Prácticas de ansiólisis preoperatoria en pacientes pediátricos: prevalencia, limitantes y otros factores relacionados / Preoperative anxiolysis practices in pediatric patients: prevalence, limitations and other related factors

Resumen: Introducción: La ansiedad perioperatoria en niños se asocia con desenlaces postoperatorios como pesadillas, caminar nocturno, enuresis de nueva aparición, terrores nocturnos, episodios de irritabilidad inadecuada y trastorno de ansiedad por separación. La ansiólisis perioperatoria permite disminuir la generación de esos desenlaces; sin embargo, su prevalencia es desconocida en Colombia. Objetivo: Describir la práctica de ansiólisis perioperatoria en población pediátrica, llevada a cabo por anestesiólogos en Colombia. Material y métodos: Se realizó un estudio descriptivo, mediante encuestas electrónicas autodiligenciadas se exploraron variables demográficas, conocimientos, actitudes y prácticas sobre la conducta y la prevención de la ansiedad perioperatoria en niños. Se excluyeron registros incompletos para el análisis de variables asociadas y se realizó un análisis de sensibilidad para determinar el impacto de la exclusión de respuestas incompletas en los resultados. El envío de las encuestas estuvo a cargo de la Sociedad Colombiana de Anestesiología. Resultados: Se obtuvieron 220 encuestas completas, en su mayoría de Bogotá, Valle del Cauca y Antioquia. La prevalencia de ansiólisis perioperatoria fue de 86.8%, su práctica no se relacionó con la presencia de formación de subespecialidad. Limitantes como «falta de fomento institucional¼ (p = 0.000 OR = 1.69), «no disponibilidad de fármacos ansiolíticos ideales¼ (p = 0.000 OR = 3.52) y «temor a los eventos adversos asociados con algunos fármacos ansiolíticos¼ (p = 0.013 OR = 5.47) se relacionaron con la no realización de ansiólisis perioperatoria en niños, así como un menor puntaje. Conclusión: Existen diferentes factores, que limitan la realización de ansiólisis perioperatoria en niños, potencialmente modificables con políticas nacionales, institucionales y profesionales.

Abstract. Introduction: Perioperative anxiety in children is associated with postoperative outcomes such as, nightmares, sleep-walking, new onset enuresis, night terrors, separation anxiety disorder and tantrums. Perioperative anxiolysis allows to diminish the presentation of these outcomes, however, it's prevalence its unknown in Colombia. Aim: To describe the practice of perioperative anxiolysis in pediatric populations, carried out by Colombian anesthesiologists. Material and methods: A descriptive study was carried out, self-completed electronic surveys explored demographic variables, knowledge, attitudes and practices about management and prevention of perioperative anxiety in children. Incomplete records were excluded for analysis. A sensitivity analysis was done to determine the impact of the exclusion of incomplete records. Colombian Anesthesiology Society was in charge of sending the surveys. Results: Two-hundred and twenty (220) complete records were obtained, mostly from Bogotá, Valle del Cauca and Antioquia. The prevalence of perioperative anxiolysis was 86.8%, its practice was not related with any subspecialty. Barriers such as «Lack of institutional promotion¼ (p = 0.000 OR = 1.69), «Unavailability of ideal anxiolytic medicines¼ (p = 0.000 OR = 3.52) and «Fear of drug-related adverse reactions¼ (p = 0.013 OR = 5.47) were identified in multivariate analysis. Conclusion: Different factors limit the execution of perioperative anxiolysis in children, all of them potentially modifiable with national, institutional and professional policies.

Cirugía citorreductiva y quimioterapia intraperitoneal hipertérmica: Conceptos importantes para el anestesiólogo / Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: main concepts for anesthetists

Abstract Introduction: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex therapeutic procedure used to complement cytoreductive surgery and intravenous chemotherapy for the management of primary peritoneal neoplasms and peritoneal carcinomatosis. Objectives: To review considerations regarding the surgical procedure, physiological changes associated with fluid, blood and protein loss, increase in intra-abdominal pressure, metabolic rate, and systemic hyperthermia, from the perspective of the anesthetist. Methods: A nonsystematic search was conducted in the Medline/PUBMED and Google Academics databases using the terms cytoreductive surgery, hyperthermia, HIPEC, peritoneal carcinomatosis, and Sugarbaker. No limits for publication dates were used. The articles were reviewed independently by each of the authors, and the final text was edited and approved by the main author. Results: Overall, 151 articles were identified, and, of these, 64 were included in the review. The aspects studied included the surgical technique, physiological changes during the procedure, and anesthetic management. Conclusion: Cytoreductive surgery with hyperthermic intra-peritoneal chemotherapy is a therapeutic option for patients with peritoneal carcinomatosis. This procedure involves risks for the patient, first because of an initial phase which involves fluid and blood loss, and, second, because the hyperthermic phase gives rise to a hyperdynamic state with hemodynamic instability. Anesthetists must be familiar with the basic aspects of management to reduce complications and improve patient outcomes.

