Chelsea Skinner, Roshni Sreedharan, Carlos Trombetta, S. Khanna
a Anesthesiology Institute, Cleveland Clinic Foundation. Ohio, USA. b Department of Intensive Care and Resuscitation. Ohio, USA. c Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation. Ohio, USA. d Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation. Ohio, USA. e Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation. Ohio, USA. Correspondence: Department of Cardiothoracic Anesthesiology, Department of General Anesthesiology and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation. 9500 Euclid Avenue, E3-108, Cleveland Clinic Foundation, Cleveland, Ohio 44122 OPEN
克利夫兰诊所基金会麻醉研究所。美国俄亥俄州b重症监护和复苏部。美国俄亥俄州c克利夫兰诊所基金会麻醉研究所全身麻醉科。美国俄亥俄州d克利夫兰诊所基金会麻醉研究所心胸麻醉科。美国俄亥俄州e克利夫兰诊所基金会麻醉研究所结果研究部。美国俄亥俄州通讯：克利夫兰诊所基金会麻醉研究所心胸麻醉科、全身麻醉科和结果研究科。9500 Euclid Avenue，E3-108，克利夫兰诊所基金会，俄亥俄州克利夫兰44122 OPEN
{"title":"Melkersson Rosenthal Syndrome: anesthetic implications","authors":"Chelsea Skinner, Roshni Sreedharan, Carlos Trombetta, S. Khanna","doi":"10.5554/22562087.e1030","DOIUrl":"https://doi.org/10.5554/22562087.e1030","url":null,"abstract":"a Anesthesiology Institute, Cleveland Clinic Foundation. Ohio, USA. b Department of Intensive Care and Resuscitation. Ohio, USA. c Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation. Ohio, USA. d Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation. Ohio, USA. e Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation. Ohio, USA. Correspondence: Department of Cardiothoracic Anesthesiology, Department of General Anesthesiology and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation. 9500 Euclid Avenue, E3-108, Cleveland Clinic Foundation, Cleveland, Ohio 44122 OPEN","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49243836","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}
Carlos Andrés Galeano Castañeda, Jessica Valentina Hoyos Redondo, Juan Camilo Gómez Salgado
Introduction: The Surgical Safety Checklist implemented by the World Health Organization has proven to decrease perioperative morbidity and mortality; however, the barriers and limitations to its implementation are consistently reported in the literature. Objective: To establish the level of appropriation of the surgical safety checklist in the training of human resources in anesthesiology, in addition to identifying the perception and the level of implementation of such checklist at the national scale. Methods: Descriptive cross-sectional study conducted through a survey administered to the residents of anesthesiology in Colombia. Likert-type questions were included, distributed into three domains: appropriation, perception and implementation. Results: 215 answers corresponding to 54.5 % of the population were analyzed, comprising participants from all of the anesthesiology programs in the country. 20% of the residents have never been subject to formal academic reviews about checklists, and this trend did not change throughout the residency; 97.2 % considers that the implementation of the lists improves the safety of surgical procedures and 40 % have seen rejection or indifference by surgeons. 80.5 % of the residents have seen the frequent use of the checklist, while only 13.5% have seen the use of the checklist during the three surgical moments – before the induction of anesthesia, before the surgical incision, and before the patient leaves the operating room -; 88 % have observed that the form is completed without actually doing the verification. Conclusions: There is limited exposure to education about the surgical safety checklist in anesthesiology postgraduate programs in the country. The residents have a favorable perception about the value of the list, however, there are some shortcomings in its administration.
