Estudio de cohortes para evaluar la prevalencia de QT prolongado y arritmias en pacientes críticos durante la primera fase de la pandemia por COVID-19 / Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic

Antecedentes y objetivo: Los pacientes con infección por SARS-CoV-2 pueden presentar afectación cardiovascular, incluyendo miocarditis, arritmias y prolongación del intervalo QT. Nuestro objetivo fue evaluar el impacto de la COVID-19 y su tratamiento en la repolarización ventricular y el desarrollo de arritmias en pacientes críticos. Material y métodos: Estudio de cohortes retrospectivo de pacientes críticos con infección confirmada por SARS-CoV-2 durante un periodo de 3meses. Se registraron los datos clínicos relevantes y el tratamiento específico administrado para la COVID-19. Se consideró QTc prolongado cuando medía ≥460ms en mujeres y ≥450ms en hombres. Se registró la incidencia y el tipo de arritmias durante el mismo periodo. Resultados: Se evaluaron 77 pacientes con una edad media de 62±13años: 20 mujeres y 57 hombres. El 60% de los pacientes eran hipertensos, el 52% presentaban un IMC>30 y el 70% desarrollaron fracaso renal agudo durante el ingreso. El 56% de los pacientes presentaron prolongación del QTc. El 44% presentaron algún tipo de arritmia durante su estancia en la UCI, siendo en el 21% arritmias auriculares. La mortalidad global fue del 53%, sin diferencias entre los pacientes con o sin QTc prolongado. Conclusiones: En nuestra serie, una elevada proporción de pacientes críticos con COVID-19 han presentado QTc prolongado y arritmias. Los factores implicados se han relacionado con la elevación de biomarcadores cardiacos, la propia afectación miocárdica del virus y la medicación concomitante recibida en la UCI.(AU)

Introduction and objective: Patients with SARS-CoV-2 infection may present cardiovascular involvement including myocarditis, arrhythmias and QT interval prolongation. Our objective was to evaluate the impact of COVID-19 and its treatment on ventricular repolarization and development of arrhythmias in critically ill patients. Material and methods: Retrospective cohort study of critically ill COVID-19 patients during a 3-month period in whom at least one ECG was available. Relevant clinical data and specific treatment administered for COVID-19 were recorded. Prolonged QTc was considered prolonged when it measured ≥460ms in women and ≥450ms in men. The incidence and type of arrhythmias during the same period were recorded. Results: A total of 77 patients with a mean age of 62±13years, 20 women and 57 men, were evaluated. Sixty percent of the patients were hypertensive, 52% had a BMI>30, and 70% developed acute renal failure during admission. Some 56% of the patients presented QTc prolongation. Forty-four percent presented some type of arrhythmia during their stay in the ICU, 21% of which were atrial arrhythmias. Overall mortality was 53%, with no differences between patients with or without prolonged QTc. Conclusions: In our series, a high proportion of critical patients with COVID-19 presented prolonged QTc and arrhythmias. The factors involved have been related to the elevation of cardiac biomarkers, the myocardial involvement of the virus and concomitant medication received in the ICU.(AU)

Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic.

INTRODUCTION: Patients with SARS-CoV-2 infection may present cardiovascular involvement including myocarditis, arrhythmias and QT interval prolongation. Our objective was to evaluate the impact of COVID-19 and its treatment on ventricular repolarization and development of arrhythmias in critically ill patients. METHODS: Retrospective cohort study of critically ill COVID-19 patients during a 3-month period in whom at least one ECG was available. Relevant clinical data and specific treatment administered for COVID-19 were recorded. Prolonged QTc was considered prolonged when it measured ≥ 460 ms in women and ≥450 ms in men. The incidence and type of arrhythmias during the same period were recorded. RESULTS: A total of 77 patients with a mean age of 62 ±â€¯13 years, 20 women and 57 men, were evaluated. Sixty percent of the patients were hypertensive, 52% had a BMI > 30, and 70% developed acute renal failure during admission. Some 56% of the patients presented QTc prolongation. Forty-four percent presented some type of arrhythmia during their stay in the ICU, 21% of which were atrial arrhythmias. Overall mortality was 53%, with no differences between patients with or without prolonged QTc. CONCLUSIONS: In our series, a high proportion of critical patients with COVID-19 presented prolonged QTc and arrhythmias. The factors involved have been related to the elevation of cardiac biomarkers, the myocardial involvement of the virus and concomitant medication received in the ICU.

