Juan Carlos Bocanegra Rivera, Luz María Gómez Buitrago, Nubia Fernanda Sánchez Bello, Alexandra Chaves Vega
Introduction: Prevention, identification, analysis and reduction of adverse events (AEs) are all activities designed to increase safety of care in the clinical setting. Closed claims reviews are a strategy that allows to identify patient safety issues. This study analyzes adverse events resulting in malpractice lawsuits against anesthesiologist affiliated to an insurance fund in Colombia between 2013-2019. Objective: To analyze adverse events in closed medicolegal lawsuits against anesthesiologist affiliated to an insurance fund between 2013-2019. Methods: Cross-sectional observational study. Convenience sampling was used, including all closed claims in which anesthesiologist affiliated to an insurance fund in Colombia were sued during the observation period. Variables associated with the occurrence of AEs were analyzed. Results: Overall, 71 claims were analyzed, of which 33.5% were due to anesthesia-related AEs. Adverse events were found more frequently among ASA I-II patients (78.9%), and in surgical procedures (95.8%). The highest number of adverse events occurred in plastic surgery (29.6%); the event with the highest proportion was patient death (43.7%). Flaws in clinical records and failure to comply with the standards were found in a substantial number of cases. Conclusions: When compared with a previously published study in the same population, an increase in ethical, disciplinary and administrative claims was found, driven by events not directly related to anesthesia. Most of the anesthesia-related events occurred in the operating theater during surgical procedures in patients and procedures categorized as low risk, and most of them were preventable.
{"title":"Adverse events in anesthesia: Analysis of claims against anesthetists affiliated to an insurance fund in Colombia. Cross-sectional study","authors":"Juan Carlos Bocanegra Rivera, Luz María Gómez Buitrago, Nubia Fernanda Sánchez Bello, Alexandra Chaves Vega","doi":"10.5554/22562087.e1043","DOIUrl":"https://doi.org/10.5554/22562087.e1043","url":null,"abstract":"Introduction: Prevention, identification, analysis and reduction of adverse events (AEs) are all activities designed to increase safety of care in the clinical setting. Closed claims reviews are a strategy that allows to identify patient safety issues. This study analyzes adverse events resulting in malpractice lawsuits against anesthesiologist affiliated to an insurance fund in Colombia between 2013-2019. \u0000Objective: To analyze adverse events in closed medicolegal lawsuits against anesthesiologist affiliated to an insurance fund between 2013-2019. \u0000Methods: Cross-sectional observational study. Convenience sampling was used, including all closed claims in which anesthesiologist affiliated to an insurance fund in Colombia were sued during the observation period. Variables associated with the occurrence of AEs were analyzed. \u0000Results: Overall, 71 claims were analyzed, of which 33.5% were due to anesthesia-related AEs. Adverse events were found more frequently among ASA I-II patients (78.9%), and in surgical procedures (95.8%). The highest number of adverse events occurred in plastic surgery (29.6%); the event with the highest proportion was patient death (43.7%). Flaws in clinical records and failure to comply with the standards were found in a substantial number of cases. \u0000Conclusions: When compared with a previously published study in the same population, an increase in ethical, disciplinary and administrative claims was found, driven by events not directly related to anesthesia. Most of the anesthesia-related events occurred in the operating theater during surgical procedures in patients and procedures categorized as low risk, and most of them were preventable.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42376941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariana González La Rotta, V. Mazzanti, Laura Serna Rivas, C. A. Triana Schoonewolff
Introduction: Cognitive load determines working memory ability to store and retain information in long-term memory, thus conditioning learning. Objective: To compare cognitive loads among different simulation activities, including anesthesia and surgery simulation workshops in medical students. Methods: Cross-sectional analytical observational study. Two cognitive load measurement scales (Paas and NASA-TLX) were given to the students after each simulation workshop. Comparisons were made based on the scores derived from the scales. Results: Relevant differences were found in terms of the mental effort assessed by means of the Paas scale, as relates to student rotation order in the airway management workshop, with a greater effort being found in the group that rotated initially in surgery (6.19 vs. 5.53; p = 0.029). The workshop with the highest associated rate of frustration was the airway management workshop. Higher scores were obtained for this workshop in all the items of the NASA-TLX scale, reflecting a higher cognitive load when compared to the others. Conclusion: It was not possible to determine whether higher scores in some of the activities were associated with the inherent difficulty of airway management or the specific workshop design. Consequently, further studies are required to distinguish between those components in order to improve the way learning activities are designed.