{"title":"The Surgical Safety Checklist from the resident's perspective. Observational study","authors":"Carlos Andrés Galeano Castañeda, Jessica Valentina Hoyos Redondo, Juan Camilo Gómez Salgado","doi":"10.5554/22562087.e1029","DOIUrl":"https://doi.org/10.5554/22562087.e1029","url":null,"abstract":"Introduction: The Surgical Safety Checklist implemented by the World Health Organization has proven to decrease perioperative morbidity and mortality; however, the barriers and limitations to its implementation are consistently reported in the literature. \u0000Objective: To establish the level of appropriation of the surgical safety checklist in the training of human resources in anesthesiology, in addition to identifying the perception and the level of implementation of such checklist at the national scale. \u0000Methods: Descriptive cross-sectional study conducted through a survey administered to the residents of anesthesiology in Colombia. Likert-type questions were included, distributed into three domains: appropriation, perception and implementation. \u0000Results: 215 answers corresponding to 54.5 % of the population were analyzed, comprising participants from all of the anesthesiology programs in the country. 20% of the residents have never been subject to formal academic reviews about checklists, and this trend did not change throughout the residency; 97.2 % considers that the implementation of the lists improves the safety of surgical procedures and 40 % have seen rejection or indifference by surgeons. 80.5 % of the residents have seen the frequent use of the checklist, while only 13.5% have seen the use of the checklist during the three surgical moments – before the induction of anesthesia, before the surgical incision, and before the patient leaves the operating room -; 88 % have observed that the form is completed without actually doing the verification. \u0000Conclusions: There is limited exposure to education about the surgical safety checklist in anesthesiology postgraduate programs in the country. The residents have a favorable perception about the value of the list, however, there are some shortcomings in its administration.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47590849","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}
S. Kanakalakshmi, M. Prabhu, Nita Varghese, V. Pandey
Introduction: Management of intraoperative hemodynamics and postoperative analgesia during arthroscopic shoulder surgeries remains a challenge. Although interscalene brachial plexus block (ISB) is considered ideal for shoulder anesthesia it requires skill and proficiency unlike intravenous (IV) dexmedetomidine. Objective: This randomized trial was performed to observe the efficacy of dexmedetomidine infusion which is less invasive and demands lesser skills than plexus block. Methodology: All patients scheduled for elective arthroscopic shoulder surgery under general anesthesia were assigned either to group DEX, which received an IV dexmedetomidine bolus of 0.5 mcg/kg over 20 minutes, followed by an infusion of 0.5 mcg/kg/hour that was stopped 30 minutes before surgery the end of surgery or to group BLOCK which received ultrasound guided ISB with 20ml of 0.25% bupivacaine. The primary outcome assessed was intraoperative hemodynamics; the secondary outcomes were immediate postoperative pain, operating condition as assessed by the surgeon, recovery time, and patient satisfaction after 24 hours. Blinded investigator and composite scores were used for the assessment. Results: Both groups displayed equivalent scores for intraoperative hemodynamics whereas ISB resulted in a better post-operative analgesia (p < 0.001). Surgeon’s opinion and recovery time were comparable. Overall, the patients had a satisfactory experience with both techniques, according to the quality assessment. Conclusion: IV dexmedetomidine infusion is an effective alternative to ISB for reconstructive shoulder surgeries under general anesthesia.
{"title":"A randomized comparison between interscalene block and dexmedetomidine for arthroscopic shoulder surgery","authors":"S. Kanakalakshmi, M. Prabhu, Nita Varghese, V. Pandey","doi":"10.5554/22562087.e1028","DOIUrl":"https://doi.org/10.5554/22562087.e1028","url":null,"abstract":"Introduction: Management of intraoperative hemodynamics and postoperative analgesia during arthroscopic shoulder surgeries remains a challenge. Although interscalene brachial plexus block (ISB) is considered ideal for shoulder anesthesia it requires skill and proficiency unlike intravenous (IV) dexmedetomidine. \u0000Objective: This randomized trial was performed to observe the efficacy of dexmedetomidine infusion which is less invasive and demands lesser skills than plexus block. \u0000Methodology: All patients scheduled for elective arthroscopic shoulder surgery under general anesthesia were assigned either to group DEX, which received an IV dexmedetomidine bolus of 0.5 mcg/kg over 20 minutes, followed by an infusion of 0.5 mcg/kg/hour that was stopped 30 minutes before surgery the end of