Prospective cohort study on the management and complications of peripheral venous catheter in patients hospitalised in internal medicine.

OBJECTIVE: To analyse compliance with the recommendations on the insertion-maintenance of peripheral venous catheter (PVC) and the incidence of complications according to the healthcare department that inserted the PVCs. PATIENTS AND METHODS: We conducted a prospective cohort follow-up study of PVCs, from their insertion in the emergency or internal medicine (IM) department until their withdrawal. RESULTS: We monitored 590 PVCs, 274 from the emergency department and 316 from IM. In terms of compliance with the process indicators, there was a cannulation rate in the antecubital fossa of 3.5 and 1.6 per 100 catheters-day (p < .001) in the emergency and IM departments, respectively. The sterile placement rates were 1.6 and 12.4 (p < .001), and the rate for transparent dressing was 2.1 and 11.5 (p < .001) per 100 catheters-day in the emergency and IM departments, respectively. The complications rates showed no differences between the departments. The most common complication was phlebitis (95 cases, 16.1%). CONCLUSIONS: Compliance with the insertion-maintenance recommendations for PVC showed differences between the departments; however, the incidence of complications was similar.

Estudio de cohortes prospectivo sobre el manejo y las complicaciones del catéter venoso periférico en pacientes ingresados en Medicina Interna / Prospective cohort study on the management and complications of peripheral venous catheter in patients hospitalised in Internal Medicine

Objetivo Analizar la adherencia a las recomendaciones de inserción-mantenimiento del catéter venoso periférico (CVP) y la incidencia de complicaciones según el servicio asistencial de inserción. Pacientes y métodos Estudio de cohortes prospectivo de seguimiento del CVP desde su inserción en Urgencias o Medicina Interna (MI) hasta su retirada. Resultados Se monitorizaron 590 CVP: 274 de Urgencias y 316 de MI. Entre la adherencia a indicadores de proceso destaca la tasa de canalización en fosa antecubital de 3,5 vs. 1,6 por 100 catéteres-día (p <0,001) en Urgencias y MI, respectivamente. La tasa de fijación estéril fue 1,6 vs. 12,4 (p <0,001) y el apósito transparente de 2,1 vs. 11,5 (p <0,001) por 100 catéteres-día en Urgencias y MI, respectivamente. Las tasas de complicaciones no mostraron diferencias entre los servicios. La más frecuente fue la flebitis 95 (16,1%). Conclusiones La adherencia a las recomendaciones de inserción-mantenimiento del CVP mostró diferencias entre servicios; sin embargo, la incidencia de complicaciones fue similar (AU)

Objective To analyse compliance with the recommendations on the insertion-maintenance of peripheral venous catheter (PVC) and the incidence of complications according to the healthcare department that inserted the PVCs. Patients and methods We conducted a prospective cohort follow-up study of PVCs, from their insertion in the emergency or internal medicine (IM) department until their withdrawal. Results We monitored 590 PVCs, 274 from the emergency department and 316 from IM. In terms of compliance with the process indicators, there was a cannulation rate in the antecubital fossa of 3.5 and 1.6 per 100 catheters-day (P<.001) in the emergency and IM departments, respectively. The sterile placement rates were 1.6 and 12.4 (P<.001), and the rate for transparent dressing was 2.1 and 11.5 (P<.001) per 100 catheters-day in the emergency and IM departments, respectively. The complications rates showed no differences between the departments. The most common complication was phlebitis (95 cases, 16.1%). Conclusions Compliance with the insertion-maintenance recommendations for PVC showed differences between the departments; however, the incidence of complications was similar (AU)

Prospective cohort study on the management and complications of peripheral venous catheters in patients hospitalised in Internal Medicine. / Estudio de cohortes prospectivo sobre el manejo y las complicaciones del catéter venoso periférico en pacientes ingresados en Medicina Interna.

