[Parental presence in the operating room: effect on the quality of anesthetic induction and postoperative agitation in children]. / Efectos de la presencia paterna en quirófano sobre la calidad de la inducción anestésica y agitación postoperatoria en niños.

BACKGROUND AND OBJECTIVE: Various nonpharmacologic strategies for reducing anxiety in children and improving cooperation during induction of anesthesia have been investigated. Parental presence during anesthetic induction has been the alternative studied most often, especially in English-speaking populations. Mixed results have been reported, however. The aim of this study was to evaluate the quality of anesthetic induction and the development of postoperative agitation in Spanish children undergoing ear, nose, or throat surgery with or without parental presence in the operating room. PATIENTS AND METHODS: Children in American Society of Anesthesiologists class 1 or 2 who were scheduled for ear, nose or throat surgery under inhalation anesthesia were randomized to 2 groups for presence or absence of a parent in the operating room. The induction experience was classified as easy, carried out with moderate resistance, or traumatic. The postoperative period was assessed as easy or traumatic. RESULTS: Forty children were randomized. Time to onset of anesthesia was similar in the 2 groups. Induction was easy for 65% of the children with parental presence and for 25% of the children without a parent present (P < .05). Induction was traumatic for 25% in the parental presence group and for 35% in the parental absence group (P < .05). The incidence of moderate resistance during induction was similar in the 2 groups; the quality of the postoperative experience was also similar. CONCLUSIONS: Parental presence during induction of inhalation anesthesia improves the induction experience of nonpremeditated Spanish children, increasing the incidence of easy induction and decreasing the presence of traumatic induction. The quality of the postoperative experience is similar.

Efectos de la presencia paterna en quirófano sobre la calidad de la inducción anestésica y agitación postoperatoria en niños / Parental presence in the operating room: effect on the quality of anesthetic induction and postoperative agitation in children

Objetivos: Se han investigado diversas alternativas no farmacológicas para reducir el estrés y mejorar la cooperación de los niños durante la inducción anestésica. La presencia de los padres durante la inducción anestésica ha sido la intervención más comúnmente estudiada, sobre todo en la población anglosajona y con resultados contradictorios. El objetivo del presente trabajo es evaluar la calidad de la inducción anestésica y del postoperatorio según la presencia paterna o no durante la misma en niños españoles no premedicados sometidos a cirugía otorrinolaringológica. Pacientes y métodos: Niños ASA I-II programados para cirugía otorrinolaringológica con inducción inhalatoria, asignados de forma aleatoria a dos grupos, según entraran los padres (grupo P) o no (grupo C) en el quirófano. La calidad de la inducción anestésica fue valorada como suave, moderada o traumática y el postoperatorio como suave o traumático. Resultados: Se incluyeron 40 niños. El tiempo de inducción anestésica fue similar en ambos grupos. Hubo una inducción suave en el 65% de los niños del grupo P frente al 25% en el grupo C (p<0,05), y una inducción traumática en el 25% de los niños del grupo P, frente al 35% del grupo C (p<0,05). La incidencia de inducción moderada y la calidad de postoperatorio fueron similares en ambos grupos. Conclusión: La presencia paterna durante la inducción de la anestesia inhalatoria mejora la calidad de la inducción del niño no premedicado, aumentando la incidencia de inducciones suaves frente a las traumáticas. No se han encontrado diferencias en la calidad del postoperatorio(AU)

Background and objective: Various nonpharmacologic strategies for reducing anxiety in children and improving cooperation during induction of anesthesia have been investigated. Parental presence during anesthetic induction has been the alternative studied most often, especially in English-speaking populations. Mixed results have been reported, however. The aim of this study was to evaluate the quality of anesthetic induction and the development of postoperative agitation in Spanish children undergoing ear, nose, or throat surgery with or without parental presence in the operating room. Patients and methods: Children in American Society of Anesthesiologists class 1 or 2 who were scheduled for ear, nose or throat surgery under inhalation anesthesia were randomized to 2 groups for presence or absence of a parent in the operating room. The induction experience was classified as easy, carried out with moderate resistance, or traumatic. The postoperative period was assessed as easy or traumatic. Results: Forty children were randomized. Time to onset of anesthesia was similar in the 2 groups. Induction was easy for 65% of the children with parental presence and for 25% of the children without a parent present (P<.05). Induction was traumatic for 25% in the parental presence group and for 35% in the parental absence group (P<.05). The incidence of moderate resistance during induction was similar in the 2 groups; the quality of the postoperative experience was also similar. Conclusions: Parental presence during induction of inhalation anesthesia improves the induction experience of nonpremeditated Spanish children, increasing the incidence of easy induction and decreasing the presence of traumatic induction. The quality of the postoperative experience is similar(AU)