surgery or to group BLOCK which received ultrasound guided ISB with 20ml of 0.25% bupivacaine. The primary outcome assessed was intraoperative hemodynamics; the secondary outcomes were immediate postoperative pain, operating condition as assessed by the surgeon, recovery time, and patient satisfaction after 24 hours. Blinded investigator and composite scores were used for the assessment. \u0000Results: Both groups displayed equivalent scores for intraoperative hemodynamics whereas ISB resulted in a better post-operative analgesia (p < 0.001). Surgeon’s opinion and recovery time were comparable. Overall, the patients had a satisfactory experience with both techniques, according to the quality assessment. \u0000Conclusion: IV dexmedetomidine infusion is an effective alternative to ISB for reconstructive shoulder surgeries under general anesthesia.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47289497","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}
Sherif Abdullah, N. Elshalakany, Yousr Farrag, Sayed M Abed
Introduction: Inadequate pain control after major surgery can lead to significant complications. Ultrasound (US) guided plane blocks account for significant progress in regional anesthesia. Objectives: This study explored the analgesic superiority of ultrasound-guided erector spinae (ESPB) and transversus abdominis (TAPB) plane blocks in patients undergoing major ovarian cancer surgery under general anesthesia. There have been no previous studies comparing their efficacy under these circumstances. Methods: This double-blind randomized comparative study included 60 patients undergoing major ovarian cancer surgery under general anesthesia. The ESPB group (n=30), received preoperative ultrasound-guided ESPB and the TAPB group (n=30), received preoperative low TAPB. Opioid consumption, HR, MAP, visual analogue scale (VAS) and adverse events were documented over 24 hours after surgery. Results: There was a highly significant difference in tramadol consumption between the two groups, with (95% CI: 16.23 to 50.43) and (95% CI: 59.23 to 95.43) for ESPB and TAPB groups, respectively. A significant difference (P < 0.01) was shown in intraoperative fentanyl consumption with (95% CI: 113 to 135.6) and (95% CI: 141.8 to 167.6) for ESPB and TAPB groups, respectively. A highly significant longer time to first analgesic request was recorded in the ESPB group (95% CI: 5.5 -15.3) (P < 0.001). VAS had a median of 2 (1-3) and 4 (2-6) for ESPB and TAPB groups, respectively, with F(1)=18.15, P=0.001 between groups. Postoperative HR and MAP in the TAPB group were significantly higher with more incidence of PONV. Conclusions: ESPB provided a more reliable analgesia versus TAPB in patients undergoing ovarian cancer surgery.
{"title":"The use of erector spinae versus transversus abdominis blocks in ovarian surgery: A randomized, comparative study","authors":"Sherif Abdullah, N. Elshalakany, Yousr Farrag, Sayed M Abed","doi":"10.5554/22562087.e1025","DOIUrl":"https://doi.org/10.5554/22562087.e1025","url":null,"abstract":"Introduction: Inadequate pain control after major surgery can lead to significant complications. Ultrasound (US) guided plane blocks account for significant progress in regional anesthesia. \u0000Objectives: This study explored the analgesic superiority of ultrasound-guided erector spinae (ESPB) and transversus abdominis (TAPB) plane blocks in patients undergoing major ovarian cancer surgery under general anesthesia. There have been no previous studies comparing their efficacy under these circumstances. \u0000Methods: This double-blind randomized comparative study included 60 patients undergoing major ovarian cancer surgery under general anesthesia. The ESPB group (n=30), received preoperative ultrasound-guided ESPB and the TAPB group (n=30), received preoperative low TAPB. Opioid consumption, HR, MAP, visual analogue scale (VAS) and adverse events were documented over 24 hours after surgery. \u0000Results: There was a highly significant difference in tramadol consumption between the two groups, with (95% CI: 16.23 to 50.43) and (95% CI: 59.23 to 95.43) for ESPB and TAPB groups, respectively. A significant difference (P < 0.01) was shown in intraoperative fentanyl consumption with (95% CI: 113 to 135.6) and (95% CI: 141.8 to 167.6) for ESPB and TAPB groups, respectively. A highly significant longer time to first analgesic request was recorded in the ESPB group (95% CI: 5.5 -15.3) (P < 0.001). VAS had a median of 2 (1-3) and 4 (2-6) for ESPB and TAPB groups, respectively, with F(1)=18.15, P=0.001 between groups. Postoperative HR and MAP in the TAPB group were significantly higher with more incidence of PONV. \u0000Conclusions: ESPB provided a more reliable analgesia versus TAPB in patients undergoing ovarian cancer surgery.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47463251","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}
Alexandra Chaves Vega, Nubia Fernanda Sánchez Bello, Juan Carlos Bocanegra Rivera, Luz María Gómez Buitrago