OBJECTIVE: To analyse compliance with the recommendations on the insertion-maintenance of peripheral venous catheters (PVC) and the incidence of complications according to the healthcare department that inserted the PVCs. PATIENTS AND METHODS: We conducted a prospective cohort follow-up study of PVCs, from their insertion in the emergency or internal medicine (IM) department until their withdrawal. RESULTS: We monitored 590 PVCs, 274 from the emergency department and 316 from IM. In terms of compliance with the process indicators, there was a cannulation rate in the antecubital fossa of 3.5 and 1.6 per 100 catheters-day (P<.001) in the emergency and IM departments, respectively. The sterile placement rates were 1.6 and 12.4 (P<.001), and the rate for transparent dressing was 2.1 and 11.5 (P<.001) per 100 catheters-day in the emergency and IM departments, respectively. The complications rates showed no differences between the departments. The most common complication was phlebitis (95 cases, 16.1%). CONCLUSIONS: Compliance with the insertion-maintenance recommendations for PVC showed differences between the departments; however, the incidence of complications was similar.

Analgesia multimodal domiciliaria con metadona en perfusión intravenosa mediante bomba elastomérica en cirugía mayor ambulatoria / Outpatient intravenous multimodal elastomeric pump with methadone in ambulatory surgery

Antecedentes y objetivo: La analgesia en cirugía mayor ambulatoria (CMA) necesita evolucionar paralelamente a la complejidad quirúrgica. Diseñamos un estudio para intentar mejorar la analgesia en cirugía dolorosa mediante elastómera intravenosa. Como novedad, se incluyó metadona. Pacientes y métodos: Estudio observacional en pacientes ASA I-II, intervenidos en CMA de cirugías con dolor postoperatorio moderado-severo. Se administró analgesia durante 48h mediante elastómera intravenosa de metadona, tramadol, dexketoprofeno y ondansetrón a dosis bajas, y paracetamol oral. A las 24 y 48h se evaluó la eficacia analgésica en reposo y en movimiento (Escala Visual Analógica [EVA], Escala de Andersen y Test de Lattinen), la necesidad de analgesia de rescate y los efectos adversos. Resultados: Se incluyeron 73 pacientes: un 37% de ellos intervenidos de cirugía de pared abdominal, un 30% de hemorroidectomías y un 33% de cirugía del periné. La mediana en reposo a las 24 y 48h fue EVA=0, y en movimiento, fue de 3 a las 24h y de 2 a las 48h. En la Escala de Andersen, a las 24h el 89% presentó puntuación ≤1. En el Test de Lattinen, el 90% presentó una puntuación ≤6. Precisó rescate el 30%. Dos pacientes presentaron vómitos a las 24 y 48h. Se observaron problemas menores con el catéter y la elastómera en el 8% de los pacientes. Conclusiones: La analgesia multimodal con metadona intravenosa administrada mediante bomba elastómera para cirugía ambulatoria dolorosa es eficaz y segura. Sin embargo, es necesaria vigilancia para identificar disfunciones del dispositivo

Background and objective: Analgesia in Ambulatory Surgery (AS) needs to evolve in parallel with surgical complexity. We designed a study to try to improve analgesia in painful surgery using an intravenous elastomeric pump. As a novelty, methadone was included. Patients and methods: An observational study, physical status ASA I-II, underwent ambulatory surgeries with moderate-severe postoperative pain. Analgesia was administered for 48h by an intravenous multimodal elastomeric pump (methadone, tramadol, dexketoprofen and ondansetron at low doses). Visual Analogue Scale (VAS) at rest and movement were evaluated at 24 and 48h. Andersen Scale, Lattinen Test, rescue analgesia and side-effects were recorded at 24h after surgery. Results: We included 73 patients: 37% abdominal wall surgery, 30% hemorrhoidectomies and 33% perineal surgery. Median VAS score at rest and movement were 0 and 3 at 24h, and 0 and 2 at 48h. At 24h, Andersen's Scale score was ≤1 in 89%, and Lattinen Test ≤6 in 90% of patients. Rescue medication was administered in 30% of patients. Two patients had vomiting at 24 and 48h. Minor catheter and pump dysfunctions were observed in 8% of patients. Conclusions: Multimodal analgesia with intravenous methadone administered by elastomeric perfusion at home is effective and safe. However, monitoring is needed to diagnosis dysfunction of devices

Outpatient intravenous multimodal elastomeric pump with methadone in ambulatory surgery. / Analgesia multimodal domiciliaria con metadona en perfusión intravenosa mediante bomba elastomérica en cirugía mayor ambulatoria.

