Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology.

: The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34 066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

[ESTIMATE OF THE INTRINSIC ERROR OF THE MEASURING INSTRUMENT OF THE LABORATORY FOR ANALYTICAL DETERMINATIONS OF THE CRITICAL PATIENT]. / Estimación del error intrínseco del instrumento de medida del laboratorio. PARA LAS DETERMINACIONES ANALÍTICAS DEL PACIENTE CRÍTICO.

Decrease blood loss associated with the analytical laboratory is a determinant of safety and quality in the preanalytical phase, in order to achieve an optimal level of care, where nurses have leading role to be responsible for the care of the critically ill patient.

Estimación del error intrínsico del instrumento de medida del laboratorio para las determinaciones analíticas del paciente crítico / Estimate of the intrinsic error of the measuring instrument of the laboratory for analytical determinations of the critical patient

Disminuir las pérdidas sanguíneas asociadas a las analíticas de laboratorio constituye un determinante de seguridad y calidad en la fase preanalítica, para llegar a alcanzar un óptimo nivel asistencial donde las enfermeras poseen gran protagonismo, al ser responsables del cuidado del paciente críticamente enfermo (AU)

Decrease blood loss associated with the analytical laboratory is a determinant of safety and quality in the preanalytical phase, in order to achieve an optimal level of care, where nurses have leading role to be responsible for the care of the critically ill patient (AU)

Fiabilidad de los resultados analíticos de muestra sanguínea desechando el doble del espacio muerto del catéter / Reliability of laboratory findings from blood samples when only the double dead space in catheter is discarded

OOBJETIVO: determinar la fiabilidad de dos métodos de extracción desangre a través de catéter arterial en los pacientes ingresados en una unidad de reanimación postquirúrgica. MATERIAL Y MÉTODO: estudio cuasi experimental realizado en el Hospital de la Princesa de Madrid, de febrero a mayo de 2010, en el que se compararon dos métodos de extracción de muestra de sangre para análisis a través de catéter arterial periférico, realizados secuencialmente: primero la intervención= 2 cc sangre desechada + 13,5 muestra a analizar, y segundo el control= inmediatamente después de la extracción previa= 15,5 cc + 13,5 muestra a analizar, en relación a los resultados de parámetros analíticos bioquímicos, hematológicos y de coagulación. RESULTADOS: la diferencia de las medias es muy pequeña en todos los parámetros estudiados; en todos los casos el "0" se encuentra incluido en los respectivos intervalos de confianza, no siendo estadísticamente significativos (p> 0,05). Las correlaciones son superiores a 0,93 en todos los parámetros estudiados en el caso de la bioquímica, superiores a0,84 en el caso de la hematimetría y superiores a 0,90 en el caso de la coagulación, obteniendo en todos los casos unos valores de p< de 0,05.CONCLUSIONES: para garantizar la calidad de los resultados de laboratorio es suficiente desechar el volumen correspondiente al doble del espacio muerto del sistema (en el presente estudio 2 cc)

PURPOSE: to assess reliability of two blood sample drawing methods though an arterial catheter in patients admitted to a postoperative resuscitation unit. MATERIAL AND METHODS: a quasi-experimental study was carried out at Hospital de la Princesa, Madrid, Spain, from February to May 2010.Two sequentially used methods for drawing blood samples for laboratory tests through a peripheral arterial catheter were compared: firstly the intervention procedure = 2 cc of blood discarded + a 13.5 sample for laboratory testing; and secondly the control procedure = immediately after previous sample drawing = 15.5 cc + a 13.5 sample for laboratory testing. Biochemistry, hematology and coagulation laboratory parameters were compared. RESULTS: differences in mean values were very low for all assessed parameters. Zero value is always included in confidence intervals; therefore, differences were not statistically significant (p > 0.05). Correlation is higher than 0.93 for all assessed biochemistry parameters, higher than 0.84 for hematology parameters, and higher than 0.90 for coagulation parameters (p < 0.05 for all comparisons).CONCLUSIONS: discarding the volume corresponding to the doubledead space in the system (2 cc in our study) is adequate to ensure quality in laboratory testing results

Extracción de muestras sanguíneas en el paciente crítico. Práctica enfermera / Extraction of blood samples in the critical patient