Introduction: The risk of suicide among anesthesiologists seems to be higher than in other areas of specialization, probably because of the significant stress associated with this specialty, easy access to strong medications and the profound knowledge about the use of these drugs. There is a poor knowledge about the impact of suicide on anesthesiologists in Colombia and the resources available to deal with this situation are limited. Objective: This survey is intended to indirectly identify the frequency of suicide among the Colombian anesthesiologists and the experiences associated with the suicide of a colleague. Methods: Observational, cross-sectional study based on a survey administered to all the anesthesiologists members of the Colombian Society of Anesthesiology and Resuscitation S.C.A.R.E., at a national scale. Results: 403 anesthesiologists completed the survey. Eighty (19.8 %) of the respondents said they were aware of the death of at least one colleague that committed suicide. Most of them are male anesthesiologists or intensivists, and the age group with the highest rate of reports is between 25 - 29 years old in males. The primary causal mechanism was opioid overdose (58.5 %). Conclusions: In an indirect characterization of suicide among Colombian anesthesiologists, 99 suicide reports were identified corresponding to 80 anesthesiologists. Suicide is preventable and the worksite should provide the support mechanisms required to identify occupational stress, drug dependence, depression and suicide.
{"title":"Suicide in Colombian anesthesiologists. National survey study","authors":"Alexandra Chaves Vega, Nubia Fernanda Sánchez Bello, Juan Carlos Bocanegra Rivera, Luz María Gómez Buitrago","doi":"10.5554/22562087.e1026","DOIUrl":"https://doi.org/10.5554/22562087.e1026","url":null,"abstract":"Introduction: The risk of suicide among anesthesiologists seems to be higher than in other areas of specialization, probably because of the significant stress associated with this specialty, easy access to strong medications and the profound knowledge about the use of these drugs. There is a poor knowledge about the impact of suicide on anesthesiologists in Colombia and the resources available to deal with this situation are limited. \u0000Objective: This survey is intended to indirectly identify the frequency of suicide among the Colombian anesthesiologists and the experiences associated with the suicide of a colleague. \u0000Methods: Observational, cross-sectional study based on a survey administered to all the anesthesiologists members of the Colombian Society of Anesthesiology and Resuscitation S.C.A.R.E., at a national scale. \u0000Results: 403 anesthesiologists completed the survey. Eighty (19.8 %) of the respondents said they were aware of the death of at least one colleague that committed suicide. Most of them are male anesthesiologists or intensivists, and the age group with the highest rate of reports is between 25 - 29 years old in males. The primary causal mechanism was opioid overdose (58.5 %). \u0000Conclusions: In an indirect characterization of suicide among Colombian anesthesiologists, 99 suicide reports were identified corresponding to 80 anesthesiologists. Suicide is preventable and the worksite should provide the support mechanisms required to identify occupational stress, drug dependence, depression and suicide.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45730541","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}
Lucía Arroyo Castillo, Angélica Arango-Gutiérrez, Esther de Vries
Chronic diseases such as cancer have imposed challenges on health systems. Colombia has worked on the construction and implementation of a legal framework for palliative care, but a comprehensive approach to the care provided to cancer patients at the end of their lives is still lacking. Such an approach should be based on understanding of the perceptions of its different actors in order to allow for adequate decision-making and improved support during this stage. Currently, the infrastructure to provide adequate oncological support is insufficient, the administrative procedures that patients and families have to go through to get authorization for treatments and medications for symptom relief are overwhelming and, many times, costs must be paid out of pocket. On the other hand, it is important to train healthcare personnel to develop communication skills to approach patients from a place of compassion, personal development and reflection, creating spaces in which patients can speak openly about their wishes, fears and worries, even if they come together with the desire to accelerate the end of life. In addition, healthcare staff should support and initiate conversations about life and the end of life between patients and their families if this communication is complicated, given its importance for healthcare, quality of life and death. This article seeks to reflect on the end of life of the cancer patient from the perceptions of the actors involved, namely, patients, caregivers and healthcare professionals.