Resumen Introducción: La quimioterapia intraperitoneal hipertérmica (Hyperthermic Peritoneal Chemotherapy - HIPEC) es un procedimiento terapéutico complejo, utilizado como complemento de la cirugía citorreductiva (CCR) y de la quimioterapia endovenosa, para manejo de las neoplasias peritoneales primarias y la carcinomatosis peritoneal. Objetivos: Revisar desde la perspectiva del anestesiólogo, conceptos generales sobre el procedimiento quirúrgico, los cambios fisiológicos asociados a la pérdida de fluidos, sangre y proteínas, al aumento de la presión intra-abdominal, la tasa metabólica y la hipertermia sistémica. Métodos: Se realizó una búsqueda no sistemática en las bases de datos Medline/PUBMED y Google Academics utilizando los términos cytoreductive surgery, hyperthermia, HIPEC, peritoneal carcinomatosis y Sugarbaker. No se establecieron límites para fecha de publicación. Los artículos fueron revisados de manera independiente por cada uno de los autores y el texto final fue editado y aprobado por el autor principal. Resultados: Fueron identificados 151 artículos, de los cuales se incluyeron 64 para la revisión. Los aspectos estudiados incluyeron la técnica quirúrgica, los cambios fisiológicos durante el procedimiento y el manejo anestésico. Conclusión: La cirugía citorreductiva más quimioterapia intraperitoneal hipertérmica es una alternativa terapéutica para los pacientes con carcinomatosis peritoneal. Este procedimiento supone riesgos para el paciente, tanto por una primera fase que implica pérdidas de fluidos y sangre, como por la fase de hipertermia que genera un estado hiperdinámico con inestabilidad hemodinámica. El anestesiólogo debe conocer los aspectos fundamentales del manejo para disminuir las complicaciones y mejorar los desenlaces de los pacientes.

Social, cultural and economic factors associated with self-medication.

INTRODUCTION: Self-medication is an increasingly frequent phenomenon worldwide; some studies suggest that there is a relationship with socio-economic and cultural factors. OBJECTIVE: To determine the prevalence of self-medication and its related factors in a Colombian city. MATERIALS AND METHODS: Cross-sectional descriptive study, in Pereira, Colombia. We selected 414 adults using simple randomization sampling with houses used as the observational unit. The IRIS-AM instrument was used to collect the information required. RESULTS: Four hundred and fourteen (414) people were interviewed, 62.6% were females, and mean age was 44 years; 77.5% of the sample had self-medicated at least once in their life and 31.9% during the last month. The most commonly used medications were: analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs and anti-rheumatic medication (36.4%), and anti-histamine medication (8.5%). The most commonly self-medicated symptoms were: headache (55.7%), cold (16.2%) and muscular pain (13.2%). Multivariate analysis revealed an association between self-medication throughout life and storing medications at home, and between a high level of education and having a favorable opinion of self-medication. Storing medications at home and recommending them to others were associated with self-medication during the previous 30 days. CONCLUSION: Self-medication rates were found to be similar to those reported globally, but there is not an established pattern for this practice. Associations were found between social and demographic variables and self-medication, which require further characterization. Intention to self-medicate has not been well-described in other studies, and may be an important indicator which will contribute to future understanding of this phenomenon.