Emulsiones lipídicas en la intoxicación por anestésicos locales y otros fármacos. Revisión sobre mecanismos de acción y recomendaciones de uso / Lipid emulsions in the treatment of intoxications by local anesthesics and other drugs. Review of mechanisms of action and recommendations for use

La emulsiones lipídicas intravenosas (ELI) se han utilizado ampliamente para el tratamiento de la intoxicación por anestésicos locales (AL) y se han propuesto como tratamiento de la intoxicación por otros fármacos. Sin embargo, el grado de evidencia de este tipo de terapias no es sólido, ya que proviene en su mayoría de casos clínicos. El objetivo de esta revisión narrativa es describir los mecanismos de acción propuestos para las ELI en la intoxicación por AL y otros fármacos, y evaluar los estudios recientes realizados en animales que sustentan las recomendaciones de su uso y la experiencia en humanos que apoyan el empleo de las ELI tanto en la intoxicación por AL como por otros fármacos. Para ello, se llevó a cabo una búsqueda en las bases de datos Embase, Medline, Cochrane y Google Scholar abarcando los artículos relevantes durante los últimos 10 años. En caso de intoxicación por AL, se recomienda aplicar los protocolos dictados por las guías internacionales, sabiendo que el grado de evidencia no es muy elevado. En la intoxicación por otros fármacos, las ELI están aconsejadas en situaciones graves inducidas por xenobióticos liposolubles que no responden al tratamiento estándar.(AU)

Intravenous lipid emulsions (ILEs) have been used widely for the treatment of local anesthetic (LA) poisoning and have been proposed as a treatment for intoxication by other drugs. However, the degree of evidence for this kind of therapy is not strong, as it comes mostly from clinical cases. The aim of this narrative review is to describe the proposed mechanisms of action for ILEs in poisoning by LA and other drugs and to evaluate recent studies in animals that support the recommendations for their use and the experience in humans that support the use of ILESs in both LA and other drug poisoning. For this purpose, a search was performed in the Embase, Medline and Google Scholar databases covering relevant articles over the last 10 years. In the case of AL poisoning, we recommend applying the protocols dictated by international guidelines, knowing that the degree of evidence is not very high. In poisoning by other drugs, ILEs are recommended in serious situations induced by liposoluble xenobiotics that do not respond to standard treatment.(AU)

Lipid emulsions in the treatment of intoxications by local anesthesics and other drugs. Review of mechanisms of action and recommendations for use.

Intravenous lipid emulsions (ILEs) have been used widely for the treatment of local anesthetic (LA) poisoning and have been proposed as a treatment for intoxication by other drugs. However, the degree of evidence for this kind of therapy is not strong, as it comes mostly from clinical cases. The aim of this narrative review is to describe the proposed mechanisms of action for ILEs in poisoning by LA and other drugs and to evaluate recent studies in animals that support the recommendations for their use and the experience in humans that support the use of ILESs in both LA and other drug poisoning. For this purpose, a search was performed in the Embase, Medline and Google Scholar databases covering relevant articles over the last 10 years. In the case of AL poisoning, we recommend applying the protocols dictated by international guidelines, knowing that the degree of evidence is not very high. In poisoning by other drugs, ILEs are recommended in serious situations induced by liposoluble xenobiotics that do not respond to standard treatment.

Liver transplant with controlled donors after circulatory death with normothermic regional perfusion and brain dead donors: A multicenter cohort study of transfusion, one-year graft survival and mortality.

BACKGROUND: Controlled donation after circulatory death (cDCD) has expanded the donor pool for liver transplantation (LT). However, transfusion requirements and perioperative outcomes should be elucidated. The aim of this multicenter study was to assess red blood cell (RBC) transfusions, one-year graft and patient survival after LT after cDCD with normothermic regional perfusion (NRP) compared with donors after brain death (DBD). METHODS: 591 LT carried out in ten centers during 2019 were reviewed. Thromboelastometry was used to manage coagulation and blood product transfusion in all centers. Normothermic regional perfusion was the standard technique for organ recovery. RESULTS: 447 patients received DBD and 144 cDCD with NRP. Baseline MCF Extem was lower in the cDCD group There were no differences in the percentage of patients (63% vs. 61% p = 0.69), nor in the number of RBC units transfused (4.7 (0.2) vs 5.5 (0.4) in DBD vs cDCD, p = 0.11. Twenty-six patients (6%) died during admission for LT in the DBD group compared with 3 patients (2%) in the cDCD group (p = 0.15). To overcome the bias due to a worse coagulation profile in cDCD recipients, matched samples were compared. No differences in baseline laboratory data, or in intraoperative use of RBC or one-year outcome data were observed between DBD and cDCD recipients. CONCLUSIONS: cDCD with NRP is not associated with increased RBC transfusion. No differences in graft and patient survival between cDCD and DBD were found. Donors after controlled circulatory death with NRP can increasingly be utilized with safety, improving the imbalance between organ donors and the ever-growing demand.

Lipid emulsions in the treatment of intoxications by local anesthesics and other drugs. Review of mechanisms of action and recommendations for use. / Emulsiones lipídicas en la intoxicación por anestésicos locales y otros fármacos. Revisión sobre mecanismos de acción y recomendaciones de uso.