{"title":"Cognitive load in academic clinical simulation activities. Cross-sectional study","authors":"Mariana González La Rotta, V. Mazzanti, Laura Serna Rivas, C. A. Triana Schoonewolff","doi":"10.5554/22562087.e1044","DOIUrl":"https://doi.org/10.5554/22562087.e1044","url":null,"abstract":"Introduction: Cognitive load determines working memory ability to store and retain information in long-term memory, thus conditioning learning. \u0000Objective: To compare cognitive loads among different simulation activities, including anesthesia and surgery simulation workshops in medical students. \u0000Methods: Cross-sectional analytical observational study. Two cognitive load measurement scales (Paas and NASA-TLX) were given to the students after each simulation workshop. Comparisons were made based on the scores derived from the scales. \u0000Results: Relevant differences were found in terms of the mental effort assessed by means of the Paas scale, as relates to student rotation order in the airway management workshop, with a greater effort being found in the group that rotated initially in surgery (6.19 vs. 5.53; p = 0.029). The workshop with the highest associated rate of frustration was the airway management workshop. Higher scores were obtained for this workshop in all the items of the NASA-TLX scale, reflecting a higher cognitive load when compared to the others. \u0000Conclusion: It was not possible to determine whether higher scores in some of the activities were associated with the inherent difficulty of airway management or the specific workshop design. Consequently, further studies are required to distinguish between those components in order to improve the way learning activities are designed.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45375520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. F. Quintero-Cifuentes, Juan Camilo Clement, G. A. Cruz-Suárez, Katheryne Chaparro-Mendoza, Alejandra Holguín-Noreña, María A. Vélez-Esquivia
Multimodal analgesia in cardiac surgery sternotomy includes bilateral continuous erector spinae plane block (BC-ESPB). However, the effectiveness of the local anesthetic regimens is still uncertain. The purpose of this study was to assess pain control achieved with a multimodal analgesia regimen including BC-ESPB at the level of T5 with PCA with a 0.125 % bupivacaine infusion and rescue boluses. This is a descriptive case series study which recruited 11 adult patients undergoing cardiac surgery through sternotomy in whom multimodal analgesia including BC-ESPB was used, between February and April 2021, at a fourth level institution. All patients reported pain according to the numeric rating scale (NRS) ≤ 3 both at rest and in motion, at extubation and then 4 and 12 hours after surgery. After 24 hours the pain was NRS ≤ 3 in 100 % of the patients at rest and in 63.6 % in motion. At 48 h 81 % of the patients reported pain NRS ≤ 3 at rest and in motion. At 72h all patients reported pain NRS ≤ 3 at rest and 82 % in motion. The average intraoperative use of fentanyl was 2.35 µg/kg and postoperative hydromorphone was 5.3, 4.1 and 3.3 mg at 24, 48 and 72 hours, respectively. Hence, bilateral ESP block in continuous infusion plus rescue boluses allows for proper control of acute intra and post-operative pain.
