Assessment of cerebral blood flow velocities, brain midline shift and optic nerve sheath diameter by ultrasound in patients undergoing elective craniotomy: A prospective observational feasibility study.

BACKGROUND: Brain ultrasound allows measuring the cerebral flow velocity, brain midline shift and optic nerve sheath diameter. Literature is scarce in determining the feasibility to perioperatively perform these measurements altogether and the cerebrovascular behavior in patients scheduled for elective craniotomy. METHODS: We assessed bilateral cerebral flow velocities, composite index, brain midline shift and optic nerve sheath diameter by cerebral ultrasound in patients scheduled for elective craniotomy before anesthetic induction, at extubation, and at 6 and 24 h after. The aim was to assess the feasibility of brain ultrasound in patients for elective craniotomy and to describe the changes in cerebral flow velocities, brain midline shift and optic nerve sheath diameter from baseline values at different times in the postoperative period. RESULTS: Sixteen patients were included, of these two were excluded from analysis due to an inadequate sonographic window. There were no changes throughout the study regarding cerebral flow velocity, brain midline shift nor optic nerve sheath diameter assessments. All parameters were maintained in the physiological range without significant variations during the procedure. No perioperative complications were detected. CONCLUSIONS: The results of our study show the feasibility to perform a perioperative assessment of cerebral flow velocity, brain midline shift or optic nerve sheath diameter jointly and successfully to obtain additional information of baseline cerebral hemodynamics in patients scheduled for elective craniotomy and their postoperative changes during the first 24 h. Future studies with lager samples are needed to address the efficacy of cerebral ultrasound as a monitoring tool.

Medición de las velocidades de flujo sanguíneo cerebral, desviación de la línea media y diámetro de la vaina del nervio óptico mediante ecografía en pacientes sometidos a craneotomía electiva: Estudio observacional prospectivo / Assessment of cerebral blood flow velocities, brain midline shift and optic nerve sheath diameter by ultrasound in patients undergoing elective craniotomy: A prospective observational feasibility study

Introducción: La ecografía cerebral permite valorar las velocidades del flujo sanguíneo cerebral (VFSC), la desviación de la línea media (DLM) y el diámetro de la vaina del nervio óptico (DVNO). La literatura es escasa en determinar la viabilidad de realizar dichas medidas, de forma conjunta en el perioperatorio, en pacientes programados para craneotomía electiva. Métodos: Evaluamos las VFSC de forma bilateral con sus índices compuestos, la DLM y el DVNO por medio de ultrasonido cerebral en pacientes programados para craneotomía electiva antes de la inducción anestésica, en la extubación inmediata, a las seis y 24 horas posoperatorias. El objetivo fue evaluar la viabilidad del uso de la ecografía cerebral en pacientes sometidos a craneotomía electiva y describir los cambios de estas mediciones en diferentes momentos con respecto a los valores basales. Resultados: Fueron incluidos 16 pacientes en el estudio, de los cuales dos se excluyeron del análisis debido a una mala ventana ecográfica. No hubo cambios a lo largo del estudio con respecto a las VFSC, tampoco en la DLM o en el DVNO. Todos los parámetros se mantuvieron dentro de los rangos fisiológicos sin variaciones significativas durante el procedimiento. No hubo complicaciones perioperatorias. Conclusiones: Los resultados de nuestro trabajo muestran la factibilidad de realizar una valoración perioperatoria de las VFSC, DLM y DVNO de forma conjunta y exitosa para obtener información de la hemodinámica cerebral basal en pacientes programados para craneotomía electiva y valorar sus cambios durante las primeras 24 horas del posoperatorio. Son necesarios estudios con mayor número de pacientes para evaluar la eficacia del ultrasonido cerebral como herramienta de monitorización neurológica perioperatoria.(AU)