Intravenous lipid emulsions (ILEs) have been used widely for the treatment of local anesthetic (LA) poisoning and have been proposed as a treatment for intoxication by other drugs. However, the degree of evidence for this kind of therapy is not strong, as it comes mostly from clinical cases. The aim of this narrative review is to describe the proposed mechanisms of action for ILEs in poisoning by LA and other drugs and to evaluate recent studies in animals that support the recommendations for their use and the experience in humans that support the use of ILESs in both LA and other drug poisoning. For this purpose, a search was performed in the Embase, Medline and Google Scholar databases covering relevant articles over the last 10 years. In the case of AL poisoning, we recommend applying the protocols dictated by international guidelines, knowing that the degree of evidence is not very high. In poisoning by other drugs, ILEs are recommended in serious situations induced by liposoluble xenobiotics that do not respond to standard treatment.

Estudio multicéntrico observacional de la mascarilla Ambu® AuraGain® en pacientes adultos / A multicenter and observational study of the Ambu™ AuraGain™ laryngeal mask in adult patients

Antecedentes: Ambu® AuraGain® es un dispositivo supraglótico de segunda generación de un solo uso, recientemente lanzado al mercado, que permite la intubación traqueal guiada con fibrobroncoscopio. El principal objetivo del presente estudio multicéntrico fue evaluar el éxito global de Ambu AuraGain como dispositivo de ventilación en una amplia gama de indicaciones y características de pacientes. Métodos: Se incluyeron un total de 250 pacientes adultos con estado físico ASA i a iii, procedentes de cinco hospitales de España, que recibieron anestesia general y en los que se utilizó para el manejo de la vía aérea AuraGain. Resultados: El objetivo primario se evaluó en 244 pacientes y AuraGain fue efectiva en el 97,2% de las intervenciones (IC 95%, 0,99-0,94) durante todo el procedimiento. La mediana de la presión de fuga orofaríngea (PFO) fue de 32 cm H2O (RIQ 28-36 cm H2O). La inserción se logró en el primer intento en el 85% de los casos, y de forma global en el 98% de los casos, con una media de tiempo de inserción de 15 s (12-22,5), aunque el 61% de los pacientes requirió maniobras para facilitar su inserción. La inserción de la sonda gástrica se realizó fácilmente en el 99,6% de los pacientes, y la visión fibroscópica mostró visión de las cuerdas vocales en el 96,3% de los casos. Mediante análisis de regresión logística se identificó que el uso de tamaños más pequeños que los recomendados fue un factor asociado a una baja PFO (< 25 cm H2O). La principal complicación registrada fue la presencia de sangre en la retirada del dispositivo (15%). Conclusiones: Nuestros resultados confirman que el uso de AuraGain® proporciona una ventilación fiable y eficaz, logrando un alto nivel de PFO constante en una amplia gama de indicaciones. El éxito de funcionamiento global fue consistente en los cinco centros, con una baja incidencia de complicaciones asociadas.(AU)

Purpose: The main objective of this study was to evaluate the performance of the Ambu™ AuraGain™ device by determining its main parameters of use and complications. Methods: A total of 250 adult ASA physical status i to iii patients from five hospitals in Spain who received general anaesthesia with a supraglottic airway (SGA) device were enrolled in this study. Results: The primary outcome was analysed for 244 patients and a median OLP of 32 cm H2O (IQR 28-36 cm H2O) was obtained. Insertion was achieved at first attempt in 85% of cases, and overall in 98% of cases, in a median time of 15 s (12-22.5). We applied manoeuvres in 61% of patients to facilitate the process. Ventilation was effective in 97.2% of the interventions (95% CI 0.99-0.94) throughout the procedure. Insertion of the gastric tube was easily performed in 99.6% of the patients, and the vocal cords were viewed by fibrobronchoscopy in 96.3% of cases. Logistic regression analysis identified the use of sizes smaller than those recommended as a risk factor for low OLP (< 25 cm H2O). The main complication recorded was the presence of blood when withdrawing the SGA device (15%). Conclusions: Our results confirm that the use of AuraGain allows airway management in a reliable and effective way achieving high OLP and low incidence of associated complications, establishing it as a useful alternative in the routine clinical setting of anaesthesiologists. AuraGain performance was consistent in all five centres.(AU)

[Parents' satisfaction in onco-hematology units]. / Satisfacción de los padres en unidades de oncohematología.