{"title":"End of life of the cancer patient: patient, family and physician perceptions","authors":"Lucía Arroyo Castillo, Angélica Arango-Gutiérrez, Esther de Vries","doi":"10.5554/22562087.e1024","DOIUrl":"https://doi.org/10.5554/22562087.e1024","url":null,"abstract":"Chronic diseases such as cancer have imposed challenges on health systems. Colombia has worked on the construction and implementation of a legal framework for palliative care, but a comprehensive approach to the care provided to cancer patients at the end of their lives is still lacking. Such an approach should be based on understanding of the perceptions of its different actors in order to allow for adequate decision-making and improved support during this stage. \u0000Currently, the infrastructure to provide adequate oncological support is insufficient, the administrative procedures that patients and families have to go through to get authorization for treatments and medications for symptom relief are overwhelming and, many times, costs must be paid out of pocket. \u0000On the other hand, it is important to train healthcare personnel to develop communication skills to approach patients from a place of compassion, personal development and reflection, creating spaces in which patients can speak openly about their wishes, fears and worries, even if they come together with the desire to accelerate the end of life. In addition, healthcare staff should support and initiate conversations about life and the end of life between patients and their families if this communication is complicated, given its importance for healthcare, quality of life and death. \u0000This article seeks to reflect on the end of life of the cancer patient from the perceptions of the actors involved, namely, patients, caregivers and healthcare professionals.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46735758","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 methods most frequently used at the present time in Colombia for the administration of general anesthesia are based on halogenated and intravenous drugs. However, in view of the lack of differential clinical outcomes, the existence of cost variations between the two is not clear. Objective: To determine the expected cost of the use of both techniques in patients taken to surgery, within the framework of the Colombian national health system. Methods: A cost minimization study was carried out using the decision tree as the analytical model. A time frame of 6 postoperative hours was used as the assumption. Only direct healthcare-related costs were included using a case study approach. An econometric model was used based on the frequency with which each technology is applied and the type of drug used, and a deterministic and probabilistic sensitivity analysis was performed. Results: For the case study, total intravenous anesthesia (TIVA) is more costly than the inhalational technique, with an incremental cost of $102,718 per patient. The deterministic analysis shows that both the incidence of postoperative nausea and vomiting (PONV) as well as the use of target controlled infusion (TCI) techniques are the main cost determinants. The probabilistic analysis shows that the cost difference can even be nil in more than 50% of the simulated settings, when the difference in the risk of PONV is higher. Conclusions: Although the total intravenous technique can be more costly than the inhalational technique, this difference is offset by a lower cost of the postanesthesia care unit, given the lower risk of postoperative nausea and vomiting.
{"title":"Total intravenous anesthesia vs inhalational anesthesia in patients undergoing surgery under general anesthesia. Cost-minimization study","authors":"F. D. Casas-Arroyave","doi":"10.5554/22562087.e1023","DOIUrl":"https://doi.org/10.5554/22562087.e1023","url":null,"abstract":"Introduction: The methods most frequently used at the present time in Colombia for the administration of general anesthesia are based on halogenated and intravenous drugs. However, in view of the lack of differential clinical outcomes, the existence of cost variations between the two is not clear. \u0000Objective: To determine the expected cost of the use of both techniques in patients taken to surgery, within the framework of the Colombian national health system. \u0000Methods: A cost minimization study was carried out using the decision tree as the analytical model. A time frame of 6 postoperative hours was used as the assumption. Only direct healthcare-related costs were included using a case study approach. An econometric model was used based on the frequency with which each technology is applied and the type of drug used, and a deterministic and probabilistic sensitivity analysis was performed. \u0000Results: For the case study, total intravenous anesthesia (TIVA) is more costly than the inhalational technique, with an incremental cost of $102,718 per patient. The deterministic analysis shows that both the incidence of postoperative nausea and vomiting (PONV) as well as the use of target controlled infusion (TCI) techniques are the main cost determinants. The probabilistic analysis shows that the cost difference can even be nil in more than 50% of the simulated settings, when the difference in the risk of PONV is higher. \u0000Conclusions: Although the total intravenous technique can be more costly than the inhalational technique, this difference is offset by a lower cost of the postanesthesia care unit, given the lower risk of postoperative nausea and vomiting.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44387089","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}