Background: Brain ultrasound allows measuring the cerebral flow velocity, brain midline shift and optic nerve sheath diameter. Literature is scarce in determining the feasibility to perioperatively perform these measurements altogether and the cerebrovascular behavior in patients scheduled for elective craniotomy. Methods: We assessed bilateral cerebral flow velocities, composite index, brain midline shift and optic nerve sheath diameter by cerebral ultrasound in patients scheduled for elective craniotomy before anesthetic induction, at extubation, and at 6 and 24 hours after. The aim was to assess the feasibility of brain ultrasound in patients for elective craniotomy and to describe the changes in cerebral flow velocities, brain midline shift and optic nerve sheath diameter from baseline values at different times in the postoperative period. Results: Sixteen patients were included, of these two were excluded from analysis due to an inadequate sonographic window. There were no changes throughout the study regarding cerebral flow velocity, brain midline shift nor optic nerve sheath diameter assessments. All parameters were maintained in the physiological range without significant variations during the procedure. No perioperative complications were detected. Conclusions: The results of our study show the feasibility to perform a perioperative assessment of cerebral flow velocity, brain midline shift or optic nerve sheath diameter jointly and successfully to obtain additional information of baseline cerebral hemodynamics in patients scheduled for elective craniotomy and their postoperative changes during the first 24 hours. Future studies with lager samples are needed to address the efficacy of cerebral ultrasound as a monitoring tool.(AU)

Whole-Genome Sequencing and De Novo Assembly of 61 Staphylococcus pseudintermedius Isolates from Healthy Dogs and Dogs with Pyoderma.

We have de novo assembled and polished 61 Staphylococcus pseudintermedius genome sequences with Nanopore-only long reads. Completeness was 99.25%. The average genome size was 2.70 Mbp, comprising 2,506 coding sequences, 19 complete rRNAs, 56 to 59 tRNAs, and 4 noncoding RNAs (ncRNAs), as well as CRISPR arrays.

Circuitos postoperatorios en los pacientes sometidos a craneotomía programada. Revisión narrativa / Postoperative circuits in patients undergoing elective craniotomy. A narrative review

En 2017 la sección de Neurociencias de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor publicó una encuesta nacional sobre los circuitos de atención y tratamiento postoperatorio en neurocirugía. La encuesta evidenció una gran heterogeneidad de respuestas en función del centro, el anestesiólogo y la afección del paciente. En la actualidad, no disponemos de un estándar de circuito postoperatorio y existe evidencia suficiente para no indicar de forma rutinaria el ingreso en Unidades de Cuidados Críticos Postquirúrgicos a todos los pacientes intervenidos de craneotomía programada. El objetivo de este estudio es hacer una revisión narrativa de los circuitos postoperatorios en la craneotomía programada, para intentar homogeneizar nuestra práctica clínica a la luz de los estudios publicados. Se ha hecho una revisión bibliográfica de los últimos diez años, fecha de actualización noviembre 2019, utilizando las palabras clave neurosurgery and postoperative care y craniotomyand postoperative care en MEDLINE (PubMed)

In 2017, the Neurosciences section of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy published a national survey on postoperative care and treatment circuits in neurosurgery. The survey showed that practices vary widely, depending on the centre, the anaesthesiologist and the pathology of the patient. There is currently no standard postoperative circuit for cranial neurosurgical procedures in Spanish hospitals, and there is sufficient evidence to show that not all patients undergoing elective craniotomy should be routinely admitted to a postsurgical critical care unit. The aim of this study is to perform a narrative review of postoperative circuits in elective craniotomy in order to standardise clinical practice in the light of published studies. For this purpose, we searched MEDLINE (PubMed) to retrieve studies published in the last ten years, up to November 2019, using the keywords neurosurgery and postoperative care, craniotomyand postoperative care

Postoperative circuits in patients undergoing elective craniotomy. A narrative review. / Circuitos postoperatorios en los pacientes sometidos a craneotomía programada. Revisión narrativa.

In 2017, the Neurosciences section of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy published a national survey on postoperative care and treatment circuits in neurosurgery. The survey showed that practices vary widely, depending on the centre, the anaesthesiologist and the pathology of the patient. There is currently no standard postoperative circuit for cranial neurosurgical procedures in Spanish hospitals, and there is sufficient evidence to show that not all patients undergoing elective craniotomy should be routinely admitted to a postsurgical critical care unit. The aim of this study is to perform a narrative review of postoperative circuits in elective craniotomy in order to standardise clinical practice in the light of published studies. For this purpose, we searched MEDLINE (PubMed) to retrieve studies published in the last ten years, up to November 2019, using the keywords neurosurgery and postoperative care, craniotomyand postoperative care.

¿Es la presión arterial «normal» la presión arterial «óptima» para cada uno de nuestros pacientes? / Is "normal" arterial blood pressure "optimal" in all patients?