{"title":"Bilateral continuous erector spinae plane block for cardiac surgery: case series","authors":"I. F. Quintero-Cifuentes, Juan Camilo Clement, G. A. Cruz-Suárez, Katheryne Chaparro-Mendoza, Alejandra Holguín-Noreña, María A. Vélez-Esquivia","doi":"10.5554/22562087.e1042","DOIUrl":"https://doi.org/10.5554/22562087.e1042","url":null,"abstract":"Multimodal analgesia in cardiac surgery sternotomy includes bilateral continuous erector spinae plane block (BC-ESPB). However, the effectiveness of the local anesthetic regimens is still uncertain. \u0000The purpose of this study was to assess pain control achieved with a multimodal analgesia regimen including BC-ESPB at the level of T5 with PCA with a 0.125 % bupivacaine infusion and rescue boluses. \u0000This is a descriptive case series study which recruited 11 adult patients undergoing cardiac surgery through sternotomy in whom multimodal analgesia including BC-ESPB was used, between February and April 2021, at a fourth level institution. \u0000All patients reported pain according to the numeric rating scale (NRS) ≤ 3 both at rest and in motion, at extubation and then 4 and 12 hours after surgery. After 24 hours the pain was NRS ≤ 3 in 100 % of the patients at rest and in 63.6 % in motion. At 48 h 81 % of the patients reported pain NRS ≤ 3 at rest and in motion. At 72h all patients reported pain NRS ≤ 3 at rest and 82 % in motion. The average intraoperative use of fentanyl was 2.35 µg/kg and postoperative hydromorphone was 5.3, 4.1 and 3.3 mg at 24, 48 and 72 hours, respectively. \u0000Hence, bilateral ESP block in continuous infusion plus rescue boluses allows for proper control of acute intra and post-operative pain.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42284000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Calvache, Maria Delgado, L. Stefani, B. Biccard, R. Pearse
We need more than 100 million additional surgical procedures each year in lowand middle-income countries (LMICs) to achieve safe, timely and affordable surgery at population level (1, 2). As with any human system, perioperative and medical health care have inherent risks that can vary among populations, including between and within countries, specific settings, and individual providers. Indeed, increasing the volume of surgical activity includes expecting an increase in complications and deaths after surgery, especially in fragile perioperative health systems (3). Perioperative mortality has declined significantly over the past 50 years, with the greatest decline in developed high-income countries, (4) but there has been a paucity of epidemiological research to describe perioperative mortality and complications after surgery, especially in LMICs (5). Latin America includes 33 countries and 14 territories, with a huge diversity in socio-cultural factors, ethnicity, geography, and political systems. These in turn, lead to widespread differences in healthcare provision and the population of patients who require surgery. As an example, Colombia is a predominantly urban country (76% of the population) of over 48 million inhabitants (6) with a widespread variability in the surgical systems across the country. Urban settings show top-quality hospitals and educational programs while rural remote locations have a deficient, fragmented, and disorganized healthcare provision (5). Recent studies have recognized the critical importance of social deprivation and population inequities as risk factors for poor patient outcomes after surgery, (7,8) including timely and affordable access to elective surgical care (9). The availability of objective and robust data allowed clinicians, researchers, and healthcare policymakers to focus on the issues of greatest importance to our patients and contextualize our populations in terms of needs, and availability of surgical services. Nevertheless, in LMICs the large size of the surgical population makes longitudinal epidemiological studies difficult or impossible to be conducted. Routine national datasets are either unavailable or not accessible, and there is little or no research delivery workforce to collect source data. In addition, several barriers to promoting collaborative research have been identified including language barriers, the frailty of health care systems, inappropriate data registries, limitations with approvals from ethical committees and individualism and selfishness in research (10). However, previous collaborative studies during the COVID-19 pandemic were successfully conducted (CovidSurg, CovidSurg-Cancer, CovidSurg Week and CovidSurg 3), including many Latin American countries with a very important number of hospitals, professionals and OPEN
