Propuesta de un programa de formación usando un modelo experimental para el manejo anestésico del trasplante hepático / Proposed experimental model to provide training in the management of anesthesia in liver transplantation

Objetivos: Proponemos y evaluamos un programa de entrenamiento para anestesiólogos, en modelo porcino, para aumentar la calidad del manejo anestésico durante el trasplante hepático. Material y método: Cinco anestesiólogos, facultativos especialistas de área, sin experiencia previa en el manejo anestésico del trasplante hepático que no trabajan en centros donde se realiza la cirugía de trasplante hepático, realizaron el programa de entrenamiento y evaluación de manera voluntaria, anestesiando cinco animales cada uno. La cirugía se realizó bajo anestesia total balanceada, realizando monitorización hemodinámica, ventilatoria, determinación bioquímica, gasometrías arteriales y coagulación. Para evaluar a los alumnos se utilizaron criterios publicados previamente, considerando su habilidad para mantener al paciente estable. Fueron evaluados en los tiempos T1 (basal), T2-15 min fase preanhepática, T3-final fase preanhepática, T4-15 min fase anhepática, T5-final fase anhepática, T6-15 min fase postanhepática, T7-final fase postanhepática. Los alumnos completaron una encuesta al finalizar el programa para valorar su utilidad. Los cambios en la puntuación de los criterios de calidad fueron analizados utilizando ANOVA. Resultados: Durante la fase postimplantación, los cambios metabólicos (acidosis) y cardiacos (hipotensión y bradicardia) fueron las alteraciones más críticas a las que tuvieron que hacer frente los alumnos. Se evidenció un incremento significativo en las habilidades de los alumnos para hacer frente a los cambios hemodinámicos y metabólicos (p < 0,05). Todos los alumnos expresaron su preferencia por la realización de un entrenamiento previo en modelo porcino. Conclusiones: Utilizando este modelo de entrenamiento, los cambios hemodinámicos y fisiológicos que acontecen durante el trasplante, fueron entendidos y manejados. En nuestra opinión, la realización de un programa de formación en modelo porcino permite al anestesiólogo adquirir experiencia y habilidad para el manejo anestésico del trasplante hepático(AU)

Objetive: To propose and evaluate the use of a porcine model for training in how to manage and improve the quality of anesthesia during liver transplantation. Material and Methods: Five trained anesthesiologists who had no previous experience in managing anesthesia during liver transplantation and who did not work in hospitals where the procedure was performed volunteered for the training course and evaluated it. Each trainee anesthetized 5 animals. Surgery was performed under total balanced anesthesia with monitoring of hemodynamics, ventilation, biochemistry, arterial blood gases, and coagulation. Previously set criteria were used to evaluate the trainees' skill in maintaining patient stability. Their work was assessed 7 times: at baseline, 15 minutes into the preanhepatic phase, at the end of the preanhepatic stage, 15 minutes into the anhepatic phase, at the end of the anhepatic phase, 15 minutes into the postanhepatic phase, and at the end of the postanhepatic phase. After completing the course, the trainees filled in a questionnaire to evaluate its usefulness. Analysis of variance was applied to score changes in anesthetic quality criteria. Results: After implantation, changes in metabolic (acidosis) and cardiac (hypotension and bradycardia) status were the most critical abnormalities the trainees faced. Their skill in coping with hemodynamic and metabolic changes improved significantly (P<.05). All participants expressed a preference for receiving training in a porcine model before providing anesthesia in this surgical setting. Conclusions: Under this training model, the anesthesiologists understood and were able to manage the hemodynamic and physiologic changes that develop during a liver transplant procedure. We believe that training using a porcine model allows an anesthesiologist to acquire experience and skill in this setting(AU)

[Proposed experimental model to provide training in the management of anesthesia in liver transplantation]. / Propuesta de un programa de formación usando un modelo experimental para el manejo anestésico del trasplante hepático.