BACKGROUND AND OBJECTIVE: Analgesia in Ambulatory Surgery (AS) needs to evolve in parallel with surgical complexity. We designed a study to try to improve analgesia in painful surgery using an intravenous elastomeric pump. As a novelty, methadone was included. PATIENTS AND METHODS: An observational study, physical status ASA I-II, underwent ambulatory surgeries with moderate-severe postoperative pain. Analgesia was administered for 48h by an intravenous multimodal elastomeric pump (methadone, tramadol, dexketoprofen and ondansetron at low doses). Visual Analogue Scale (VAS) at rest and movement were evaluated at 24 and 48h. Andersen Scale, Lattinen Test, rescue analgesia and side-effects were recorded at 24h after surgery. RESULTS: We included 73 patients: 37% abdominal wall surgery, 30% hemorrhoidectomies and 33% perineal surgery. Median VAS score at rest and movement were 0 and 3 at 24h, and 0 and 2 at 48h. At 24h, Andersen's Scale score was ≤1 in 89%, and Lattinen Test ≤6 in 90% of patients. Rescue medication was administered in 30% of patients. Two patients had vomiting at 24 and 48h. Minor catheter and pump dysfunctions were observed in 8% of patients. CONCLUSIONS: Multimodal analgesia with intravenous methadone administered by elastomeric perfusion at home is effective and safe. However, monitoring is needed to diagnosis dysfunction of devices.

Cirugía del lado erróneo: implicación del paciente y los profesionales. Experiencia en la Cirugía Mayor Ambulatoria de la Unidad del Pie / Surgery on the wrong side: implication for the patient and the professional. Experience in a Major Ambulatory Surgery of the Foot Unit

La cirugía del lado erróneo es una complicación poco frecuente en cirugía ortopédica, pero con serias consecuencias para el paciente, el cirujano y la institución sanitaria, debiéndose poner todas las medidas necesarias para evitar que se produzca. Hemos efectuado un estudio prospectivo de la implantación de un protocolo para prevenir la cirugía del lado erróneo en 101 pacientes intervenidos en la Unidad de Cirugía Mayor Ambulatoria (CMA) de cualquier patología del pie, realizándose tres marcajes independientes para la verificación del lado: por el paciente, la enfermera y el anestesista. Revisamos la existencia de la información del lado en los documentos de la historia vlínica (HC) y su correlación con el lado operado. Un 24,8% de los pacientes no fueron informados que tenían que realizarse una marca del pie a operar. Un 18,4% de los pacientes avisados no se marcaron, no existiendo relación con el sexo, edad, nivel de estudios, vivir solo o intervención previa de pies. En 37 pacientes existía una falta de anotación del lado en los documentos siendo más frecuente esta omisión en la HC de Cirugía Ortopédica y Traumatología y de Anestesiología. Se detectaron 9 casos de incongruencias de lado quirúrgico, todos en pacientes con cirugía previa de algún pie. El marcaje de lado se ha incorporado como una práctica rutinaria en la cirugía del pie, siendo beneficioso para la seguridad del paciente, debiéndose convertir en un futuro próximo en una conducta habitual en todas las áreas quirúrgicas (AU)

Surgery of the wrong side is a very uncommo complication in orthopaedic surgery, but with serious consequences for the patient, the surgeon and the health institution, having to put all the necessary measures in place to prevent this occurring. We have conducted a prospective study on the introduction of a protocol to prevent surgery of the wrong side in 101 patients operated on for any foot disease in the Major Surgery Ambulatory Unit, performing three independent controls to verify the side: by the patient, by the nurse and by the anaesthetist. We review the information available of the side in the medical records and their correlation with the side operated on. Almost a quarter of the patients, 24.8%, were not informed that they had to make a mark on the foot to be operated on. No mark was made by 18.4% of the patients informed to do so, with no relationship between age, gender, education level, to live alone or previous foot operations. There was a lack of noting the side in the documentation, with this omission being more frequent in the Orthopaedic and Traumatology and Anaesthesiology medical records. Nine cases of inconsistency in the surgical side were detected, all in patients who had previous surgery in any foot. Marking of the side has been incorporated as routine practice in foot surgery, being beneficial for the safety of the patient, and should become normal practice in all surgical areas in the near future (AU)

[Surgery on the wrong side: implication for the patient and the professional. Experience in a Major Ambulatory Surgery of the Foot Unit]. / Cirugía del lado erróneo: implicación del paciente y los profesionales. Experiencia en la Cirugía Mayor Ambulatoria de la Unidad del Pie.

