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Anesth Analg ; 135(1): 6-19, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35389378


Patient safety is a core principle of anesthesia care worldwide. The specialty of anesthesiology has been a leader in medicine for the past half century in pursuing patient safety research and implementing standards of care and systematic improvements in processes of care. Together, these efforts have dramatically reduced patient harm associated with anesthesia. However, improved anesthesia patient safety has not been uniformly obtained worldwide. There are unique differences in patient safety outcomes between countries and regions in the world. These differences are often related to factors such as availability, support, and use of health care resources, trained personnel, patient safety outcome data collection efforts, standards of care, and cultures of safety and teamwork in health care facilities. This article provides insights from national anesthesia society leaders from 13 countries around the world. The countries they represent are diverse geographically and in health care resources. The authors share their countries' current and future initiatives in anesthesia patient safety. Ten major patient safety issues are common to these countries, with several of these focused on the importance of extending initiatives into the full perioperative as well as intraoperative environments. These issues may be used by anesthesia leaders around the globe to direct collaborative efforts to improve the safety of patients undergoing surgery and anesthesia in the coming decade.

Anestesia , Anestesiologia , Anestesia/efeitos adversos , Humanos , Segurança do Paciente
Rev. colomb. anestesiol ; 49(4): e100, Oct.-Dec. 2021.
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1341235


The S.C.A.R.E. members assembly held on March 3ist, 2021, was quite revealing: its leitmotiv was the challenging work situation experienced by the colleagues across the country. The similarity with the very first assembly meeting I attended in Pasto in 1990 as a young anesthetist, invited by the tireless of doctor Jorge Osorio, was mystifying. It is rather striking to see how history repeats itself after 31 years, bringing back times that we thought were something of the past.

La asamblea de socios de la S.C.A.R.E. celebrada el 3 de marzo de 2021 fue bastante reveladora: su leitmotiv fue la desafiante situación laboral que viven los colegas de todo el país. La similitud con la primera asamblea a la que asistí en Pasto en 1990 como joven anestesista, invitado por el incansable del doctor Jorge Osorio, fue desconcertante. Es bastante llamativo ver cómo la historia se repite después de 31 años, trayendo de vuelta tiempos que creíamos que eran cosa del pasado.

Humanos , Anestesistas , Anestesiologia , Associação , Pensamento , Colômbia , História
Sci Rep ; 9(1): 7148, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31073216


Asthenospheric mantle flow drives lithospheric plate motion and constitutes a relevant feature of Earth gateways. It most likely influences the spatial pattern of seismic velocity and deep electrical anisotropies. The Drake Passage is a main gateway in the global pattern of mantle flow. The separation of the South American and Antarctic plates since the Oligocene produced this oceanic and mantle gateway connecting the Pacific and Atlantic oceans. Here we analyze the deep crustal and upper mantle electrical anisotropy of its northern margin using long period magnetotelluric data from Tierra del Fuego (Argentina). The influence of the surrounding oceans was taken into account to constrain the mantle electrical conductivity features. 3D electrical models were calculated to fit 18 sites responses in this area. The phase tensor pattern for the longest periods reveals the existence of a well-defined NW-SE electrical conductivity anisotropy in the upper mantle. This anisotropy would result from the mantle flow related to the 30 to 6 Ma West Scotia spreading, constricted by the subducted slab orientation of the Pacific plate, rather than the later eastward mantle flow across the Drake Passage. Deep electrical anisotropy proves to be a key tool for a better understanding of mantle flow.

Environ Monit Assess ; 190(2): 100, 2018 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-29374329


Over 40 years, the detrital aquifer of the Plana de Castellón (Spanish Mediterranean coast) has been subjected to seawater intrusion because of long dry periods combined with intensive groundwater exploitation. Against this backdrop, a managed artificial recharge (MAR) scheme was implemented to improve the groundwater quality. The large difference between the electrical conductivity (EC) of the ambient groundwater (brackish water due to marine intrusion) and the recharge water (freshwater) meant that there was a strong contrast between the resistivities of the brackish water saturated zone and the freshwater saturated zone. Electrical resistivity tomography (ERT) can be used for surveying similar settings to evaluate the effectiveness of artificial recharge schemes. By integrating geophysical data with lithological information, EC logs from boreholes, and hydrochemical data, we can interpret electrical resistivity (ER) with groundwater EC values and so identify freshwater saturated zones. Using this approach, ERT images provided a high-resolution spatial characterization and an accurate picture of the shape and extent of the recharge plume of the MAR site. After 5 months of injection, a freshwater plume with an EC of 400-600 µS/cm had formed that extended 400 m in the W-E direction, 250 m in the N-S direction, and to a depth of 40 m below piezometric level. This study also provides correlations between ER values with different lithologies and groundwater EC values that can be used to support other studies.