INTRODUCTION: patient satisfaction is a quality of care predictor that allows to identify specific areas of improvement. Frequently, parents are who provide this information when their children are too young or cannot communicate. The aim of the study was to determine parents' satisfaction with paediatric oncology care and its relationship with sociodemographic variables. MATERIAL AND METHODS: a cross-sectional observational study was carried out. Parents whose children suffered from cancer and were treated in the oncology ward and oncology day hospital in Asturias were included. A questionnaire with sociodemographic variables and the Cuestionario de Calidad de Cuidados de Enfermería (CUCACE), that evaluates experience and satisfaction with care through two dimensions (range from 0 to 100), were used. RESULTS: 24 parents agreed to particape. The average in experience dimension of CUCACE was 88,99 and 87,01 in satisfaction. All participants referred as positive the treat received at the units, however, 41,7% declared it should be enhanced. No relationship between satisfaction and sociodemographic variables were found. CONCLUSIONS: Parents of children with cancer demonstrated high satisfaction with care. Information and communication with medical staff need to be strengthened.

Analysis of Emergency Healthcare Demand in a Prison.

OBJECTIVE: To analyze the reasons for seeking emergency medical care amongst prison inmates and their relationship to sociodemographic characteristics. MATERIAL AND METHOD: An observational, descriptive and retrospective study was carried out. We collected the sociodemographic variables of inmates and their healthcare needs at the referral hospital over nine years. RESULTS: A total of 972 hospital visits were included. The most common healthcare needs, in descending order, were multiple trauma, limb problems and dyspnea. Mondays and Wednesdays were found to be the busiest days (P <0.001). The average stay in cases of hospitalization was 6.1 (SD: 4.3) days; patients with nontraumatic healthcare needs required a longer stay. The majority of the inmates native to Africa, Asia and America received emergency healthcare services due to traumatic injuries; by contrast the most common injuries among Europeans were non-traumatic and unrelated to suicide attempts (P <0.001). European inmates were on average 4.2 years older than Africans and 4.7 years older than American inmates (P <0.001). DISCUSSION: The reasons for seeking emergency care are clearly differentiated according to the inmates' nationality, one notable outcome was the greater longevity of European internees. These results highlight the importance of understanding healthcare demand within the prison system in order to better address considerations such as prevention, organization and the location of healthcare units.

A multicenter and observational study of the Ambu™ AuraGain™ laryngeal mask in adult patients. / Estudio multicéntrico observacional de la mascarilla Ambu® AuraGain® en pacientes adultos.

PURPOSE: The main objective of this study was to evaluate the performance of the Ambu™ AuraGain™ device by determining its main parameters of use and complications. METHODS: A total of 250 adult ASA physical status i to iii patients from five hospitals in Spain who received general anaesthesia with a supraglottic airway (SGA) device were enrolled in this study. RESULTS: The primary outcome was analysed for 244 patients and a median OLP of 32 cm H2O (IQR 28-36 cm H2O) was obtained. Insertion was achieved at first attempt in 85% of cases, and overall in 98% of cases, in a median time of 15 s (12-22.5). We applied manoeuvres in 61% of patients to facilitate the process. Ventilation was effective in 97.2% of the interventions (95% CI 0.99-0.94) throughout the procedure. Insertion of the gastric tube was easily performed in 99.6% of the patients, and the vocal cords were viewed by fibrobronchoscopy in 96.3% of cases. Logistic regression analysis identified the use of sizes smaller than those recommended as a risk factor for low OLP (< 25 cm H2O). The main complication recorded was the presence of blood when withdrawing the SGA device (15%). CONCLUSIONS: Our results confirm that the use of AuraGain allows airway management in a reliable and effective way achieving high OLP and low incidence of associated complications, establishing it as a useful alternative in the routine clinical setting of anaesthesiologists. AuraGain performance was consistent in all five centres.

Valor de la duración del intervalo QRS para predecir la toxicidad por ropivacaína. Implicaciones en la práctica de la anestesia regional en Cirugía Mayor Ambulatoria / Value of QRS interval duration to predict ropivacaine toxicity. Implications in the practice of regional anesthesia in Major Ambulatory Surgery

Objetivo: La anestesia regional es ampliamente utilizada en Cirugía Mayor Ambulatoria (CMA), asociando innumerables ventajas y un mejor control del dolor postoperatorio. La ropivacaína surgió como una alternativa menos tóxica a la bupivacaína, sin embargo, se han descrito casos de arritmias o parada cardiorrespiratoria tras su administración. Las alteraciones electrocardiográficas en la intoxicación por anestésicos locales afectan a la conducción ventricular, prolongando el intervalo QRS del ECG. Nuestro objetivo fue evaluar si la prolongación del intervalo QRS se correlaciona con niveles elevados en sangre de ropivacaína, lo que podría alertar al clínico de una intoxicación grave. Material y métodos: El estudio se realizó en 4 cerdos minipig premedicados con ketamina intramuscular (20 mg/kg) que fueron anestesiados con tiopental sódico (5 mg/kg) y sevoflurano. Tras la instrumentalización y monitorización continua del ECG se administraron 5 mg/kg de ropivacaína intravenosa. Se realizaron determinaciones analíticas y mediciones de parámetros electrocardiográficos basales y a los 5, 15 y 30 minutos. Se evaluó la correlación entre los niveles plasmáticos de ropivacaína y la duración del intervalo QRS. Análisis estadístico: test de correlación de Spearman. Significación estadística: p < 0,05. Resultados: La ropivacaína indujo un aumento significativo del intervalo QRS a los 5, 15 y 30 minutos. Los intervalos PR, QT y QTc también aumentaron. El porcentaje de aumento máximo del QRS fue de un 51 % a los 5 minutos. Se observó una correlación positiva entre la duración del intervalo QRS y los niveles de ropivacaína, r = 0,8 (p < 0,0001). Conclusión: Nuestro modelo experimental ha permitido relacionar la duración del intervalo QRS con los niveles sanguíneos de ropivacaína. Su ensanchamiento instantáneo puede ser un marcador útil para detectar casos de intoxicación sistémica por ropivacaína, muy utilizada en anestesia regional en CMA (AU)