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Revisión narrativa del dolor agudo poscraneotomía. Concepto y estrategias de prevención y tratamiento del dolor / Narrative review of acute post-craniotomy pain. Concept and strategies for prevention and treatment of pain

El objetivo de esta revisión narrativa es confirmar si el dolor agudo tras craneotomía es frecuente y presenta una intensidad entre moderada-severa. Además, pretende informar de la importancia de tratar no solo el dolor tras craneotomía, sino prevenirlo para disminuir la incidencia de la cronificación del dolor. Debemos conocer que entre las opciones actuales no solo disponemos de los analgésicos convencionales para el postoperatorio (antiinflamatorios no esteroideos, paracetamol, inhibidores de la ciclooxigenasa 2 y opiáceos). La realización de un bloqueo nervioso del cuero cabelludo previo a la incisión quirúrgica o tras la cirugía, el uso de dexmedetomidina intraoperatoria y la administración perioperatoria de pregabalina son alternativas que están ganando fuerza. El manejo del dolor poscraneotomía debe basarse, por tanto, en una analgesia multimodal durante todo el perioperatorio, enmarcándose dentro del concepto actual del protocolo enhaced recovery after surgery

The aim of this narrative review is to confirm that acute pain after craniotomy is frequent and presents with moderate to severe intensity. We also highlight the importance of not only treating post-craniotomy pain, but also of preventing it in order to reduce the incidence of chronic pain. Physicians should be aware that conventional postoperative analgesics (non-steroidal anti-inflammatory, paracetamol, cyclooxygenase inhibitors 2, opioids) are not the only options available. Performing a scalp block prior to surgical incision or after surgery, the use of intraoperative dexmedetomidine, and the perioperative administration of pregabalin are just some alternatives that are gaining ground. The management of post-craniotomy pain should be based on perioperative multimodal analgesia in the framework of an "enhaced recovery after surgery" (ERAS) approach

Narrative review of acute post-craniotomy pain. Concept and strategies for prevention and treatment of pain. / Revisión narrativa del dolor agudo poscraneotomía. Concepto y estrategias de prevención y tratamiento del dolor.

The aim of this narrative review is to confirm that acute pain after craniotomy is frequent and presents with moderate to severe intensity. We also highlight the importance of not only treating post-craniotomy pain, but also of preventing it in order to reduce the incidence of chronic pain. Physicians should be aware that conventional postoperative analgesics (non-steroidal anti-inflammatory, paracetamol, cyclooxygenase inhibitors 2, opioids) are not the only options available. Performing a scalp block prior to surgical incision or after surgery, the use of intraoperative dexmedetomidine, and the perioperative administration of pregabalin are just some alternatives that are gaining ground. The management of post-craniotomy pain should be based on perioperative multimodal analgesia in the framework of an "enhaced recovery after surgery" (ERAS) approach.

Calidad y seguridad del paciente en el código ictus, en el ámbito neurointervencionista / Quality and safety in endovascular therapy for acute ischemic stroke

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Encuesta nacional sobre los circuitos de atención y tratamiento postoperatorio en neurocirugía / National survey on postoperative care and treatment circuits in neurosurgery

Introducción. El análisis de los procesos quirúrgicos debe ser un estándar de los sistemas de salud. Describimos el circuito de atención y tratamiento postoperatorio para intervenciones neuroquirúrgicas en los centros de nuestro país. Material y métodos. Desde junio a octubre de 2014 se difundió una encuesta a jefes de Anestesiología de 73 hospitales españoles con neurocirugía y a miembros de la Sección de Neurociencia de la SEDAR, sobre tratamientos perioperatorios y sobre los circuitos postoperatorios tras procedimientos neuroquirúrgicos. Resultados. Obtuvimos 45 respuestas de 30 centros (41,09%). Un 60% de los anestesiólogos realiza tratamiento preventivo analgésico locorregional; la intensidad del dolor es evaluada sistemáticamente por un 78%. Las combinaciones de paracetamol, antiinflamatorios no esteroideos y morfina son las más utilizadas. Un 51,1% conoce la incidencia de NVPO tras craneotomía y el 86,7% considera necesaria la profilaxis multimodal. La dexametasona se administra como antiemético (88,9%) y/o tratamiento antiedema (68,9%). Un 44,4% de los anestesiólogos administra sistemáticamente profilaxis anticomicial en pacientes con tumores supratentoriales (levetiracetam, 88,9%). El 73,3% de los anestesiólogos disponen de protocolos de vigilancia postoperatoria. El anestesiólogo (73,3%) es quien decide el destino del paciente, que suele ser UCI (83,3%) o URPA (50%). La monitorización neurológica en el postoperatorio varió según el tipo de intervención, si bien la fuerza y la sensibilidad se exploraron en el 70-80%. Conclusiones. Existe una gran variabilidad en las respuestas, probablemente atribuible a la ausencia de guías, diferentes estructuras y equipamiento hospitalario, tipo de cirugía y personal cualificado. Necesitamos protocolos consensuados para estandarizar el tratamiento y el grado de monitorización necesaria durante el postoperatorio (AU)

