Valoración del Euroscore y SAPS III como predictor de mortalidad hospitalaria en el postoperatorio de cirugía cardiaca / Assessment of Euroscore and SAPS III as hospital mortality predicted in cardiac surgery

Objetivos. Realizar una validación externa del Euroscore I, Euroscore II y SAPS III. Pacientes y método. Estudio de cohorte retrospectivo durante 3 años de todos los pacientes adultos intervenidos de cirugía cardiaca. Se revisó la historia clínica siguiendo al paciente hasta el alta hospitalaria (vivo, muerto). Se calcularon las mortalidades predichas por el Euroscore I (EI), II (EII) y SAPS III. La validación de los modelos se determinó mediante la discriminación mediante el área bajo la curva ROC y la calibración mediante el test de Hosmer-Lemeshow. Resultados. Ochocientos sesenta y seis pacientes incluidos, el 62,5% varones, con una edad mediana de 69 años. El 6,1% falleció durante su ingreso hospitalario. Mortalidad predicha: EI 7,94%, EII 3,54, SAPS III 12,1%. Área bajo la curva (IC 95%): EI 0,862 (0,812-0,912); EII 0,861 (0,806-0,915); SAPS III 0,692 (0,601-0,784). Prueba de Hosmer-Lemeshow: EI 14,0046 (p=0,08164); EII 33,67 (p=0,00004660); SAPS III 11,57 (p=0,171). Conclusiones. el EII presentó una discriminación adecuada, aunque la calibración no fue apropiada con cifras de mortalidad predicha menores a la real. El EI mostró la mejor discriminación con una calibración adecuada y una tendencia a sobreestimar la mortalidad. El SAPS III ha mostrado mala discriminación con una calibración adecuada y una tendencia a aumentar exageradamente la predicción de la mortalidad. No hemos observado ninguna mejoría en el rendimiento predictivo del EII sobre el I y rechazamos la utilización del SAPS III en este tipo de enfermos (AU)

Objectives. To perform an external validation of Euroscore I, Euroscore II and SAPS III. Patients and method. Retrospective cohort study over three years on all adult patients who underwent cardiac surgery. We reviewed the clinical data, following the patient until outcome or discharge from hospital (dead, alive). We computed the predicted mortality by Euroscore I (EI), II (EII) and SAPS III. The model validation was assessed by discrimination: area under curve ROC; and calibration (Hosmer-Lemeshow test). Results. 866 patients were included. 62.5% of them male, with a median age of 69 years, 6.1% died during hospitalization. Predicted mortality: E I 7.94%, E II 3.54, SAPS III 12.1%. Area under curve (95% IC): E I 0.862 (0.812-0.912); E II 0.861 (0.806-0.915); SAPS III 0.692 (0.601-0.784). Hosmer-Lemeshow test: E I 14.0046 (P=.08164); E II 33.67 (P=.00004660); SAPS III 11.57 (P=.171). Conclusions. EII had good discrimination, but the calibration was not good with predicted mortality lower than the real mortality. E I showed the best discrimination with good calibration and a tendency to overestimate the mortality. SAPS III showed poor discrimination with good calibration and a tendency to greatly overestimate the predicted mortality. We saw no improvement in the predictive performance of EII over I and we reject the use of SAPS III in this kind of patient (AU)

Assessment of Euroscore and SAPS III as hospital mortality predicted in cardiac surgery. / Valoración del Euroscore y SAPS III como predictor de mortalidad hospitalaria en el postoperatorio de cirugía cardiaca.

OBJECTIVES: To perform an external validation of Euroscore I, Euroscore II and SAPS III. PATIENTS AND METHOD: Retrospective cohort study over three years on all adult patients who underwent cardiac surgery. We reviewed the clinical data, following the patient until outcome or discharge from hospital (dead, alive). We computed the predicted mortality by Euroscore I (EI), II (EII) and SAPS III. The model validation was assessed by discrimination: area under curve ROC; and calibration (Hosmer-Lemeshow test). RESULTS: 866 patients were included. 62.5% of them male, with a median age of 69 years, 6.1% died during hospitalization. Predicted mortality: E I 7.94%, E II 3.54, SAPS III 12.1%. Area under curve (95% IC): E I 0.862 (0.812-0.912); E II 0.861 (0.806-0.915); SAPS III 0.692 (0.601-0.784). Hosmer-Lemeshow test: E I 14.0046 (P=.08164); E II 33.67 (P=.00004660); SAPS III 11.57 (P=.171). CONCLUSIONS: EII had good discrimination, but the calibration was not good with predicted mortality lower than the real mortality. E I showed the best discrimination with good calibration and a tendency to overestimate the mortality. SAPS III showed poor discrimination with good calibration and a tendency to greatly overestimate the predicted mortality. We saw no improvement in the predictive performance of EII over I and we reject the use of SAPS III in this kind of patient.

