[The objective structured clinical evaluation of teaching in anaesthesiology and resuscitation]. / La evaluación clínica objetiva estructurada en la docencia en Anestesiología y Reanimación.

OBJECTIVES: To find out the acquirement of professional competencies of Anaesthesiology and Resuscitation medical residents at the end of their training period using the Objective Structured Clinical Evaluation (OCSE) tool. MATERIAL AND METHODS: Six competency components to evalúate were defined as follows: clinical interview (communication), technical ability and relationship abilities (leadership, decision making, work in a team), diagnostic assessment, therapeutic management, and medical records. Different methodologies were determined depending on the knowledge and skills to evaluate. Twelve clinical cases were developed that were performed in 12 stations. A total of 107 Ítems, specified within the stations, evaluated the competency components. A total of 43 residents were invited to participate in the last 4 months of their training in hospitals in Andalusia and Extremadura. RESULTS: A total of 33 residents participated. The overall mean of the classifications obtained in the 12 stations was 64.2 out of a maximum of 100. The medical residents demonstrated higher competency in obstetrics, paediatric anaesthesia, and that associated with difficult airway. The main competency gaps were detected in the area of one-day surgery, chronic pain, and literature management, in which approximately half passed the test. CONCLUSIONS: We believe that training evaluations, such as the OCSE, help in determining the skill levels of the medical resident, making it easier to continually improve the training of the future anaesthesiologist.

La evaluación clínica objetiva estructurada en la docencia en Anestesiología y Reanimación / The objective structured clinical evaluation of teaching in anaesthesiology and resuscitation

Objetivos: Conocer el nivel de adquisición de competencias de los médicos residentes de Anestesiología y Reanimación al final de su periodo formativo mediante la herramienta de Evaluación Clínica Objetiva Estructurada (ECOE). Método: Se definieron seis componentes competenciales que evaluar: la entrevista clínica (comunicación), la habilidad técnica y las habilidades relacionales (liderazgo, toma de decisiones, trabajo en equipo), la valoración diagnóstica, el manejo terapéutico y el registro clínico. Se determinaron distintas metodologías en función de los conocimientos y las habilidades en evaluación. Se desarrollaron 12 casos clínicos, que se llevaron a cabo en 12 estaciones. Dentro de las estaciones, se especificó un total de 107 ítems que evaluaban los componentes competenciales. Se invitó a participar a los 43 residentes en los últimos 4 meses de su formación en los centros hospitalarios de Andalucía y Extremadura. Resultados: Participaron 33 residentes. La media general de las calificaciones obtenidas en las 12 estaciones fue de 64,2 sobre un máximo de 100. Los MIR demostraron mayor destreza en obstetricia, anestesia pediátrica y la relacionada con la vía aérea difícil. Las principales lagunas competenciales se detectaron en el área de cirugía ambulatoria, dolor crónico y manejo bibliográfico, en las que superó la prueba aproximadamente la mitad. Conclusiones: Consideramos que evaluaciones formativas como la ECOE permiten conocer el nivel de adquisición de competencias del médico residente y facilitan la mejora continua de la formación del futuro anestesiólogo(AU)

Objectives: To find out the acquirement of professional competencies of Anaesthesiology and Resuscitation medical residents at the end of their training period using the Objective Structured Clinical Evaluation (OCSE) tool. Material and methods: Six competency components to evaluate were defined as follows: clinical interview (communication), technical ability and relationship abilities (leadership, decision making, work in a team), diagnostic assessment, therapeutic management, and medical records. Different methodologies were determined depending on the knowledge and skills to evaluate. Twelve clinical cases were developed that were performed in 12 stations. A total of 107 items, specified within the stations, evaluated the competency components. A total of 43 residents were invited to participate in the last 4 months of their training in hospitals in Andalusia and Extremadura. Results: A total of 33 residents participated. The overall mean of the classifications obtained in the 12 stations was 64.2 out of a maximum of 100. The medical residents demonstrated higher competency in obstetrics, paediatric anaesthesia, and that associated with difficult airway. The main competency gaps were detected in the area of one-day surgery, chronic pain, and literature management, in which approximately half passed the test. Conclusions: We believe that training evaluations, such as the OCSE, help in determining the skill levels of the medical resident, making it easier to continually improve the training of the future anaesthesiologist(AU)

[Anesthetic conserving device (AnaConDa) used after cardiac surgery: experience in a postoperative recovery unit]. / Experiencia clínica de la utilización del sistema AnaConDa en una unidad de reanimación de cirugía cardiaca.

OBJECTIVE: To assess the safety and efficacy of using the Anesthetic Conserving Device (AnaConDa) when maintaining sedation after cardiac surgery. MATERIAL AND METHODS: Descriptive study of 46 consecutive patients in the postoperative recovery unit after cardiac surgery between January and April 2009. The patients were under sevoflurane sedation administered with the AnaConDa placed in the inhalation tube. No exclusion criteria were established before enrollment. The sevoflurane dose was set using the manufacturer's normogram and was later adjusted to give an end-tidal concentration of sevoflurane between 0.5% and 0.7% on the basis of data from a gas analyzer. Remifentanil was administered to all patients; a fast-track extubation protocol was used. The only criterion for excluding a patient's data from analysis was prolonged sedation (> 5 hours). RESULTS: The mean (SD) time patients were under sedation with the AnaConDa in place was 2588 (12.32) minutes. The end-tidal concentration of sevoflurane never exceeded 1%. Scores on the Richmond agitation-sedation scale were -5 at 60 minutes in all cases; there was some score variability at 120 minutes. Deeper sedation was desired for the first 60 minutes to avoid awakening related to rewarming. The mean time until awakening was 6.17 minutes (range, 1-30 minutes). The mean time until extubation was 43 (6.69) minutes. The most common adverse effect was arterial hypotension (12 cases). Hypotension was related to bleeding in 3 patients and to low cardiac output in 4 patients. CONCLUSION: Administering sevoflurane through the AnaConDa can be a safe, valid, and reliable method for sedating patients after cardiac surgery. With this device, it is possible to monitor the concentration administered.

[Fulminant pulmonary lymphangioleiomyomatosis: a case report and review of the literature]. / Linfangioleiomiomatosis pulmonar: presentación de un caso de evolución fulminante y revisión de la literatura.

Pulmonary lymphangioleiomyomatosis is a very rare disease that affects women of childbearing age. It presents a challenge for the anesthesiologist during mechanical ventilation because of the restrictive pattern caused by the disease and because of such complications as recurrent pneumothorax and hemoptysis. We report the fulminant course of lymphangioleiomyomatosis in a 38-year-old woman with a history of recurrent spontaneous pneumothorax whose condition was unsuspected. The literature is reviewed.