Introduction. The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country. Material and methods. From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR. Results. We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70-80%. Conclusions. There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardize the treatment and the degree of monitoring needed during the postoperative period (AU)

National survey on postoperative care and treatment circuits in neurosurgery. / Encuesta nacional sobre los circuitos de atención y tratamiento postoperatorio en neurocirugía.

INTRODUCTION: The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country. MATERIAL AND METHODS: From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR. RESULTS: We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70-80%. CONCLUSIONS: There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardize the treatment and the degree of monitoring needed during the postoperative period.

Consciencia, cognición y redes neuronales: nuevas perspectivas / Consciousness, cognition and brain networks: new perspectives

Hemos realizado un análisis de la literatura más reciente sobre los mecanismos de la consciencia y cognición basado en la teoría de las redes neuronales. La respuesta inmunoinflamatoria del proceso anestésico-quirúrgico induce modulación de la plasticidad neuronal, influyendo en las funciones cognitivas superiores. Los fármacos anestésicos podrían causar inconsciencia, produciendo una disrupción funcional de la integración cortical y del complejo córtico-talámico. Las percepciones externas e internas se procesan mediante una intrincada red de conexiones neuronales, implicando la actividad de los centros nerviosos superiores, especialmente la corteza cerebral. Para ello se requiere un modelo integrado formado por redes neuronales y sus interacciones entre regiones altamente especializadas, a través de redes a gran escala o large scale networks, que se distribuyen por el cerebro recogiendo el flujo de información de estas percepciones. La conectividad funcional y la efectiva entre las redes a gran escala son fundamentales para la consciencia, inconsciencia y cognición. Es lo que se llama el «conectoma humano» o mapa de las redes neuronales (AU)

A detailed analysis of the literature on consciousness and cognition mechanisms based on the neural networks theory is presented. The immune and inflammatory response to the anesthetic-surgical procedure induces modulation of neuronal plasticity by influencing higher cognitive functions. Anesthetic drugs can cause unconsciousness, producing a functional disruption of cortical and thalamic cortical integration complex. The external and internal perceptions are processed through an intricate network of neural connections, involving the higher nervous activity centers, especially the cerebral cortex. This requires an integrated model, formed by neural networks and their interactions with highly specialized regions, through large-scale networks, which are distributed throughout the brain collecting information flow of these perceptions. Functional and effective connectivity between large-scale networks, are essential for consciousness, unconsciousness and cognition. It is what is called the "human connectome" or map neural networks (AU)

Guía de práctica clínica sobre tromboprofilaxis y manejo de los fármacos anticoagulantes y antiagregantes en pacientes neuroquirúrgicos y neurocríticos / Clinical practice guideline on thromboprophylaxis and management of anticoagulant and antiplatelet drugs in neurosurgical and neurocritical patients

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Consciousness, cognition and brain networks: New perspectives. / Consciencia, cognición y redes neuronales: nuevas perspectivas.

A detailed analysis of the literature on consciousness and cognition mechanisms based on the neural networks theory is presented. The immune and inflammatory response to the anesthetic-surgical procedure induces modulation of neuronal plasticity by influencing higher cognitive functions. Anesthetic drugs can cause unconsciousness, producing a functional disruption of cortical and thalamic cortical integration complex. The external and internal perceptions are processed through an intricate network of neural connections, involving the higher nervous activity centers, especially the cerebral cortex. This requires an integrated model, formed by neural networks and their interactions with highly specialized regions, through large-scale networks, which are distributed throughout the brain collecting information flow of these perceptions. Functional and effective connectivity between large-scale networks, are essential for consciousness, unconsciousness and cognition. It is what is called the "human connectome" or map neural networks.