{"title":"The need for a joint response. Perioperative mortality in Latin America and the time for LASOS Study","authors":"J. Calvache, Maria Delgado, L. Stefani, B. Biccard, R. Pearse","doi":"10.5554/22562087.e1041","DOIUrl":"https://doi.org/10.5554/22562087.e1041","url":null,"abstract":"We need more than 100 million additional surgical procedures each year in lowand middle-income countries (LMICs) to achieve safe, timely and affordable surgery at population level (1, 2). As with any human system, perioperative and medical health care have inherent risks that can vary among populations, including between and within countries, specific settings, and individual providers. Indeed, increasing the volume of surgical activity includes expecting an increase in complications and deaths after surgery, especially in fragile perioperative health systems (3). Perioperative mortality has declined significantly over the past 50 years, with the greatest decline in developed high-income countries, (4) but there has been a paucity of epidemiological research to describe perioperative mortality and complications after surgery, especially in LMICs (5). Latin America includes 33 countries and 14 territories, with a huge diversity in socio-cultural factors, ethnicity, geography, and political systems. These in turn, lead to widespread differences in healthcare provision and the population of patients who require surgery. As an example, Colombia is a predominantly urban country (76% of the population) of over 48 million inhabitants (6) with a widespread variability in the surgical systems across the country. Urban settings show top-quality hospitals and educational programs while rural remote locations have a deficient, fragmented, and disorganized healthcare provision (5). Recent studies have recognized the critical importance of social deprivation and population inequities as risk factors for poor patient outcomes after surgery, (7,8) including timely and affordable access to elective surgical care (9). The availability of objective and robust data allowed clinicians, researchers, and healthcare policymakers to focus on the issues of greatest importance to our patients and contextualize our populations in terms of needs, and availability of surgical services. Nevertheless, in LMICs the large size of the surgical population makes longitudinal epidemiological studies difficult or impossible to be conducted. Routine national datasets are either unavailable or not accessible, and there is little or no research delivery workforce to collect source data. In addition, several barriers to promoting collaborative research have been identified including language barriers, the frailty of health care systems, inappropriate data registries, limitations with approvals from ethical committees and individualism and selfishness in research (10). However, previous collaborative studies during the COVID-19 pandemic were successfully conducted (CovidSurg, CovidSurg-Cancer, CovidSurg Week and CovidSurg 3), including many Latin American countries with a very important number of hospitals, professionals and OPEN","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43614401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alejandro Rivera Palacios, Johana Andrea España, J. G. Gómez González, Guillermo Salazar Gutierrez, Diana Ávila Reyes, Paula Moreno, Angie Vanessa Lara Martinez, Mateo Aguirre-Flórez, Adrian Giraldo-Diaconeasa
Introduction: The ventilator-induced lung injury (VILI) depends on the amount of energy per minute transferred by the ventilator to the lung measured in Joules, which is called mechanical power. Mechanical power is a development variable probably associated with outcomes in ventilated patients. Objective: To describe the value of mechanical power in patients with SARS-CoV-2 infection and ventilated for other causes and its relationship between days of mechanical ventilation, length of stay in the intensive care unit (ICU), and mortality. Methods: A multicenter, analytical, observational cohort study was conducted in patients with SARS-CoV-2 infection who required invasive mechanical ventilation and patients ventilated for other causes for more than 24 hours. Results: The cohort included 91 patients on mechanical ventilation in three tertiary care centers in the city of Pereira, Colombia. The average value of the mechanical power found was 22.7 ± 1 Joules/min. In the subgroup of patients with SARS-CoV-2 infection, the value of mechanical power was higher 26.8 ± 9 than in the subgroup of patients without a diagnosis of SARS-CoV-2 infection 18.2 ± 1 (p <0.001). Conclusion: Mechanical power is an important variable to consider during the monitoring of mechanical ventilation. This study found an average value of mechanical power of 22.7 ± 1 Joules/min, being higher in patients with SARS-CoV-2 infection related to longer days of mechanical ventilation and a longer stay in the ICU.