Objective: Regional anaesthesia is widely used in ambulatory surgery (AS) and is associated with numerous benefits and a better control of postoperative pain. Ropivacaine emerged as a less toxic alternative to bupivacaine, however, cases of arrhythmias or cardiorespiratory arrest have been reported following accidental administration. Electrocardiographic alterations in local anaesthetic intoxication affect ventricular conduction by prolonging the QRS interval of the EKG. Our aim was to assess whether QRS interval prolongation correlates with elevated blood levels of ropivacaine, which could alert the clinician to the presence of severe intoxication. Material and methods: The study was performed in 4 minipig pigs premedicated with intramuscular ketamine (20 mg/kg) and anaesthetized with sodium thiopental (5 mg/kg) and sevoflurane. After instrumentation and continuous ECG monitoring, 5 mg/kg of intravenous ropivacaine was administered. Analytical blood gas samples determinations and measurements of electrocardiographic parameters were performed at baseline and at 5, 15 and 30 minutes. Correla tion between plasmatic levels of ropivacaine and QRS interval duration was assessed. Statistical analysis: Spearman correlation test. Statistical significance: p < 0.05. Results: Ropivacaine induced a significant increase in the QRS interval at 5, 15 and 30 minutes. The PR, QT and QTc intervals also increased. The percentage of maximum QRS increase was 51 % at 5 minutes. A positive correlation was observed between QRS interval duration and ropivacaine levels, correlation coefficient r = 0.8 (p < 0.0001). Conclusion: our experimental model has allowed us to relate QRS interval duration to ropivacaine blood levels. Its instantaneous widening could be a useful marker to detect cases of systemic intoxication by ropivacaine, widely used in regional anesthesia in AS (AU)

Adaptation and validation of the Stanford Presenteeism Scale-6 in healthcare professionals.

AIM: To develop and psychometrically test the Stanford Presenteeism Scale-6 to assess presenteeism in the Spanish healthcare population. BACKGROUND: Presenteeism, referring to going to work despite being ill, has been associated with job stress, productivity losses, reduced patient safety and increased health problems among the professionals who suffer from it. INTRODUCTION: The highest prevalence of presenteeism in the healthcare sector is among nurses. Their decision to attend work while ill has been related to role overload, lack of supervisor support, mental health and physical conditions. METHODS: A cross-sectional and validation study was conducted between September 2015 and June 2016 in a hospital in Asturias, Spain. Four hundred and ninety-five healthcare professionals voluntarily agreed to participate (281 nurses, 122 physicians and 92 nursing assistants). RESULTS: Presenteeism prevalence was high; the majority of it being in the nursing category. Bartlett's test and the Kaiser-Meyer-Olkin test indicated that the data meet the conditions for factorial analysis, evidencing a small variability in the median of each sample item and a significant standard deviation. Adjustment rates obtained in the exploratory factor analysis showed adequacy, and reliability rates also showed adequacy for both factors. It was verified by a confirmatory analysis that the factors of presenteeism are positively associated with burnout. CONCLUSION: The Stanford Presenteeism Scale-6 showed good psychometric properties to study presenteeism in the Spanish healthcare sector. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing leaders must develop measurements to assess and control psychosocial risks in order to improve the physical and mental health of professionals and reduce patient safety risks.