Evaluación de la telemedicina aplicada a la cirugía ambulatoria / No disponible

Objetivo: El objetivo de este trabajo es evaluar la utilidad de un sistema de control mediante telefonía móvil en el contexto del postoperatorio domiciliario de cirugía ambulatoria. Material y métodos: Se elijen aleatoriamente dos grupos de60 pacientes intervenidos de la misma patología. A ambos grupos se les somete a una entrevista telefónica protocolizada y estandarizada. A los pacientes del grupo estudio se les entrega un teléfono móvil multimedia preprogramado para enviar imágenes desde el domicilio y un pulsioxímetro. A los del grupo control se le realiza el control telefónico convencional. Se realiza una encuesta de satisfacción. Resultados: Se realiza un incremento de un 9,1% en el número de llamadas efectivas para los pacientes con móvil. Se reduce en un 63,6% el número de visitas a urgencias con respecto a los pacientes sin móvil. El tiempo medio de control telefónico es mayor (41,40 minutos/paciente) en los pacientes del grupo piloto con respecto al grupo control (16 minutos/paciente). En cuanto acostes se observa que el ahorro producido por evitar que el paciente acuda a urgencias es de un 5,6% con respecto al grupo control. El 93,8% de los pacientes opinan que el sistema ha tenido un resultado positivo en su evolución. Conclusiones: El mayor impacto clínico del sistema es que evita en un 63,6% las visitas a urgencias de los pacientes del grupo estudio. Este hecho tiene un beneficio directo en el incremento de la calidad de vida del paciente así como en el incremento de la calidad del cuidado que recibe. También aumenta el tiempo que el personal tiene que dedicarle. Aunque el tiempo de control es mayor en el grupo piloto que en el grupo control, el sistema es un5,6% más barato que el control telefónico convencional. Además tiene una alta aceptación entre los usuarios llegando a un nivel de satisfacción del 93,8% (AU)

Objective: The goal of this study was to evaluate the use of a mobile telephone control system for post-operative follow-up after ambulatory surgery. Material and methods: Two groups of patients underwent a protocolized and standard telephone interview. Patients in the study group were given a multimedia mobile telephone, pre-programmed to send images from the patient’s home as well as a pulsioxymeter. The control group was followed through the usual telephone calls. A satisfaction questionnaire was given. Results: There is a 9.1% increase of effective phone calls for patients with a mobile phone. The number of patients seen as emergency visits was reduced 63.6% compared to patients without a phone. Median phone call time was higher (41.40 min/patient)in the pilot group compared to the control group (16min/patient). Regarding costs, there is a 5.6% reduction by avoiding patients going to emergency compared with the control group. 93.8% of patients thought that the system had a positive result on their evolution. Conclusions: The biggest clinical impact of this system is that it avoids 63.6% of visits to the emergency department of the patients in the study group. This has a direct benefit on patients’ increased quality of life and on the increase in quality of the care received. The time the care givers dedicate to each patient is also increased. Although the control time is high in the pilot group, this system is5.6% cheaper than conventional telephone control. It is also very well accepted by patients with a satisfaction index of 93.8% (AU)

Telemedicina para el seguimiento postoperatorio domiciliario / No disponible

No disponible

Tracheoplasty in a large tracheoesophageal fistula.

Postintubation tracheoesophageal fistulas (TEFs) are severe lesions that can be associated with tracheal stenosis and therapeutic difficulties. A case is reported of a woman with TEF and postintubation tracheal stenosis with 6.5 cm of affected trachea, and total esophageal exclusion. A tracheoplasty method is described patching the loss of the tracheal membranous wall with the posterior esophageal wall. In a final step, a self-expanded tracheal stent and esophagocolic bypass were added.

[Evaluation of amplified spontaneous pattern ventilation in postoperative patients. Comparison with pressure support]. / Evaluación de la ventilación con patrón espontáneo amplificado en pacientes postoperados. Comparación con la presión de soporte.

HYPOTHESIS: Amplified spontaneous pattern (ASP) ventilation is a new method for giving partial support by reproducing, in an amplified manner, the patients' own spontaneous flow wave form, thereby optimizing patient adaptation to support. OBJECTIVES: To study clinical use of ASP ventilation for the first time in terms of flow wave form, patient synchronization, ventilation pattern, work of breathing (WOB), and inspiratory effort by transpulmonary pressure (TPP) and to compare ASP and pressure support ventilation applied in a similar clinical setting. PATIENTS AND METHOD: We studied 20 patients after heart surgery during weaning from controlled ventilation. Each patient was ventilated during 4 phases of 15 min each with two similar levels of support using ASP and PS applied successively and randomly. Maximum support (ASPmax and PSmax) was that which was set to give the same respiratory frequency (F) and tidal volume (VT) as that recorded during the earlier period of controlled ventilation. Half support (PEA1/2 and PS1/2) was set for half the aforementioned levels. At the end of each phase we obtained gas measurements and flow (V) curves and VT and pressure in airways and esophagus (Pes) to measure F, VT, the ratio of inspiratory to total time (TI/TTOT and TPP, as well as the VT/Pes loop with a mechanical ventilation monitor. The WOB was determined by measuring area under the curve (Campbell's method). RESULTS: We observed no significant differences between the two modes, with similar levels of support, with regard to ventilation (PaCO2) or ventilatory pattern (F, VT, TI/TTOT). De-adaptation occurred, however, eight times with PS (25%) but never with ASP. WOB and TPP decreased with PS when level of support increased, whereas with ASP these variables were constant regardless of level of amplification within the normal range. CONCLUSIONS: Adaptation to support is better with ASP than with PS during postoperative weaning and causes no significant respiratory work overload.