Monitoramento Ambiental/métodos , Água Subterrânea/química , Água do Mar/análise , Condutividade Elétrica , Água Doce , Salinidade , Tomografia
Anesth Analg ; 125(1): 162-169, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28622175


BACKGROUND: Despite the frequency of new clinically important atrial fibrillation (AF) after noncardiac surgery and its increased association with the risk of stroke at 30 days, there are limited data informing their prediction, association with outcomes, and management. METHODS: We used the data from the PeriOperative ISchemic Evaluation trial to determine, in patients undergoing noncardiac surgery, the association of new clinically important AF with 30-day outcomes, and to assess management of these patients. We also aimed to derive a clinical prediction rule for new clinically important AF in this population. We defined new clinically important AF as new AF that resulted in symptoms or required treatment. We recorded an electrocardiogram 6 to 12 hours postoperatively and on the 1st, 2nd, and 30th days after surgery. RESULTS: A total of 211 (2.5% [8351 patients]; 95% confidence interval, 2.2%-2.9%) patients developed new clinically important AF within 30 days of randomization (8140 did not develop new AF). AF was independently associated with an increased length of hospital stay by 6.0 days (95% confidence interval, 3.5-8.5 days) and vascular complications (eg, stroke or congestive heart failure). The usage of an oral anticoagulant at the time of hospital discharge among patients with new AF and a CHADS2 score of 0, 1, 2, 3, and ≥4 was 6.9%, 10.2%, 23.0%, 9.4%, and 33.3%, respectively. Two independent predictors of patients developing new clinically important AF were identified (ie, age and surgery). The prediction rule included the following factors and assigned weights: age ≥85 years (4 points), age 75 to 84 years (3 points), age 65 to 74 years (2 points), intrathoracic surgery (3 points), major vascular surgery (2 points), and intra-abdominal surgery (1 point). The incidence of new AF based on scores of 0 to 1, 2, 3 to 4, and 5 to 6 was 0.5%, 1.0%, 3.1%, and 5.3%, respectively. CONCLUSIONS: Age and surgery are independent predictors of new clinically important AF in the perioperative setting. A minority of patients developing new clinically important AF with high CHADS2 scores are discharged on an oral anticoagulant. There is a need to develop effective and safe interventions to prevent this outcome and to optimize the management of this event when it occurs.

Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Abdome/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Eletrocardiografia , Feminino , Humanos , Incidência , Laparotomia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
Rev. colomb. anestesiol ; 40(1): 21-26, ene.-mar. 2012. tab
Artigo em Espanhol | LILACS, COLNAL | ID: lil-650036


Análisis del desenlace mortal de una sedación profunda por un médico no anestesiólogo, que después de un proceso legal terminó en una condena en los Estados Unidos. Se hace una discusión del potencial impacto de la implementación de las recomendaciones recientemente publicadas, para la sedación por no anestesiólogos, desarrolladas por la Sociedad Colombiana de Anestesiología (SCARE) en conjunto con otras sociedades científicas en la seguridad de estos procedimientos.

Analysis of the death resulting from a deep sedation administered by a non anesthetist physician who, after a trial in the United States, was convicted. A discussion is made of the potential impact of the adoption of the recently published recommendations for sedation by non anesthetists, developed by the Sociedad Colombiana de Anestesiologia (SCARE) along with other scientific societies.

Rev. colomb. anestesiol ; 40(1): 67-74, ene.-mar. 2012. tab
Artigo em Espanhol | LILACS, COLNAL | ID: lil-650041


Las complicaciones relacionadas con la sedación son, en su enorme mayoría, prevenibles. El presente documento establece unas recomendaciones para que los no anestesiólogos puedan realizar sedaciones nivel I y II con un buen nivel de seguridad. Sus aspectos másimportantes son: administración de la sedación por una persona diferente del operador; recomendaciones en cuanto a la capacitación, la monitorización, el uso de un solo medicamento para la sedación y la disponibilidad de medicamentos y equipos de respaldo;la necesidad de realizar una evaluación previa a la sedación, así como el consentimiento informado y el registro durante el procedimiento; y recomendaciones para considerar un bajo umbral con el fin de solicitar el apoyo de un anestesiólogo.