Estudio piloto de Directorio de Unidades de Cirugía Mayor Ambulatoria / Day surgery units data upgrade

No disponible

Nuevas aportaciones de la mascarilla laríngea en cirugía ambulatoria. Contribución de la mascarilla laríngea Supreme / No disponible

Desde la introducción de la mascarilla laríngea, su uso se ha expandido especialmente en el contexto de la cirugía ambulatoria. La mascarilla laríngea representa el “patrón oro” de los dispositivos supraglóticos, y es la referencia con la que los nuevos dispositivos deben ser comparados. La presente revisión es una actualización de las principales indicaciones de la mascarilla laríngea en usos avanzados, incluyendo el abordaje de la vía aérea difícil en el paciente intervenido de forma ambulatoria. Así mismo se incluye una revisión de las indicaciones, aportaciones, y ventajas de la mascarilla laríngea Supreme aplicadas al contexto de la cirugía sin ingreso (AU)

Since the introduction of the original laryngeal mask airway(LMA) in the nineties in our country, its use has expanded especially in the context of outpatient surgery. The LMA remains the “gold standard” of the supraglotic devices and the standard by which all other devices should be compared. This review is an update of the main indications of the LMA in advanced applications, including addressing the difficult airway in the patient operated on an outpatient basis. Also includes a review of the information, contributions, and advantages of the LMA supreme applied to the context of day surgery (AU)

El anestesiólogo como gestor de la unidad de Cirugía Mayor Ambulatoria / The anestesiologist as Manager of an Ambulatory Surgical Unit

No disponible

Cuidados anestésicos monitorizados y anestesia general en cirugía ambulatoria / Monitored anaesthetic care and general anaesthesia in ambulatory surgery

Uno de los objetivos en Cirugía Ambulatoria es conseguir el mayor confort perioperatorio para el paciente minimizando las complicaciones y con la mayor seguridad posible. En la práctica de la anestesia ambulatoria moderna, los Cuidados Anestésicos Monitorizados y la Anestesia General ofrecen a los pacientes elevada calidad al utilizar fármacos que permiten una rápida inducción, un rápido despertar y una recuperación precoz de los parámetros de recuperación con mínimos efectos indeseables. En anestesia ambulatoria la combinación de propofol y remifentanilo junto con el manejo de la vía aérea mediante mascarilla laríngea ofrece los mejores resultados. Sin embargo, para garantizar el éxito de los procedimientos sin ingreso es necesario diseñar estrategias multimodales para prevenir el Dolor Postoperatorio y las Náuseas y/o Vómitos. En este trabajo se realiza una revisión bibliográfica sobre Cuidados Anestésicos Monitorizados y Anestesia General en Cirugía Ambulatoria (AU)

One of the objectives of Ambulatory Surgery is to achieve the best and safest peri-operative comfort for patients with a minimum of complications. In modern ambulatory anaesthesic practice, Monitorized Anesthesic Care and General Anaesthesia offer high quality to patients if we use drugs that allow fast induction and awakening, early post-anaesthesia recovery and minimal adverse effects. In ambulatory anaesthesia, the combination of propofol and remifentanil and the management of the airway using a laryngeal mask offer the best results. However, it is necessary to design multimodal strategies for prevention of postoperative pain and nausea and/or vomiting to ensure the success of the ambulatory procedure. This communication is a bibliographic review of Monitorized Anaesthesic Care and General Anaesthesia in Ambulatory Surgery (AU)

[Ondansetron in the prevention of postoperative nausea and vomiting in ambulatory surgery]. / Ondansetrón como profilaxis de las náuseas y vómitos postoperatorios en cirugía mayor ambulatoria.

OBJECTIVE: To evaluate the efficacy of antiemetic prophylaxis with ondansetron administered before major ambulatory surgery. PATIENTS AND METHOD: We retrospectively analyzed 1,881 patients (566 women, 31%) who underwent ambulatory surgery for various conditions between January and December 1993; 84% were ASA I, 15% ASA II and 1% ASA III: Mean age was 35.82 +/- 21.66 years; mean weight was 61.26 +/- 21.77 kg, and mean height was 155.13 +/- 19.27 cm. The techniques employed were total intravenous anesthesia in 64.8%, epidural in 22%, regional intravenous in 5.8%, local in 3.8%, peripheral blockade in 2.6% and intradural in 1%. One thousand thirty-three patients were premedicated with 4 mg ondansetron 30 minutes before the start of surgery; the remaining 848 received no antiemetic drug. We determined the incidences of nausea and vomiting during the 24 hours after surgery and the data were subjected to analysis of variance, covariance adjustment for quantitative variables, chi 2 test with continuity correction for nausea and vomiting. RESULTS: The incidences of nausea and vomiting were significantly lower in the patients premedicated with ondansetron. Only 36 (3.48%) of the premedicated patients experienced nausea, in comparison with 63 (7.4%) patients with no antiemetic premedication. Vomiting was experienced by 68 (6.58%) patients who received ondansetron, as compared to 112 (13.2%) patients who did not receive the drug. CONCLUSION: In our experience, administering 4 mg of ondansetron before major ambulatory surgery significantly reduces the incidence of nausea and vomiting in the immediate postoperative period.