Recomendaciones en la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria / Recommendations on Testing Before Outpatient Dermatologic Surgery

Introducción: La cirugía dermatológica ambulatoria es una práctica clínica cada vez más habitual, basada en la extirpación de tumores cutáneos mediante anestesia local y con un tiempo quirúrgico reducido. Tradicionalmente, la valoración preoperatoria se ha realizado con el fin de detectar alguna alteración o proceso patológico desconocido que pudiera modificar el plan anestésico y/o quirúrgico. Existe una gran variabilidad entre centros y especialistas sobre las pruebas a solicitar en aquellos pacientes que van a ser sometidos a una intervención quirúrgica dermatológica ambulatoria, teniendo en cuenta que, por el perfil de esta cirugía, prácticamente ningún hallazgo podría modificar o contraindicar la intervención. El objetivo es ofrecer una referencia de actuación para la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria. Métodos: En 2017 se desarrolló en nuestro centro un protocolo para intentar unificar la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria. Se realizó un estudio observacional, descriptivo y retrospectivo analizando las pruebas solicitadas a pacientes sometidos a este tipo de cirugía, comparando antes y después de la aplicación del protocolo. Resultados: Tras la instauración del protocolo se solicitó menor número de pruebas complementarias, sin diferencias estadísticamente significativas en el tipo de cirugía ni complicaciones postoperatorias. Conclusiones: Los pacientes que vayan a ser sometidos, bajo anestesia local, a cirugía dermatológica ambulatoria, y que se encuentren en su estado de salud habitual, podrían no tener indicación de realización de pruebas complementarias preoperatorias

Introduction: Short-duration ambulatory surgery for the removal of skin tumors under local anesthesia is increasingly common in dermatology. Preoperative assessment has traditionally targeted the identification of any unknown diseases or other health conditions that might lead to changes in plans for anesthesia or surgery. Hospitals and specialists differ greatly in the tests they order in patients about to undergo outpatient dermatologic surgery given that hardly any finding would be likely to contraindicate or lead to changes in the procedure. This study aimed to provide guidance for those ordering tests before outpatient dermatologic surgery. Methods: In 2017 our hospital developed a protocol to standardize preoperative testing for outpatient dermatologic surgery. We designed an observational, descriptive, retrospective analysis of tests ordered for patients scheduled for such surgery before and after the protocol was applied. Results: Fewer tests were ordered after the protocol was introduced. We detected no statistically significant differences in relation to type of surgery planned or postoperative complications. Conclusions: Patients about to undergo outpatient dermatologic surgery under local anesthesia who have no unusual health risks may not require preoperative testing

Bupivacaine Toxicity Increases Transmural Dispersion of Repolarization, Developing of a Brugada-like Pattern and Ventricular Arrhythmias, Which is Reversed by Lipid Emulsion Administration. Study in an Experimental Porcine Model.

Unintentional administration of bupivacaine may be associated with electrocardiogram changes that promote the development cardiac arrhythmias. Ventricular repolarization markers (corrected QT, QT dispersion, Tpeak-Tend and Tpeak-Tend dispersion) are useful to predict cardiac arrhythmias. We aim to investigate the effects of bupivacaine on the transmural dispersion of repolarization and their reversion following intravenous lipid emulsion (ILE) administration. Fourteen pigs were anaesthetized with thiopental and sevoflurane and underwent tracheal intubation. After instrumentation, a 4 mg kg-bolus of bupivacaine was administrated followed by an infusion of 100 µg kg-1 min-1. QT interval, QTc:QT corrected by heart rate, Tpeak-to-Tend interval and QT and Tpeak-to-Tend dispersion were determined in a sequential fashion: after bupivacaine (at 1 min, 5 min and 10 min) and after ILE (1.5 mL kg-1 over 1 min followed by an infusion of 0.25 mL kg-1 min-1). Three additional animals received only ILE (control group). Bupivacaine significantly prolonged QT interval (∆:36%), QT dispersion (∆:68%), Tpeak-to-Tend (∆:163%) and Tpeak-to-Tend dispersion (∆:98%), from baseline to 10 min. Dispersion of repolarization was related to lethal arrhythmias [three events, including asystole, sustained ventricular tachycardia (VT)] and repeated non-sustained VT (4/14, 28%). A Brugada-like-ECG pattern was visualized at V1-4 leads in 5/14 pigs (35%). ILE significantly decreased the alterations induced by bupivacaine, with the termination of VT within 10 min. No ECG changes were observed in control group. Bupivacaine toxicity is associated with an increase of transmural dispersion of repolarization, the occurrence of a Brugada-like pattern and malignant VA. ILE reverses the changes in dispersion of repolarization, favouring the disappearance of the Brugada-like pattern and VT.

Recommendations on Testing Before Outpatient Dermatologic Surgery. / Recomendaciones en la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria.

INTRODUCTION: Short-duration ambulatory surgery for the removal of skin tumors under local anesthesia is increasingly common in dermatology. Preoperative assessment has traditionally targeted the identification of any unknown diseases or other health conditions that might lead to changes in plans for anesthesia or surgery. Hospitals and specialists differ greatly in the tests they order in patients about to undergo outpatient dermatologic surgery given that hardly any finding would be likely to contraindicate or lead to changes in the procedure. This study aimed to provide guidance for those ordering tests before outpatient dermatologic surgery. METHODS: In 2017 our hospital developed a protocol to standardize preoperative testing for outpatient dermatologic surgery. We designed an observational, descriptive, retrospective analysis of tests ordered for patients scheduled for such surgery before and after the protocol was applied. RESULTS: Fewer tests were ordered after the protocol was introduced. We detected no statistically significant differences in relation to type of surgery planned or postoperative complications. CONCLUSIONS: Patients about to undergo outpatient dermatologic surgery under local anesthesia who have no unusual health risks may not require preoperative testing.