Most of the complications related to sedation are preventable. This document defines some recommendations for non-anesthesiologists so that they can provide sedation level I and II with adequate safety. The most important recommendations are: that the sedation be provided by someone different from the person who performs the surgical procedure; designation of the training and monitoring of thje person who sedates; the use of only one medication for sedation, and the availability of medications and equipment to manage complications; the mandatory need of an assessment prior to the sedation, as well as informed consent and record of events during the procedure; and the recommendation of having a low threshold to request the support of an anesthesiologist.

Rev. colomb. anestesiol ; 37(4): 390-403, nov.-ene. 2010. ilus, tab
Artigo em Inglês, Espanhol | LILACS | ID: lil-594614


Este documento define algunos aspectos particulares al ejercicio de la anestesia en cirugía plástica que pretenden mejorar la seguridad de los pacientes. Se hace énfasis en la presentación de estrategias para reducir las complicaciones graves prevenibles más comunes, como los eventos de trombosis, embolias e infecciones. Se establece que estas metas se logran con la participación de los cirujanos y de los anestesiólogos. Estas recomendaciones son adiciones puntuales a las normas mínimas que ha desarrollado la SCARE.

This document defines some particular aspects involved in practising anaesthesia in plastic surgery which are intended to improve patient safety. It presents strategies for reducing the most common serious preventable complications, such as thrombotic, embolic and infectious events. It should be stressed that these goals have been established and must be achieved with surgeons and anaesthesiologists’ participation. These recommendations provide detailed are additions to the Minimum Standards which SCARE has developed.

Humanos , Masculino , Adolescente , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Congressos como Assunto , Consenso , Conferências de Consenso como Assunto , Procedimentos Cirúrgicos Eletivos , Segurança , Cirurgia Plástica , Pacientes Ambulatoriais , Equipamentos de Proteção , Cirurgia Plástica
Rev. colomb. anestesiol ; 37(3): 235-253, ago.-oct. 2009. tab
Artigo em Inglês, Espanhol | LILACS | ID: lil-594602


Esta es una actualización de las Normas Mínimas del 2003. Sus cambios principales son la inclusión de la Lista de Chequeo, propuestas de formatos de evaluación preanestésica, registro intraoperatorio, registro de UCPA, y consentimiento informado. Además se agregan ítems que extienden el rol del anestesiólogo como participación enla tromboprofilaxis, profilaxis antibiótica, y definición explicita del manejo del dolor perioperatorio que son pilares de la medicina perioperatoria. Se incluye también la necesidad de generar bases de datos para registrar información perioperatoria y sugerencias para la disponibilidad y uso de medicamentos seguro. Por último se actualizan los laboratorios preanestésicos recomendados.

This updates Minimum Standards 2003. The main changes concern including the Check List; proposals for preanaesthetic evaluation forms; in- traoperative records; UCPA record; and informed consent. Items have also been added extending the anaesthesiologist’s role by participating in thromboprophylaxis, antibiotic prophylaxis and an explicit definition for managing perioperative pain as the main support for perioperative medi- cine. The need for generating databases for recor- ding perioperative information and suggestions for the availability and use of safe medicaments are also included. The list of recommended prea- naesthetic laboratories has also been updated.

Humanos , Masculino , Adolescente , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Gestão da Segurança , Guias como Assunto , Monitorização Intraoperatória , Avaliação de Processos e Resultados em Cuidados de Saúde , Avaliação de Resultados em Cuidados de Saúde , Cuidados Pré-Operatórios , Gestão da Segurança , Atenção , Atenção à Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde , Enfermagem Perioperatória , Segurança
Rev. colomb. anestesiol ; 36(3): 187-197, oct. 2008. ilus, tab
Artigo em Espanhol | LILACS, COLNAL | ID: lil-635992


La informática médica se define como el manejo de la información para mejorar los procesos médicos. La anestesiología es una de las áreas médicas donde la mejoría del manejo de información puede tener un impacto positivo. Se discuten cuatro áreas: el uso de computadores en anestesia, las comunicaciones en el ambiente perioperatorio, el uso de Personal Digital Assistants (PDA) (asistentes personales digitales, mejor conocidas en Colombia como agendas digitales) en anestesia y la utilidad del uso de internet en anestesia.

Medical informatics are defined as the management of information to improve medical processes. Anesthesia is one of the medical areas where the better management of information can have a positive impact. Four informatics areas are discussed in this paper: the use of computers in anesthesia, communications in the perioperative environment, the use of PDA’s in anesthesia and the usefulness of internet in anesthesia.

