádiz]. / Incorporación del SIDA como patología invalidante en afiliados al Régimen Especial del Mar en la provincia de Cádiz.

OBJECTIVES: To identify the year in which AIDS appeared as a cause of permanent disability among the members of the Special Sea Regime (REM), and to evaluate the clinical, social and labour characteristics of AIDS patients between 1987 and 1996. DESIGN: Descriptive study of series of cases. SETTING: Cádiz Province, 1987 to 1996. PARTICIPANTS: Patients with a disability proposal report from the Provincial Medical Inspectorate of the ISM (Fleet Social Institute) in Cádiz province between 1987 and 1996. MAIN RESULTS: AIDS appeared as the cause of permanent disability for the first time in 1988. 1994 and 1995 were the years with most cases. Over 90% of the reports of permanent disability analysed, in which AIDS appeared as the cause, belonged to workers professionally classed as sailors. AIDS is a highly disabling disease and accounted for 13.26% of all absolute permanent disabilities. The risk conduct of patients for whom a disability proposal was made was rarely recorded in the reports, which made it impossible to specify it in most cases. CONCLUSIONS: There must be health education and preventive counselling of REM members who attend the Maritime Health Service for their compulsory pre-embarkation check-up.

Intracellular compounds quantification by means of flow cytometry in bacteria: application to xanthan production by Xanthomonas campestris.

The use of flow cytometry (FCM) to quantitatively analyze intracellular compounds is studied. FCM is a very useful technique for individual cell studies in microbial systems, and gives access to information which cannot be obtained in any other way. Nevertheless, it provides data in arbitrary units, that is, relative data. This analytical technique could be employed for kinetic modeling of microbial systems and even for internal phenomena analysis, but for this purpose, absolute data-that is concentration of intracellular compounds-must be used. In this work, relative flow cytometry data are transformed into absolute data by means of calibrations employing the same fluorochromes with another technique: spectrofluorymetry. Calibrations of DNA, RNA, and protein intracellular concentrations are presented for the bacteria, Xanthomonas campestris. Other analytical methods, based on biochemical determinations, were also employed to quantify intracellular compounds, but the results obtained are very poor compared with those achieved by means of spectrofluorymetry (SFM). Calibration equations and data obtained by both techniques are given. Evolutions of protein and nucleic acids during Xanthomonas campestris growth and xanthan gum production are shown.

[The gastrointestinal changes in dystrophia myotonica]. / Alteraciones gastrointestinales en la distrofia miotónica.

Myotonic dystrophy is a multisystemic disorder inherited as an autosomal dominant trait. The secondary gastrointestinal disturbances are not well recognized. Two cases of myotonic dystrophy in a 51-year-old and 39-year-old woman with gastrointestinal symptoms disturbances are reported. One patient presented motor dysfunction in the colon and esophagus, organoaxial gastric volvulus and cholestasis. The second patient developed an acute colonic pseudo-obstruction. The patient improved with cisapride. The digestive manifestations of myotonic dystrophy and the treatment are reviewed.

Effects of omeprazole, ranitidine, famotidine and placebo on gastric secretion in patients undergoing elective surgery.

We have compared the effects of omeprazole, ranitidine, famotidine and placebo on gastric secretion in a double-blind study in 110 patients undergoing elective surgery. Three hours before operation, the patients received, orally, omeprazole 40 mg, ranitidine 150 mg, famotidine 40 mg or placebo. Gastric volume and pH were measured immediately after induction of anaesthesia. Omeprazole, ranitidine and famotidine produced a significant increase in gastric pH and a significant decrease in gastric volume compared with placebo. When the effects of omeprazole on gastric volume were compared with those of ranitidine and famotidine, no significant difference was found, but omeprazole was significantly less effective in increasing gastric pH. The number of patients having a pH less than 2.5 and a volume greater than 0.4 ml kg-1 were: none in the ranitidine group, one (3%) in the famotidine group, four (15%) in the omeprazole group and six (23%) in the placebo group. We conclude that omeprazole 40 mg given 2-4 h before surgery does not afford adequate prophylaxis for the acid aspiration syndrome.

[Allergic reactions to local anesthetics]. / Reacciones alérgicas a los anestésicos locales.

We studied 35 patients which had been sent by various specialists to the Allergy department of a general hospital because they had an adverse reaction to some type of local anesthetic. The subjects underwent three types of tests: a prick test, an intradermoreaction test and a provocation test using three local anesthetics: procaine 2%, lidocaine 2%, mepivacaine 1% with no vasoconstrictors or parabens in order to rule out the possibility that the reaction was due to these substances rather than the local anaesthetic being tested. The results indicated that both the prick test and the provocation test of the local anesthetics included in the study were negative for all of the patients. One patient who had an adverse reaction to Hostacain was tested with that same anesthetic. The patient tested positive in the intradermoreaction test with a 1/10 solution but was not able to be tested with a solution free of parabens due to lack of availability. The results of our study coincide with the bibliographic research done in that real allergic reactions to local anesthetics are infrequent. The methodology used effectively distinguishes those patients with a risk of real allergic reactions there by indicating to the physician the safest local anesthetic for the patient.