Estudio radiológico para evaluar la difusión de dos volúmenes (10 vs. 20ml) de contraste radiopaco en el bloqueo de las ramas cutáneas de los nervios intercostales en la línea medio axilar (BRILMA) en un modelo experimental porcino / Radiological study to evaluate the spreading of two volumes (10 vs. 20ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model

Objetivo: Los bloqueos interfasciales de la pared torácica se están desarrollando como alternativa a los bloqueos centrales en la cirugía de mama. Sin embargo, existen escasos estudios que hayan evaluado la extensión anatómica del anestésico local. Nuestro objetivo fue analizar, mediante fluoroscopia, la difusión de dos volúmenes (10 vs. 20ml) de contraste radiopaco (iopamidol) en el bloqueo del plano serrato-intercostal (BRILMA) en un modelo experimental porcino. Material y métodos: Se seleccionaron 10 cerdos de la raza Large-White a los que se realizó un bloqueo BRILMA ecoguiado bilateral, administrando 10 y 20ml de iopamidol en hemitórax izquierdo y derecho, respectivamente. La difusión del contraste se analizó por fluoroscopia. Se utilizó el test de correlación de Spearman para evaluar la relación entre el volumen administrado y la difusión radiológica. Se consideró significativo un valor de p<0,05. Resultados: Se realizaron 20 bloqueos, pudiéndose analizar 18. La administración de 10ml de contraste se asoció con una difusión media de 2,28±0,31 espacios (IC 95%: 2,01-2,54), mientras que la administración de 20ml mostró una difusión de 3±0,25 espacios (IC 95%: 2,81-3,18). Hubo una correlación significativa entre el volumen inyectado y la difusión del contraste (coeficiente de correlación de Spearman de 0,81; p=0,0001). Conclusión: Nuestros resultados demuestran una difusión dependiente del volumen en el bloqueo BRILMA, aunque sin guardar una relación 1:1. Duplicar el volumen ha incrementado en un 31% los segmentos bloqueados. Estos hallazgos, si se corroboran en la práctica clínica, permitirían un ajuste más preciso en el volumen de anestésico administrado

Objective: Interfascial blocks of the thoracic wall are being developed as an alternative to central blocks in breast surgery. However, there are few studies that have evaluated the anatomical extension of the local anaesthetic. The objective of this study was to analyse, using fluoroscopy, the spreading of two volumes (10 vs. 20ml) of radiological contrast in the serratus-intercostal plane block in an experimental pig model. Material: and methods Ten Large-White breed pigs were selected to have a bilateral ultrasound serratus-intercostal plane block performed, with the administering of 10ml and 20ml of iopamidol in the right and left hemithorax, respectively. The spreading of contrast was analysed by fluoroscopy. The Spearman test correlation was used to evaluate the relationship between the administered volume and radiological spreading. A value of P<.05 was considered significant. Results: Twenty anaesthetic blocks were performed, being able to analyse 18 of them. The administration of 10ml of contrast was associated with a mean spreading of 2.28±0.31 (95% CI; 2.01-2.54) intercostal spaces, while the administration of 20ml showed a spreading of 3±0.25 (95% CI; 2.81-3.18) intercostal spaces. There was a significant correlation between the injected volume and the spreading of the contrast (Spearman correlation coefficient of 0.81; P=.0001). Conclusion: The results showed a spreading of volume subject to the serratus-intercostal plane block, although not maintaining a 1:1 ratio. Doubling the volume increased the blocked segments by 31%. These findings, if corroborated in the clinical practice, would allow a more precise adjustment in the anaesthetic volume administered

Réplica a la carta al editor «Técnica de la anestesia y calidad de recuperación después de la colecistectomía laparoscópica ¿caso cerrado?» / Response to the letter to the editor «Anesthesia technique and quality of recovery after laparoscopic cholecystectomy: Case closed?»

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Radiological study to evaluate the spreading of two volumes (10 vs. 20ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model. / Estudio radiológico para evaluar la difusión de dos volúmenes (10 vs. 20ml) de contraste radiopaco en el bloqueo de las ramas cutáneas de los nervios intercostales en la línea medio axilar (BRILMA) en un modelo experimental porcino.