Surgery of the wrong side is a very uncommon complication in orthopaedic surgery, but with serious consequences for the patient, the surgeon and the health institution, having to put all the necessary measures in place to prevent this occurring. We have conducted a prospective study on the introduction of a protocol to prevent surgery of the wrong side in 101 patients operated on for any foot disease in the Major Surgery Ambulatory Unit, performing three independent controls to verify the side: by the patient, by the nurse and by the anaesthetist. We review the information available of the side in the medical records and their correlation with the side operated on. Almost a quarter of the patients, 24.8%, were not informed that they had to make a mark on the foot to be operated on. No mark was made by 18.4% of the patients informed to do so, with no relationship between age, gender, education level, to live alone or previous foot operations. There was a lack of noting the side in the documentation, with this omission being more frequent in the Orthopaedic and Traumatology and Anaesthesiology medical records. Nine cases of inconsistency in the surgical side were detected, all in patients who had previous surgery in any foot. Marking of the side has been incorporated as routine practice in foot surgery, being beneficial for the safety of the patient, and should become normal practice in all surgical areas in the near future.

Nuevas aportaciones de la mascarilla laríngea en cirugía ambulatoria. Contribución de la mascarilla laríngea Supreme / No disponible

Desde la introducción de la mascarilla laríngea, su uso se ha expandido especialmente en el contexto de la cirugía ambulatoria. La mascarilla laríngea representa el “patrón oro” de los dispositivos supraglóticos, y es la referencia con la que los nuevos dispositivos deben ser comparados. La presente revisión es una actualización de las principales indicaciones de la mascarilla laríngea en usos avanzados, incluyendo el abordaje de la vía aérea difícil en el paciente intervenido de forma ambulatoria. Así mismo se incluye una revisión de las indicaciones, aportaciones, y ventajas de la mascarilla laríngea Supreme aplicadas al contexto de la cirugía sin ingreso (AU)

Since the introduction of the original laryngeal mask airway(LMA) in the nineties in our country, its use has expanded especially in the context of outpatient surgery. The LMA remains the “gold standard” of the supraglotic devices and the standard by which all other devices should be compared. This review is an update of the main indications of the LMA in advanced applications, including addressing the difficult airway in the patient operated on an outpatient basis. Also includes a review of the information, contributions, and advantages of the LMA supreme applied to the context of day surgery (AU)

[Value of the intraoperative determination of parathyroid hormone (PTH) in hyperparathyroidism surgery]. / Valor de la determinación intraoperatoria de hormona paratiroidea en la cirugía del hiperparatiroidismo.

INTRODUCTION: The success in the surgical management of hyperparathyroidism has conventionally required a bilateral neck exploration. The intraoperative monitoring of intact parathyroid hormone (PTHi), allows a less extensive procedure by confirming the complete removal of hypersecreting tissue. METHODS: Plasma samples were obtained from 32 consecutive patients before and 10 minutes after removal of abnormal parathyroid tissue. PTH was measured with a modifie immunochemiluminometric assay with a short incubation time and the results made available in 15 minutes. RESULTS: PTHi decreased by at least 60% in 30 of 32 cases. A single adenoma was removed in 26 cases, and multiple hyperplastic glands in 4 cases. The two cases in which PTHi fell < 60% were diagnosed as hyperplasia. PTHi decreased > 60% after the removal of the remnant hyperplastic glands. CONCLUSIONS: The rapid PTHi assay had excellent analytical performance and predicted the success of parathyroid surgery.