Encuesta nacional sobre la tromboprofilaxis y el manejo de los anticoagulantes y antiagregantes en pacientes neuroquirúrgicos y neurocríticos / National survey on thromboprophylaxis and anticoagulant or antiplatelet management in neurosurgical and neurocritical patients

Objetivos. Conocer la práctica clínica de los anestesiólogos españoles en la tromboprofilaxis y el manejo de los anticoagulantes y antiagregantes en pacientes neuroquirúrgicos y neurocríticos. Material y métodos. Encuesta diseñada desde la Sección de Neurociencia de la Sociedad Española de Anestesiología y Reanimación, con 22 preguntas, difundida y contestada en formato electrónico, disponible entre junio y octubre de 2012. Resultados. De los 73 centros hospitalarios con servicio de Neurocirugía incluidos en el Catálogo Nacional de Hospitales, se recibió respuesta válida a la encuesta on line por parte de 41 anestesiólogos de 37 centros (tasa de respuesta del 50,7%). Se consideró una respuesta de cada centro. Solo el 27% de los centros respondedores disponían de un protocolo escrito específico para el manejo de estos pacientes. La tromboprofilaxis mecánica se utilizó hasta en un 80%, aunque de forma variable, y la farmacológica en un 75% de los centros. La enoxaparina fue la heparina de bajo peso molecular más utilizada en pacientes sometidos a craneotomía (78%). En la mitad de los centros respondedores se realizaron craneotomías manteniendo el tratamiento con ácido acetilsalicílico en los pacientes con antecedentes de cardiopatía isquémica, stent coronario y antiagregación dual. Conclusiones. La tromboprofilaxis mecánica es más utilizada que la farmacológica en la población neuroquirúrgica de nuestro país. El manejo de los pacientes tratados previamente con anticoagulantes presenta una marcada variabilidad clínica entre los diferentes hospitales, mientras que el tratamiento con antiagregantes se modifica en función de si se trata de profilaxis primaria o secundaria (AU)

Objectives. To determine the protocols used by Spanish anaesthesiologists for thromboprophylaxis and anticoagulant or antiplatelet drugs management in neurosurgical or neurocritical care patients. Material and methods. An online survey with 22 questions, with one or multiple options, launched by the Neuroscience Subcommittee of the Spanish Anaesthesia Society and available between June and October 2012. Results. Of the 73 hospitals included in the National Hospitals Catalogue, a valid response to the online questionnaire was received by 41 anaesthesiologists from 37 sites (response rate 50.7%). Only one response per site was used. A specific protocol was available in 27% of these centres. Mechanical thromboprophylaxis is used, intraoperatively or postoperatively, in 80%, and pharmacological treatment is used by 75% of respondents. Enoxaparin was the most frequent heparin used in craniotomy patients (78%). Craniotomies were performed maintaining acetylsalicylic acid treatment in patients with coronary stents and double anti-platelet treatment in a half of the centres. Conclusions. Mechanical thromboprophylaxis is used more frequently than the pharmacological approach in neurosurgical or neurocritical populations in Spanish hospitals. Management of patients under previous anticoagulant treatment was highly heterogeneous among hospitals included in this survey. Previous antiplatelet treatment is modified depending on primary or secondary prescription (AU)

National survey on thromboprophylaxis and anticoagulant or antiplatelet management in neurosurgical and neurocritical patients.

OBJECTIVES: To determine the protocols used by Spanish anaesthesiologists for thromboprophylaxis and anticoagulant or antiplatelet drugs management in neurosurgical or neurocritical care patients. MATERIAL AND METHODS: An online survey with 22 questions, with one or multiple options, launched by the Neuroscience Subcommittee of the Spanish Anaesthesia Society and available between June and October 2012. RESULTS: Of the 73 hospitals included in the National Hospitals Catalogue, a valid response to the online questionnaire was received by 41 anaesthesiologists from 37 sites (response rate 50.7%). Only one response per site was used. A specific protocol was available in 27% of these centres. Mechanical thromboprophylaxis is used, intraoperatively or postoperatively, in 80%, and pharmacological treatment is used by 75% of respondents. Enoxaparin was the most frequent heparin used in craniotomy patients (78%). Craniotomies were performed maintaining acetylsalicylic acid treatment in patients with coronary stents and double anti-platelet treatment in a half of the centres. CONCLUSIONS: Mechanical thromboprophylaxis is used more frequently than the pharmacological approach in neurosurgical or neurocritical populations in Spanish hospitals. Management of patients under previous anticoagulant treatment was highly heterogeneous among hospitals included in this survey. Previous antiplatelet treatment is modified depending on primary or secondary prescription.