OBJECTIVE: Interfascial blocks of the thoracic wall are being developed as an alternative to central blocks in breast surgery. However, there are few studies that have evaluated the anatomical extension of the local anaesthetic. The objective of this study was to analyse, using fluoroscopy, the spreading of two volumes (10 vs. 20ml) of radiological contrast in the serratus-intercostal plane block in an experimental pig model. MATERIAL AND METHODS: Ten Large-White breed pigs were selected to have a bilateral ultrasound serratus-intercostal plane block performed, with the administering of 10ml and 20ml of iopamidol in the right and left hemithorax, respectively. The spreading of contrast was analysed by fluoroscopy. The Spearman test correlation was used to evaluate the relationship between the administered volume and radiological spreading. A value of P<.05 was considered significant. RESULTS: Twenty anaesthetic blocks were performed, being able to analyse 18 of them. The administration of 10ml of contrast was associated with a mean spreading of 2.28±0.31 (95% CI; 2.01-2.54) intercostal spaces, while the administration of 20ml showed a spreading of 3±0.25 (95% CI; 2.81-3.18) intercostal spaces. There was a significant correlation between the injected volume and the spreading of the contrast (Spearman correlation coefficient of 0.81; P=.0001). CONCLUSION: The results showed a spreading of volume subject to the serratus-intercostal plane block, although not maintaining a 1:1 ratio. Doubling the volume increased the blocked segments by 31%. These findings, if corroborated in the clinical practice, would allow a more precise adjustment in the anaesthetic volume administered.

Estudio aleatorizado cruzado para evaluar la intubación guiada con fibrobroncoscopio a través del dispositivo Air-Q® versus la mascarilla laríngea Fastrach™ en maniquís / Air-Q® versus LMA Fastrach™ for fiberoptic-guided intubation: a randomized cross-over manikin trial

Introducción. Los dispositivos supraglóticos forman parte esencial en el manejo de la vía aérea difícil. El objetivo del presente estudio fue comparar las características de la intubación con fibrobroncoscopio a través del dispositivo Air-Q® versus la mascarilla laríngea Fastrach™ (ML-Fastrach™) por residentes de anestesia en maniquís. Métodos. Estudio aleatorizado y cruzado en el que participaron 33 residentes de anestesia. Se midió el tiempo de inserción (inserción del dispositivo en el maniquí y administración de 2 insuflaciones), el tiempo hasta la intubación traqueal (intubación guiada con el fibrobroncoscopio) y el tiempo para retirar los dispositivos (retirada de la Air-Q®/ML Fastrach™ sobre el tubo endotraqueal). Se evaluó la opinión de la facilidad de utilización. Resultados. Hubo una tasa de éxito del 100% para la intubación traqueal con ambos dispositivos al primer intento. El tiempo de inserción y administración de 2 ventilaciones fue de 10±3s para Air-Q® y de 11±3s para la ML-Fastrach™, p=0,07. El tiempo de intubación traqueal fue más corto con Air-Q®, 38±15s, que con la ML-Fastrach™, 47±19s, p=0,017. El tiempo total fue significativamente más corto con Air-Q® en comparación con la ML-Fastrach™, con un tiempo medio de 74±21 y 87±28s respectivamente, p=0,002. La retirada de la Air-Q® se consideró más fácil que la de la ML-Fastrach™, p=0,005. No se registraron desplazamientos del tubo endotraqueal durante la extracción de los dispositivos. Conclusiones. Los residentes de anestesia pueden realizar la intubación con fibrobroncoscopio a través de la Air-Q® y de la ML-Fastrach™ de forma exitosa y con tiempos clínicamente aceptables (AU)

Introduction. Airway management is still a major cause of anesthesia-associated morbidity and mortality. Supraglottic devices are recommended in difficult airway management guidelines. The aim of this study was to compare the performance of the Air-Q® and the LMA Fastrach™ for fiberoptic guided tracheal intubation. Methods. Thirty-three anesthesia trainees participated in this randomized crossover study. Time to insert the dedicated airways (insertion of the airway into the manikin and delivery of two breaths), time to tracheal intubation (fiberoptic-guided tracheal intubation), time to remove the dedicated airway (removal of the Air-Q®/LMA Fastrach™ over the tracheal tube) and the opinion of the ease of use of the anesthesia trainees were measured. Results. There was 100% success rate for tracheal intubation with both devices on the first attempt. Time to insert the dedicated device and deliver two breaths was 10±3s for the Air-Q® and 11±3s for the LMA Fastrach™, P=.07. Time taken to intubate the trachea was shorter with the air-Q®, 38±15 s, than with the LMA Fastrach™, 47±19s, P=.017. Overall procedure time was significantly shorter with the Air-Q® as compared with the LMA Fastrach™, with a mean time of 74±21s and 87±28s respectively, P=.002. Air-Q® removal was considered easier than LMA Fastrach™ removal, P=.005. There were no tube dislodgements during the removal of the dedicated airways. Conclusions. Inexperienced anesthesia residents can perform fiberoptic-guided intubation through Air-Q® and LMA Fastrach™ in a clinically acceptable time with high success (AU)