{"title":"Mechanical power measurement during mechanical ventilation of SARS-CoV-2 critically ill patients. A cohort study","authors":"Alejandro Rivera Palacios, Johana Andrea España, J. G. Gómez González, Guillermo Salazar Gutierrez, Diana Ávila Reyes, Paula Moreno, Angie Vanessa Lara Martinez, Mateo Aguirre-Flórez, Adrian Giraldo-Diaconeasa","doi":"10.5554/22562087.e1037","DOIUrl":"https://doi.org/10.5554/22562087.e1037","url":null,"abstract":"Introduction: The ventilator-induced lung injury (VILI) depends on the amount of energy per minute transferred by the ventilator to the lung measured in Joules, which is called mechanical power. Mechanical power is a development variable probably associated with outcomes in ventilated patients. \u0000Objective: To describe the value of mechanical power in patients with SARS-CoV-2 infection and ventilated for other causes and its relationship between days of mechanical ventilation, length of stay in the intensive care unit (ICU), and mortality. \u0000Methods: A multicenter, analytical, observational cohort study was conducted in patients with SARS-CoV-2 infection who required invasive mechanical ventilation and patients ventilated for other causes for more than 24 hours. \u0000Results: The cohort included 91 patients on mechanical ventilation in three tertiary care centers in the city of Pereira, Colombia. The average value of the mechanical power found was 22.7 ± 1 Joules/min. In the subgroup of patients with SARS-CoV-2 infection, the value of mechanical power was higher 26.8 ± 9 than in the subgroup of patients without a diagnosis of SARS-CoV-2 infection 18.2 ± 1 (p <0.001). \u0000Conclusion: Mechanical power is an important variable to consider during the monitoring of mechanical ventilation. This study found an average value of mechanical power of 22.7 ± 1 Joules/min, being higher in patients with SARS-CoV-2 infection related to longer days of mechanical ventilation and a longer stay in the ICU.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45954112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. The SARS-CoV-2, COVID-19 pandemic changed the world, causing a global impact on economic, social and public health aspects. This public health situation alerted the international community of anesthesiologists because of the high occupational hazards due to the frequent exposure to patients with COVID-19. Objective. To identify the impact of this pandemic on Latin American anesthesiologists - in a setting with shortage of vaccines – identifying the professionals infected with SARS-CoV-2 and demises, and their geographical distribution. Methods. An observational study was conducted in Latin American anesthesiologists infected SARS-CoV-2 between March and December 2020. The data was collected from the societies, associations and federations members of the Latin American Confederation of Anesthesia Societies in March 2021. Results. 2,170 anesthesiologists infected with SARS-CoV-2 were identified. Of these, 1,550 were from South America and 620 cases were from Central America, Mexico and the Caribbean. Among the 2,170 anesthesiologists infected with SARS-CoV-2, 165 deaths were reported in Latin America, with a mean age of 58 years; 79% were males and the mortality rate was 7.6%. Conclusions. COVID-19 is an emerging disease with significant impact on the population of anesthesiologists. The reports from the societies, associations and federations members of the Latin American Confederation of Anesthesia Societies show the impact in terms of infection and number of deaths associated with the pandemic.
{"title":"Repercussions of the COVID-19 pandemic on Latin American anesthesiologists. Observational study","authors":"G. Calabrese","doi":"10.5554/22562087.e1036","DOIUrl":"https://doi.org/10.5554/22562087.e1036","url":null,"abstract":"Introduction. The SARS-CoV-2, COVID-19 pandemic changed the world, causing a global impact on economic, social and public health aspects. This public health situation alerted the international community of anesthesiologists because of the high occupational hazards due to the frequent exposure to patients with COVID-19. \u0000Objective. To identify the impact of this pandemic on Latin American anesthesiologists - in a setting with shortage of vaccines – identifying the professionals infected with SARS-CoV-2 and demises, and their geographical distribution. \u0000Methods. An observational study was conducted in Latin American anesthesiologists infected SARS-CoV-2 between March and December 2020. The data was collected from the societies, associations and federations members of the Latin American Confederation of Anesthesia Societies in March 2021. \u0000Results. 2,170 anesthesiologists infected with SARS-CoV-2 were identified. Of these, 1,550 were from South America and 620 cases were from Central America, Mexico and the Caribbean. Among the 2,170 anesthesiologists infected with SARS-CoV-2, 165 deaths were reported in Latin America, with a mean age of 58 years; 79% were males and the mortality rate was 7.6%. \u0000Conclusions. COVID-19 is an emerging disease with significant impact on the population of anesthesiologists. The reports from the societies, associations and federations members of the Latin American Confederation of Anesthesia Societies show the impact in terms of infection and number of deaths associated with the pandemic.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41955001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
