Analgesic effectiveness and improvement in quality of life after using topical sevoflurane for an extremely painful anal fissure / Eficácia analgésica e melhoria da qualidade de vida com o uso tópico de sevoflurano em fissura anal extremamente dolorosa

Painful anal fissures could be distressing conditions that severely impair the patients' quality of life. The analgesic effectiveness of topical drugs, such as calcium-antagonists and nitrates is quite variable. The inhalational anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds.We report a pioneer experience treating a painful chronic anal fissure with topical sevoflurane. A young adult male was suffering from an extremely painful chronic anal fissure, which severely affected his quality of life. The topical treatment with nitroglycerine and diltiazem gels failed. The patient agreed to the treatement with topical sevoflurane as an off-label medication, and it produced an immediate, intense, and long-lasting analgesic effect. An intense but rapidly transient burning sensation, as well as persistent but well-tolerated flatulence were the only adverse effects. The quality of life was greatly improved, and the cost of the treatment was affordable. Therefore, the off-label use of topical sevoflurane appears to be an effective alternative for the symptomatic treatment of painful anal fissures (AU)

As fissuras anais dolorosas podem ser condições angustiantes que prejudicam gravemente a qualidade de vida dos pacientes. A eficácia analgésica de medicamentos tópicos, como antagonistas de cálcio e nitratos, é bastante variável. O anestésico inalatório sevoflurano está sendo reaproveitado como analgésico tópico para feridas crônicas dolorosas. Relatamos uma experiência pioneira de tratamento com sevoflurano tópico em fissura anal crônica dolorosa. Umjovemadulto do sexomasculino sofria de uma fissura anal crônica extremamente dolorosa, que afetava gravemente sua qualidade de vida. O tratamento tópico com nitroglicerina e géis de diltiazem foi ineficaz. O paciente concordou com o tratamento com sevoflurano tópico como medicamento off-label, ou seja, com uso diferente do aprovado embula. O sevoflurano tópico produziu um efeito analgésico imediato, intenso e duradouro. Uma sensação de ardência intensa, mas transitória, e flatulência persistente, embora bem tolerada, foram os únicos efeitos adversos. A qualidade de vidamelhorou significativamente, e o custo do tratamento revelou-se acessível. Portanto, o uso off-label de sevoflurano tópico pode ser uma alternativa analgésica eficaz em casos de fissuras anais dolorosas. (AU)

Monitorización de la Infección de Localización Quirúrgica al alta tras la introducción de un Programa de Cirugía Ambulatoria en la Colecistectomía / Monitoring of surgery infection associated with a program of ambulatory surgery in collecistectomy

Objetivo. Valorar la frecuencia de infecciones de localización quirúrgica al alta del paciente, trasla introducción de un programa de Cirugía Mayor Ambulatoria.Diseño. Estudio observacional de tipo transversal.Emplazamiento. Hospital de tercer nivel.Participantes. Pacientes colecistectomizados durante el año 2000 incluidos en el programa de Cirugía Mayor Ambulatoria.Mediciones Principales. Los pacientes colecistec-tomizados fueron revisados siete días despuésde la intervención por un cirujano y entrevistados telefónicamente un mes más tarde por una enfermera de Medicina Preventiva. Calculamos el número de infecciones de localización quirúrgica detectadas por este método y la tasa de incidencia acumulada de infecciones global.Resultados. Fueron realizadas 157 entrevistas telefónicas. Se usó Profi láxis Antibiótica en 147pacientes (93,6%). Cinco pacientes presentaron infecciones de localización quirúrgica (3%).Dos de ellos (40%) se detectaron por cuestionario. La incidencia acumulada total de infecciones de localización quirúrgica fue de 3,18 x 100 pacientes operados (tasa de infecciones al alta 1,27 x 100 pacientes intervenidos y tasa de infecciones hospitalarias: 1,9 x 100 pacientes intervenidos).Conclusiones. La entrevista telefónica al alta aumenta la exhaustividad en la detección de casos de infecciones de localización quirúrgica. El bajo número de pacientes contactados y el mucho tiempo empleado en ello nos hace desechar, en nuestro caso, este método como un componente más del proceso de vigilancia

Objective. To know the frequency of surgical infection in the discharged patient, following the introduction of a programme of Major Ambulatory Surgery.Design. Observational and cross-sectional studyPlacement. Third level hospitalSubjects. Patients with collecistectomy in the year 2000, participating in a programme of MajorAmbulatory Surgery.Principal Measurements. Patients with collecistectomy were checked seven days after surgery, by a surgeon and interviewed by telephone one month later by a preventative medicine nurse. We calculated the number of surgical infections detected by this method and the rate of accumulated incidence of infections.Results. There were 157 interviews by telephone. Antibiotic prophylaxis was used in 147 patients(93.6%). Five patients suffered surgical infection (3%). Two of them (40%) were detected by questionnaire. The accumulated incidence of surgical infection was 3.18 / 100 of operated patients (the rate of infection in discharged patients = 1.27 / 100 of patients and the rate of infection in hospitalised patients = 1.9 / 100 of patients).Conclusions. The telephone interview after discharge, increases the detection rate of surgicalinfection. Due to the low number of patient contact and the amount of time invested in the work, we recommend in our case, the rejection of this method for the process of vigilance