Social, cultural and economic factors associated with self-medication / Factores económicos, sociales y culturales asociados con la automedicación

Introduction: Self-medication is an increasingly frequent phenomenon worldwide; some studies suggest that there is a relationship with socio-economic and cultural factors. Objective: To determine the prevalence of self-medication and its related factors in a Colombian city. Materials and methods: Cross-sectional descriptive study, in Pereira, Colombia. We selected 414 adults using simple randomization sampling with houses used as the observational unit. The IRIS-AM instrument was used to collect the information required. Results: Four hundred and fourteen (414) people were interviewed, 62.6% were females, and mean age was 44 years; 77.5% of the sample had self-medicated at least once in their life and 31.9% during the last month. The most commonly used medications were: analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs and anti-rheumatic medication (36.4%), and anti-histamine medication (8.5%). The most commonly self-medicated symptoms were: headache (55.7%), cold (16.2%) and muscular pain (13.2%). Multivariate analysis revealed an association between self-medication throughout life and storing medications at home, and between a high level of education and having a favorable opinion of self-medication. Storing medications at home and recommending them to others were associated with self-medication during the previous 30 days. Conclusion: Self-medication rates were found to be similar to those reported globally, but there is not an established pattern for this practice. Associations were found between social and demographic variables and self-medication, which require further characterization. Intention to self-medicate has not been well-described in other studies, and may be an important indicator which will contribute to future understanding of this phenomenon.

Introducción. La automedicación es un fenómeno cada vez más frecuente a nivel mundial. Los estudios en este campo sugieren que hay una relación entre la automedicación y diversos factores sociodemográficos y económicos. Objetivo. Determinar la prevalencia de la automedicación y los factores relacionados en Pereira, Colombia. Materiales y métodos. Estudio descriptivo de corte transversal llevado a cabo en la población de Pereira. Se hizo un muestreo aleatorio por afijación proporcional en 414 adultos, y se desarrolló y aplicó la encuesta IRIS-AM ( Instrument for Systematic Data Collection of Self-Medication ). Resultados. Se encuestaron 414 personas, 62,6 % de las cuales eran mujeres; el promedio de edad fue de 44 años. La prevalencia de la automedicación fue de 77,5 % a lo largo de la vida y de 31,9 % en los 30 días previos. Los medicamentos más comúnmente utilizados fueron los analgésicos y antipiréticos (44,3 %), los antiinflamatorios no esteroideos (36,4 %), y los antihistamínicos (8,5 %). Los síntomas que llevaron a la automedicación con mayor frecuencia fueron la cefalea (55,7 %), el resfriado (16,2 %) y el dolor muscular (13,2 %). Los análisis multivariados mostraron asociación entre la automedicación a lo largo de la vida y guardar medicamentos en casa, así como entre tener un nivel superior de escolaridad y estar a favor de la automedicación. Los factores referentes a almacenar medicamentos y recomendarlos a otros se asociaron con la automedicación en los 30 días previos. Conclusiones. La prevalencia de la automedicación hallada en este estudio fue similar a la reportada previamente a nivel mundial; aun así, no existe un patrón establecido para esta práctica. Se evidenciaron las variables sociodemográficas asociadas con la automedicación, las cuales requieren una mejor caracterización. La intención de recurrir a la automedicación ha sido poco estudiada y podría ser un indicador importante para la medición y comprensión de este fenómeno.

An economic analysis of inadequate prescription of antiulcer medications for in-hospital patients at a third level institution in Colombia.

INTRODUCTION: The prescription and costs of antiulcer medications for in-hospital use have increased during recent years with reported inadequate use and underused. AIM: To determine the patterns of prescription-indication and also perform an economic analysis of the overcost caused by the non-justified use of antiulcer medications in a third level hospital in Colombia. MATERIALS AND METHODS: Cross-sectional study of prescription-indication of antiulcer medications for patients hospitalized in "Hospital Universitario San Jorge" of Pereira during July of 2012. Adequate or inadequate prescription of the first antiulcer medication prescribed was determined as well as for others prescribed during the hospital stay, supported by clinical practice guidelines from the Zaragoza I sector workgroup, clinical guidelines from the Australian Health Department, and finally the American College of Gastroenterology Criteria for stress ulcer prophylaxis. Daily defined dose per bed/day was used, as well as the cost for 100 beds/day and the cost of each bed/drug. A multivariate analysis was carried out using SPSS 21.0. RESULTS: 778 patients were analyzed, 435 men (55.9 %) and 343 women, mean age 56.6 +/- 20.1 years. The number of patients without justification for the prescription of the first antiulcer medication was 377 (48.5 %), and during the whole in-hospital time it was 336 (43.2 %). Ranitidine was the most used medication, in 438 patients (56.3 %). The cost/month for poorly justified antiulcer medications was € 3,335.6. The annual estimated cost for inadequate prescriptions of antiulcer medications was € 16,770.0 per 100 beds. CONCLUSION: A lower inadequate prescription rate of antiulcer medications was identified compared with other studies; however it was still high and is troubling because of the major costs that these inadequate prescriptions generates for the institution.