Utilidad de un cuestionario autoadministrado multidimensional para la gestión de una unidad clínica de tratamiento de dolor / Usefulness of a multidimensional self-administered questionnaire for the clinical management of a pain treatment unit

Objective. To study the feasibility of a multidimensional self-administered questionnaire before the patient is seen at the first visit in a clinical Pain Treatment Unit (PTU) of a tertiary hospital, and its impact on the management of patients in the first visit. Patients and methods. Cross-sectional study. Self-administered questionnaire that gathered: socio-demographic data, medical history of pain, pain perception (intensity and characteristics), comorbidity of pain and patient expectations of analgesic treatment ("What do you expect from our treatment? If we cannot resolve your pain, what level of pain would you be willing to live with?). A descriptive analysis was performed. Results. A total of 293 consecutive patients (31% men, 69% women), mean age (SD) 62 (16) years-old, were included in 2011. All patients completed and returned the questionnaire before the first visit to the PTU. The questionnaire was completed fully and correctly by 80% (234, 95% CI: 75-84) of the patients, and the rest completed the questionnaire with some points unanswered. About 24% (70/293, 95% CI: 19-29) of the patients should not have been referred to the PTU [20% were not attended]. A small percentage (9%,26/293, 95% CI: 6-13) were evaluated as «urgent’» and visited over the following 7 days, with 19% (56/293, 95%CI: 15-24) being «preferential» (visited before 15 days) and 52% (152/293, 95% CI: 46-58) as «non-urgent/non-preferential» (visited before 60 days). Almost one third (30%, 87/293, 95% CI: 25-35) did not need a second visit to the PTU. Patient expectations: 21% expected complete pain relief and 64% would accept a lower pain intensity score of 4. Conclusion. The use of a multidimensional self-administered questionnaire before the first visit to a clinical Pain Treatment Unit of a tertiary hospital was a practicable and useful tool for the management of patients on the first visit. Likewise, the questionnaire provided information on the patient's perception of pain and the expectations concerning the analgesic treatment (AU)

Objetivo. Estudiar la factibilidad de un cuestionario autoadministrado multidimensional antes de que el paciente sea atendido en primera visita en la unidad de tratamiento del dolor (UTD) de un hospital terciario, y su impacto en la gestión de pacientes en la primera visita. Pacientes y métodos. Estudio transversal. Cuestionario autoadministrado: características sociodemográficas, historia clínica del dolor, percepción del dolor (intensidad y sus características), comorbilidad del dolor y expectativas del paciente al tratamiento analgésico («¿qué es lo que usted espera de nuestro tratamiento?», si no podemos resolver su dolor «¿qué nivel de dolor aceptaría?»). Se realizó un análisis descriptivo. Resultados. Durante el año 2011 fueron incluidos 293 pacientes consecutivos (31% hombres, 69% mujeres; edad media 62 ± 16 años). Todos los pacientes cumplimentaron y entregaron el cuestionario antes de la primera visita en la UTD. El 80% (234/293, IC 95%: 75-84) de pacientes lo cumplimentaron completa y correctamente; el resto lo aportaron con algunos puntos sin contestar. El 24% (70/293, IC 95%: 19-29) de pacientes no deberían haber sido remitidos a la UTD (un 20% no llegaron a ser visitados en la UTD). Un 9% (26/293, IC 95%: 6-13) de las primeras visitas se consideraron «urgentes» (y estos pacientes fueron visitados en la UTD antes de 7 días), mientras que el 19% (56/293, IC 95%: 15-24) se calificaron de «preferentes» (atendidos antes de 15 días) y el 52% (152/293, IC 95%: 46-58) de «no-urgentes/no-preferentes» (atendidos antes de 60 días). Un 30% (87/293, IC 95%: 25-35) de los casos no necesitaron una segunda visita en la UTD. Respecto a las expectativas del paciente cabe reseñar que el 21% esperaban un alivio completo de su dolor, y el 64% aceptarían continuar con un dolor de intensidad < 4. Conclusión. El uso del cuestionario autoadministrado multidimensional antes de la primera visita en una Unidad Clínica del Tratamiento del Dolor de un hospital terciario fue practicable y útil como instrumento para la gestión de los pacientes en primera visita. Asimismo, proporcionó información sobre la percepción del dolor y las expectativas del paciente referente al tratamiento analgésico (AU)