OBJECTIVE: To propose and evaluate the use of a porcine model for training in how to manage and improve the quality of anesthesia during liver transplantation. MATERIAL AND METHODS: Five trained anesthesiologists who had no previous experience in managing anesthesia during liver transplantation and who did not work in hospitals where the procedure was performed volunteered for the training course and evaluated it. Each trainee anesthetized 5 animals. Surgery was performed under total balanced anesthesia with monitoring of hemodynamics, ventilation, biochemistry, arterial blood gases, and coagulation. Previously set criteria were used to evaluate the trainees' skill in maintaining patient stability. Their work was assessed 7 times: at baseline, 15 minutes into the preanhepatic phase, at the end of the preanhepatic stage, 15 minutes into the anhepatic phase, at the end of the anhepatic phase, 15 minutes into the postanhepatic phase, and at the end of the postanhepatic phase. After completing the course, the trainees filled in a questionnaire to evaluate its usefulness. Analysis of variance was applied to score changes in anesthetic quality criteria. RESULTS: After implantation, changes in metabolic (acidosis) and cardiac (hypotension and bradycardia) status were the most critical abnormalities the trainees faced. Their skill in coping with hemodynamic and metabolic changes improved significantly (P<.05). All participants expressed a preference for receiving training in a porcine model before providing anesthesia in this surgical setting. CONCLUSIONS: Under this training model, the anesthesiologists understood and were able to manage the hemodynamic and physiologic changes that develop during a liver transplant procedure. We believe that training using a porcine model allows an anesthesiologist to acquire experience and skill in this setting.

Propuesta de un programa de formación usando un modelo experimental para el manejo anestésico del trasplante hepático / Proposed experimental model to provide training in the management of anesthesia in liver transplantation

Objetivos: Proponemos y evaluamos un programa de entrenamiento para anestesiólogos, en modelo porcino, para aumentar la calidad del manejo anestésico durante el trasplante hepático. Material y método: Cinco anestesiólogos, facultativos especialistas de área, sin experiencia previa en el manejo anestésico del trasplante hepático que no trabajan en centros donde se realiza la cirugía de trasplante hepático, realizaron el programa de entrenamiento y evaluación de manera voluntaria, anestesiando cinco animales cada uno. La cirugía se realizó bajo anestesia total balanceada, realizando monitorización hemodinámica, ventilatoria, determinación bioquímica, gasometrías arteriales y coagulación. Para evaluar a los alumnos se utilizaron criterios publicados previamente, considerando su habilidad para mantener al paciente estable. Fueron evaluados en los tiempos T1 (basal), T2-15 min fase preanhepática, T3-final fase preanhepática, T4-15 min fase anhepática, T5-final fase anhepática, T6-15 min fase postanhepática, T7-final fase postanhepática. Los alumnos completaron una encuesta al finalizar el programa para valorar su utilidad. Los cambios en la puntuación de los criterios de calidad fueron analizados utilizando ANOVA. Resultados: Durante la fase postimplantación, los cambios metabólicos (acidosis) y cardiacos (hipotensión y bradicardia) fueron las alteraciones más críticas a las que tuvieron que hacer frente los alumnos. Se evidenció un incremento significativo en las habilidades de los alumnos para hacer frente a los cambios hemodinámicos y metabólicos (p < 0,05). Todos los alumnos expresaron su preferencia por la realización de un entrenamiento previo en modelo porcino. Conclusiones: Utilizando este modelo de entrenamiento, los cambios hemodinámicos y fisiológicos que acontecen durante el trasplante, fueron entendidos y manejados. En nuestra opinión, la realización de un programa de formación en modelo porcino permite al anestesiólogo adquirir experiencia y habilidad para el manejo anestésico del trasplante hepático(AU)

Objetive: To propose and evaluate the use of a porcine model for training in how to manage and improve the quality of anesthesia during liver transplantation. Material and Methods: Five trained anesthesiologists who had no previous experience in managing anesthesia during liver transplantation and who did not work in hospitals where the procedure was performed volunteered for the training course and evaluated it. Each trainee anesthetized 5 animals. Surgery was performed under total balanced anesthesia with monitoring of hemodynamics, ventilation, biochemistry, arterial blood gases, and coagulation. Previously set criteria were used to evaluate the trainees' skill in maintaining patient stability. Their work was assessed 7 times: at baseline, 15 minutes into the preanhepatic phase, at the end of the preanhepatic stage, 15 minutes into the anhepatic phase, at the end of the anhepatic phase, 15 minutes into the postanhepatic phase, and at the end of the postanhepatic phase. After completing the course, the trainees filled in a questionnaire to evaluate its usefulness. Analysis of variance was applied to score changes in anesthetic quality criteria. Results: After implantation, changes in metabolic (acidosis) and cardiac (hypotension and bradycardia) status were the most critical abnormalities the trainees faced. Their skill in coping with hemodynamic and metabolic changes improved significantly (P<.05). All participants expressed a preference for receiving training in a porcine model before providing anesthesia in this surgical setting. Conclusions: Under this training model, the anesthesiologists understood and were able to manage the hemodynamic and physiologic changes that develop during a liver transplant procedure. We believe that training using a porcine model allows an anesthesiologist to acquire experience and skill in this setting(AU)