From its beginnings, anesthesiology as a specialty has advocated patient care, providing relief from pain and suffering during surgical procedures. A plethora of surgical specialities, procedures and technologies have emerged thanks to this specialty which, have increasingly made it safer, with its achievement of lowest adverse effects and highest patient satisfaction.(1) Since its creation, the Colombian Journal of Anesthesiology (CJA) has joined anesthetists along the road of updating their knowledge for daily practice by becoming part of the advancements in the field of peer scientific publications in the world, and gaining local, regional and world recognition. Anesthesiology, in turn, has made substantial progress during this time, improving patient safety, in particular over the past 15 years. The number of techniques, devices and specific training areas have experienced significant growth, as has also been the case with perioperative patient management and monitoring, where the role of anesthetists has been well recognized. (2) Both the specialty as well as the Journal continue to face challenges given that, over the course of the coming years, the specialty will be expected to embrace tools for accurate and personalized patient management, including genomics, epigenetics (3), telemedicine, green anesthesia and the use of perioperative diagnostic imaging supported by artificial intelligence (2). However, added to this daunting future landscape, the Lancet Commission on Global Surgery, created in 2014, identified the wide gap existing in the world in terms of access to surgery and anesthesia services and related health outcomes. This prompted a proposal focused on monitoring of six indicators that reflect safe and affordable universal access to surgical and anesthetic care (4):
从一开始，麻醉学作为一门专业就提倡病人护理，在手术过程中减轻疼痛和痛苦。由于这一专业，大量的外科专业、程序和技术已经出现，这使得它越来越安全，其不良反应最低，患者满意度最高。(1)自创刊以来，哥伦比亚麻醉学杂志(CJA)通过成为世界同行科学出版物领域的进步的一部分，与麻醉师一起更新他们的日常实践知识，并获得当地，地区和世界的认可。麻醉学在这段时间里也取得了重大进展，特别是在过去的15年里，提高了患者的安全性。技术、设备和特定培训领域的数量有了显著的增长，在围手术期患者管理和监测方面也是如此，麻醉师的作用已经得到了很好的认识。(2)该专业和《柳叶刀》杂志都将继续面临挑战，因为在未来几年，该专业将有望采用精确和个性化的患者管理工具，包括基因组学、表观遗传学(3)、远程医疗、绿色麻醉和人工智能支持的围手术期诊断成像的使用(2)。然而，在这一令人畏惧的未来前景之外，2014年成立的《柳叶刀》全球外科委员会(Lancet Commission on Global Surgery)，确定世界上在获得手术和麻醉服务及相关健康结果方面存在的巨大差距。这促使一项提案侧重于监测反映普遍获得安全和负担得起的手术和麻醉护理的六项指标(4):
{"title":"Colombian Journal of Anesthesiology, present and future challenges in its 50th","authors":"J. Eslava-Schmalbach","doi":"10.5554/22562087.e1032","DOIUrl":"https://doi.org/10.5554/22562087.e1032","url":null,"abstract":"From its beginnings, anesthesiology as a specialty has advocated patient care, providing relief from pain and suffering during surgical procedures. A plethora of surgical specialities, procedures and technologies have emerged thanks to this specialty which, have increasingly made it safer, with its achievement of lowest adverse effects and highest patient satisfaction.(1) Since its creation, the Colombian Journal of Anesthesiology (CJA) has joined anesthetists along the road of updating their knowledge for daily practice by becoming part of the advancements in the field of peer scientific publications in the world, and gaining local, regional and world recognition. Anesthesiology, in turn, has made substantial progress during this time, improving patient safety, in particular over the past 15 years. The number of techniques, devices and specific training areas have experienced significant growth, as has also been the case with perioperative patient management and monitoring, where the role of anesthetists has been well recognized. (2) Both the specialty as well as the Journal continue to face challenges given that, over the course of the coming years, the specialty will be expected to embrace tools for accurate and personalized patient management, including genomics, epigenetics (3), telemedicine, green anesthesia and the use of perioperative diagnostic imaging supported by artificial intelligence (2). However, added to this daunting future landscape, the Lancet Commission on Global Surgery, created in 2014, identified the wide gap existing in the world in terms of access to surgery and anesthesia services and related health outcomes. This prompted a proposal focused on monitoring of six indicators that reflect safe and affordable universal access to surgical and anesthetic care (4):","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45713838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Law 6 was enacted thirty years ago. Notwithstanding the fact that almost three decades have elapsed, with the exception of the regional and national leaders, many anesthesiologists are unaware of the existence of such law, of its contents or about which are the positive aspects for the specialty and for all anesthesia colleagues. There is a lack of awareness regarding the fact that the oversight committees are a valuable instrument to ensure excellence in the practice of anesthesia. This publication shall contribute to an share an overview of the efforts made to ensure the approval of the Law by the National Congress and of the Law among all anesthesiologists in the country. In this way, all practitioners will become acquainted with the information on the topic to take advantage of the provisions in the Law.