Rev. colomb. anestesiol ; 35(4): 301-312, oct.-dic. 2007. ilus
Artigo em Espanhol | LILACS | ID: lil-491020


En el presente artículo se hace un análisis pormenorizado de la indicación, necesidad, efectividad y costos de los diversos exámenes de laboratorio solicitados por los grupos quirúrgicos, en la evaluación preoperatorio de los pacientes, según tipo de cirugía, condición clínica, enfermedades asociadas, edad, riesgo, duración y sangrado previstos en situaciones de emergencia, en la perspectiva de mejorar la evolución perioperatoria. Basado en la clase y tipo de evidencia publicada en la literatura, se describen la indicación pertinencia y beneficios de los distintos exámenes de laboratorio con algunas recomendaciones originadas en el ASA y la experiencia adquirida en el registro y la observación sistematizada de miles de pacientes en la Clínica Reina Sofia. Al final se presentan unos algoritmos para factores de riesgo bajo, intermedio y en pacientes cardíacos.

Humanos , Cuidados Pré-Operatórios/instrumentação , /métodos , Medicação Pré-Anestésica/tendências , Preparação em Desastres , Risco
Rev. colomb. anestesiol ; 33(4): 259-268, oct.-dec. 2005. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-423776


La injuria secundaria es la principal causa prevenible de los desenlaces neurológicos adversos, en pacientes con TCE severo. A la luz del conocimiento actual, se sabe que una adecuada prevención de estos factores injuriantes, puede evitar estos malos desenlaces. Se describen los mecanismos causales de la injuria secundaria, que hacen que el tejido de la penumbra eventualmente empeore su perfusión, desarrolle isquemia y muerte. Es trascendental que todo el personal que intervenga en el manejo de estos pacientes conozca estos conceptos, además de comprender que la simple ejecución de intervenciones sencillas, puede salvar miles de vidas sin implicar costos inmanejables. Es responsabilidad de todos divulgar estos conceptos...

Lesões Encefálicas Traumáticas , Traumatismos Craniocerebrais , Traumatismos Cranianos Penetrantes
Rev. colomb. anestesiol ; 32(4): 288-289, oct.-dic. 2004. ilus
Artigo em Espanhol | LILACS | ID: lil-423797


Desde que se describieron los primeros casos de colecistectomía laparoscópica (colelap) en Colombia en 19911, se ha popularizado en el país como que hoy es el manejo estándar de la cirugía de la vesícula biliar2, incluso haciéndose en algunos centros de manera ambulatoria.3 Su popularidad radica en los grandes beneficios para los pacientes que esta conlleva, y que incluso produce menos morbilidad que la abierta aún en pacientes con enfermedades concomitantes. A pesar de su seguridad, como todo procedimiento, no esta exento de complicaciones. Las mas comunes son reoperación por hemorragia (0.7 por ciento), escurrimiento biliar (0.7 por ciento), neumonía (1.0 por ciento), infección de la herida (1.8 por ciento) y complicaciones embolicas (0.2 por ciento) y mas raramente, muerte (0.1 por ciento). Otras complicaciones menores son el neumomediastino, neumotórax (0.05 por ciento), y enfisema subcutáneo (0.15 por ciento).4 y 7 REPORTE DE CASO: Paciente de 82 años de 43 Kg. con cuadro de colecistitis, con antecedente de hipertensión arterial en manejo con captopril y diurético. Sin más antecedentes importantes es programada para colecistectomía laparoscópica. Signos vitales iniciales, presión arterial 170/90 mmHg y frecuencia cardiaca (FC) de 90 latidos /min. SpO2 al aire de 91 por ciento. Monitoria estándar con electrocardiografía continua, oximetría de pulso, capnografía, gases anestésicos espirados, presión arterial no invasiva. Para mejorar el control de la presión arterial, se administra metoprolol hasta disminuir la FC hasta 60 latidos/min. luego se administran remifentanil 40 mcg. rocuronio 40mg, propofol 50 mg, se coloca TOT No. 7.5 verificando su posición con auscultación simétrica. Se realiza un procedimiento sin eventualidades con una duración de 105 minutos. Se usa una insuflación estándar de de CO2 hasta una presión intraabdominal de 20 cmH2O sin problemas evidentes intraoperatorios. Se ajusta el volumen minuto en los primeros 15 minutos para mantener una EtCO2 de 28 y 32 mmHg. A partir de los 45 minutos de inicio, se observa un marcado incremento del EtCO2 muy superior al normal esperado con la insuflación de CO2 intraperitoneal a pesar que el volumen minuto permanece constante alrededor de 4 litros/minuto (ventilador de maquina anestesia Drager y Julian). Ver figura 1...

Assistência Ambulatorial , Vesícula Biliar , Laparoscopia