Objetivo. Descripción de la práctica habitual de los profesionales de enfermería en la extracción de muestras sanguíneas en el paciente crítico. Material y métodos. Estudio observacional, descriptivo y transversal realizado durante una semana de noviembre del 2010. Noventa enfermeras de cuidados intensivos participaron en el estudio donde se recogían datos referentes a la práctica habitual de estos profesionales. Resultados. Cuando los pacientes son portadores de un acceso arterial, las enfermeras eligen esta vía para la extracción de muestras sanguíneas. El volumen que se extrae, previa obtención de la muestra, y el volumen de la muestra que se ha de analizar dependen de la unidad de trabajo. Un 94,2 % de las enfermeras considera que se trata de un tema relevante. Conclusiones. El volumen de sangre extraída previa obtención de la muestra de laboratorio y la muestra extraída para analizar es superior al mínimo recomendado. No existiendo protocolos en esta línea de actuación. Un resumen del trabajo fue presentado en formato póster en el 11th Annual NATA Symposium celebrado en Barcelona los días 8 y 9 de abril de 2010: «Evaluation of the competence of nursing professionals in blood extractions in the critical patient» (AU)

Objective: To evaluate the competence of nursing in blood extractions in the Intensive Care. Material and Methods: Transversal descriptive study was done during one week of November 2010. 90 nurses working in intensive care units participate in the study. We collected information related to the normal practice. Results: When the patient has an arterial catheter, the nurses choose this way to extract the blood samples. The volume of blood extracted through the arterial catheter before taking the sample, through a venous catheter and the volume of blood that is taken for an arterial blood gas analysis depends of the nurse unit. A 94,2 % of the nurses think that it is a relevant item but there were no protocols. Conclusion: The volume of blood extracted previous obtaining the sample, and the blood taking for analysis is higher than the minimum recommended. There are no protocols in this line (AU)

[Extraction of blood samples in the critical patient]. / Extracción de muestras sanguíneas en el paciente crítico: práctica enfermera.

OBJECTIVE: To evaluate the competence of nursing in blood extractions in the Intensive Care. MATERIAL AND METHODS: Transversal descriptive study was done during one week of November 2010. 90 nurses working in intensive care units participate in the study. We collected information related to the normal practice. RESULTS: When the patient has an arterial catheter, the nurses choose this way to extract the blood samples. The volume of blood extracted through the arterial catheter before taking the sample, through a venous catheter and the volume of blood that is taken for an arterial blood gas analysis depends of the nurse unit. A 94,2 % of the nurses think that it is a relevant item but there were no protocols. CONCLUSION: The volume of blood extracted previous obtaining the sample, and the blood taking for analysis is higher than the minimum recommended. There are no protocols in this line.

Disminución de la hemoglobina en pacientes postquirúrgicos y muestras sanguíneas diagnósticas / Decrease of hemoglobin in post-surgical patients and diagnostic blood testing

La anemia es un problema frecuente en los pacientes ingresados en cuidados intensivos. Su etiología es multifactorial, aumentando los requerimientos transfusionales y la morbimortalidad. Objetivo: conocer la prevalencia de anemia y transfusión de los pacientes postquirúrgicos durante los cinco primeros días de ingreso en la unidad e reanimación y si existe relación con las pérdidas sanguíneas por la obtención de muestras analíticas .Material y métodos: estudio descriptivo, observacional y retrospectivo, de los pacientes ingresados en la unidad de reanimación postquirúrgica, desde enero a diciembre de 2008, del Hospital Universitario de "La Princesa" (Madrid). Se incluyeron en el estudio los pacientes postquirúrgicos ingresados en la unidad de reanimación durante un tiempo igual o superior a cinco días. Se excluyeron del estudio a los fallecidos durante ese periodo, sometidos a cirugía cardiaca, los politraumatizados y aquéllos con una tendencia hemorrágica mayor a la habitual. Se analizaron datos relativos a la anemia, las transfusiones y las pérdidas de masa eritrocitaria y volumen sanguíneo de las extracciones de muestras para análisis. Resultados: se han revisado las historias clínicas de los 65 pacientes ingresados que cumplían los criterios de inclusión. La prevalencia de (..) (AU)

Anemia is a common problem in patients admitted to the Intensive Care Unit. It has a multifactorial etiology, with increased transfusion requirements and higher morbimortality. Objective: to ascertain the prevalence of anemia and the transfusion of post-surgical patients during the first five days of admission to the recovery room, and if there is blood loss related to the collection of blood samples for laboratory work. Material and methods: a descriptive, observational and retrospective study of patients admitted to the postoperative recovery unit, from January to december 2008, at the "The Princess" University Hospital (Madrid). Post-surgical patients admitted to the recovery room for a period of no less than five days were included in the study. Those patients who had died during the study period, those who had undergone cardiac surgery, those with multiple trauma injuries and those with a tendency higher than usual to bleed were excluded from analysis. Data relative to anemia, transfusions and loss of blood volume and red cell (..) (AU)