{"title":"History of Law 6, 1991","authors":"Manuel Antonio Galindo","doi":"10.5554/22562087.e1034","DOIUrl":"https://doi.org/10.5554/22562087.e1034","url":null,"abstract":"Law 6 was enacted thirty years ago. Notwithstanding the fact that almost three decades have elapsed, with the exception of the regional and national leaders, many anesthesiologists are unaware of the existence of such law, of its contents or about which are the positive aspects for the specialty and for all anesthesia colleagues. There is a lack of awareness regarding the fact that the oversight committees are a valuable instrument to ensure excellence in the practice of anesthesia. \u0000This publication shall contribute to an share an overview of the efforts made to ensure the approval of the Law by the National Congress and of the Law among all anesthesiologists in the country. In this way, all practitioners will become acquainted with the information on the topic to take advantage of the provisions in the Law.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46050728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The technical standards in anesthesiology govern the professional practice and allow for the provision of safer anesthesia and surgery. This article gives a historical perspective on the creation, main content, and consequences of the implementation of the Peruvian standards in anesthesiology.
{"title":"Historical perspective of two technical standards developed in the 21st century that gave rise to profound changes in Peruvian anesthesiology","authors":"C. Shiraishi-Zapata, M. Niquen-Jimenez","doi":"10.5554/22562087.e1033","DOIUrl":"https://doi.org/10.5554/22562087.e1033","url":null,"abstract":"The technical standards in anesthesiology govern the professional practice and allow for the provision of safer anesthesia and surgery. This article gives a historical perspective on the creation, main content, and consequences of the implementation of the Peruvian standards in anesthesiology.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71105444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The importance of breastfeeding with its positive impact on the wellbeing of the mother-infant pair is well established. Anesthesiologists should encourage the promotion of lactation by being willing to give reassurance during the preoperative period and preparing a plan that does not interfere with safe breastfeeding. There is concern regarding the transfer of drugs into breast milk, which may lead to inconsistent advice from many health professionals and to early discontinuation. However, evidence shows that most anesthetic drugs are safe in terms of transfer into breast milk, and hence, compatible with breastfeeding, which should be resumed after anesthesia as soon as the mother is alert and feels well enough to hold her infant, without the need to “pump and dump”. This review provides pharmacokinetic information on commonly used anesthesia drugs and their passage into breast milk, to help practitioners discuss risks and benefits with the mother, emphasizing that anesthesia should not interfere with the benefits of breastfeeding. Four practical clinical scenarios are presented: pregnant women concerned about the effect of epidural analgesia on subsequent breastfeeding, spinal anesthesia for c-section and lactation, patients who will receive general anesthesia during cesarean section, and finally women who are breastfeeding and require anesthesia for elective or urgent surgery. Neuraxial anesthesia allows for better pain control and immediate skin-to-skin contact at the time of childbirth. Also, it interferes the least with the woman’s ability to care for her infant. Regional techniques, opioid-sparing techniques and outpatient surgery are preferred. Drugs such as opioids and longer-acting benzodiazepines should be administered cautiously, particularly in repeat doses.
{"title":"Anesthesia and breastfeeding","authors":"Juan Pablo Ghiringhelli, H. Lacassie","doi":"10.5554/22562087.e1031","DOIUrl":"https://doi.org/10.5554/22562087.e1031","url":null,"abstract":"The importance of breastfeeding with its positive impact on the wellbeing of the mother-infant pair is well established. Anesthesiologists should encourage the promotion of lactation by being willing to give reassurance during the preoperative period and preparing a plan that does not interfere with safe breastfeeding. There is concern regarding the transfer of drugs into breast milk, which may lead to inconsistent advice from many health professionals and to early discontinuation. However, evidence shows that most anesthetic drugs are safe in terms of transfer into breast milk, and hence, compatible with breastfeeding, which should be resumed after anesthesia as soon as the mother is alert and feels well enough to hold her infant, without the need to “pump and dump”. This review provides pharmacokinetic information on commonly used anesthesia drugs and their passage into breast milk, to help practitioners discuss risks and benefits with the mother, emphasizing that anesthesia should not interfere with the benefits of breastfeeding. Four practical clinical scenarios are presented: pregnant women concerned about the effect of epidural analgesia on subsequent breastfeeding, spinal anesthesia for c-section and lactation, patients who will receive general anesthesia during cesarean section, and finally women who are breastfeeding and require anesthesia for elective or urgent surgery. Neuraxial anesthesia allows for better pain control and immediate skin-to-skin contact at the time of childbirth. Also, it interferes the least with the woman’s ability to care for her infant. Regional techniques, opioid-sparing techniques and outpatient surgery are preferred. Drugs such as opioids and longer-acting benzodiazepines should be administered cautiously, particularly in repeat doses.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48052996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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