Valor de la determinación intraoperatoria de hormona paratiroidea en la cirugía del hiperparatiroidismo / Value of the intraoperative determination of parathyroid hormone (PTH) in hyperparathyroidism surgery

Introducción: El éxito de la cirugía del hiperparatiroidismo se ha basado tradicionalmente en la exploración bilateral del cuello. La monitorización intraoperatoria de hormona paratiroidea intacta (PTHi), permite la confirmación bioquímica de que todo el tejido paratiroideo hiperfuncionante ha sido resecado, consiguiéndose cirugías menos extensas. Material y métodos: Se obtuvieron muestras de sangre de 32 pacientes antes y 10 minutos después de la exéresis del tejido paratiroideo patológico. La monitorización de PTHi se llevó a cabo mediante inmunoquimioluminiscencia, con un tiempo de incubación corto y resultados disponibles en 15 minutos. Resultados: Los niveles de PTHi descendieron > 60 por ciento en 30 de los 32 pacientes estudiados, 26 casos de adenoma y 4 casos de hiperplasia. Dos casos en los que la PTHi descendió 60 por ciento tras la exéresis de las glándulas hiperplásicas remanentes. Conclusión: El análisis rápido de PTHi es una técnica fácil de realizar y es capaz de predecir el éxito de la cirugía del hiperparatiroidismo (AU)

INTRODUCTION: The success in the surgical management of hyperparathyroidism has conventionally required a bilateral neck exploration. The intraoperative monitoring of intact parathyroid hormone (PTHi), allows a less extensive procedure by confirming the complete removal of hypersecreting tissue. METHODS: Plasma samples were obtained from 32 consecutive patients before and 10 minutes after removal of abnormal parathyroid tissue. PTH was measured with a modifie immunochemiluminometric assay with a short incubation time and the results made available in 15 minutes. RESULTS: PTHi decreased by at least 60% in 30 of 32 cases. A single adenoma was removed in 26 cases, and multiple hyperplastic glands in 4 cases. The two cases in which PTHi fell < 60% were diagnosed as hyperplasia. PTHi decreased > 60% after the removal of the remnant hyperplastic glands. CONCLUSIONS: The rapid PTHi assay had excellent analytical performance and predicted the success of parathyroid surgery (AU)

Uniparental disomy for chromosome 6 results in steroid 21-hydroxylase deficiency: evidence of different genetic mechanisms involved in the production of the disease.

Congenital adrenal hyperplasia (CAH) is an inherited recessive disorder of adrenal steroidogenesis caused by mutations in the steroid 21-hydroxylase gene (CYP21) in more than 90% of affected patients. The CYP21 gene is located within the HLA complex locus on chromosome 6 (6p21.3). During a molecular characterisation study of a group of 47 Mexican families with 21-hydroxylase deficiency, we identified nine in which the mutation or mutations found in the patient did not appear to originate from one of the parents. Through DNA fingerprinting, paternity was established in all nine families with a probability of non-paternity in the range of 10(-19) to 10(-23). Among these families, we identified one patient with exclusive paternal inheritance of all eight markers tested on chromosome 6p, despite normal maternal and paternal contributions for eight additional markers on three different chromosomes. We did not identify duplication of paternal information for markers in the 6q region, consistent with lack of expression of transient neonatal diabetes owing to genomic imprinting in this patient. Our results substantiate evidence for the existence of different genetic mechanisms involved in the expression of this recessive condition in a substantial portion (approximately 19%) of affected Mexican families. In addition to the identification of a patient with paternal uniparental disomy, the occurrence of germline mutations may explain the unusual pattern of segregation in the majority of the remaining eight families.

Molecular genetic analysis of patients carrying steroid 21-hydroxylase deficiency in the Mexican population: identification of possible new mutations and high prevalence of apparent germ-line mutations.

Steroid 21-hydroxylase deficiency is the underlying cause in over 90% of patients with congenital adrenal hyperplasia, an inherited metabolic disorder of adrenal steroidogenesis. We have characterized 94 mutant alleles from 47 unrelated Mexican patients and the corresponding mutant alleles in their parents by amplification of the functional CYP21 gene by PCR, followed by direct sequence analysis. The study included patients diagnosed with the three clinical forms of the disease. Our results revealed: (1) the presence of relatively few mutations or combinations of mutations associated with particular phenotypes; (2) the presence of putative new mutations; (3) the finding of identical genotypes in patients displaying discordant phenotypes; (4) the identification of patients lacking all previous reported mutations; and (5) an apparent high frequency of germ-line mutations. The absence of previously reported mutations in about 22% of the disease alleles, the finding of putative new mutations in some of the patients lacking previously known mutations, and the apparent high prevalence of germ-line mutations make evident the differences in the genetic background leading to this disorder between the Caucasian and the Mexican populations.