Lorena Zapata Contreras, Jenny Andrea Páez Jiménez, Juan Sebastián Castro González, Andrés Villada Duque
By November 2021, at the time of preparing this article, the disease caused by the new coronavirus (Coronavirus Disease 2019 - COVID-19), declared as a pandemic by the World Health Organization (WHO) on March 11, 2020, had affected more than 128 million people and claimed upwards of 5 million lives. Many of the patients who suffered from this disease will need elective procedures, and this will require knowledge on how to perform the surgery, what tests to order and the extent of preoperative optimization. The objective of this work was to conduct a narrative review of the current evidence regarding time to the performance of an elective procedure in a patient who suffered from COVID-19, the preoperative tests that need to be ordered, and the degree of clinical optimization required according to the complexity of the surgery and individual patient clinical condition. A search was conducted in the Pubmed/Medline, Science Direct, OVID and SciELO databases, as well as in the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) web-based platforms. Although the evidence is still limited, different scientific societies have issued relevant guidelines pertaining to the timing of an elective procedure after COVID-19 infection. For patients who were asymptomatic, the time is 4 weeks after the initial diagnosis of SARS-CoV-2, whereas for symptomatic patients with a mild to moderate course, the time is at least 7 weeks, and 12 weeks if ICU admission was required. There are no guidelines pertaining to preoperative tests or the degree of clinical optimization, although institutional protocols have been developed based on expert consensus on the topic.
{"title":"Elective surgery after Covid-19: A narrative review of the literature","authors":"Lorena Zapata Contreras, Jenny Andrea Páez Jiménez, Juan Sebastián Castro González, Andrés Villada Duque","doi":"10.5554/22562087.e1022","DOIUrl":"https://doi.org/10.5554/22562087.e1022","url":null,"abstract":"By November 2021, at the time of preparing this article, the disease caused by the new coronavirus (Coronavirus Disease 2019 - COVID-19), declared as a pandemic by the World Health Organization (WHO) on March 11, 2020, had affected more than 128 million people and claimed upwards of 5 million lives. Many of the patients who suffered from this disease will need elective procedures, and this will require knowledge on how to perform the surgery, what tests to order and the extent of preoperative optimization. The objective of this work was to conduct a narrative review of the current evidence regarding time to the performance of an elective procedure in a patient who suffered from COVID-19, the preoperative tests that need to be ordered, and the degree of clinical optimization required according to the complexity of the surgery and individual patient clinical condition. A search was conducted in the Pubmed/Medline, Science Direct, OVID and SciELO databases, as well as in the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) web-based platforms. Although the evidence is still limited, different scientific societies have issued relevant guidelines pertaining to the timing of an elective procedure after COVID-19 infection. For patients who were asymptomatic, the time is 4 weeks after the initial diagnosis of SARS-CoV-2, whereas for symptomatic patients with a mild to moderate course, the time is at least 7 weeks, and 12 weeks if ICU admission was required. There are no guidelines pertaining to preoperative tests or the degree of clinical optimization, although institutional protocols have been developed based on expert consensus on the topic.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45945585","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}
Jairo C. Guevara-Farias, D. Rincón-Valenzuela, Ciro Gómez-Ardila
Introduction: Healthcare costs are increasing against the backdrop of scarce resources. Surgical procedures are an important part of healthcare spending, and the cost of anesthetic techniques is relevant as part of the total cost of care and it is a potential target for expenditure optimization. Although important economic differences have been reported internationally for general anesthesia options, there are no publications in Colombia that compare current costs and allow for informed and financially responsible decision-making. Objective: To quantify and compare direct costs associated with the various general anesthesia options most frequently used at the present time. Methods: Cost minimization analysis based on a theoretical model of balanced general anesthesia using isoflurane, sevoflurane, desflurane in combination with remifentanil, and TIVA (propofol and remifentanil). Initial results were obtained using a deterministic simulation method and a sensitivity analysis was performed using a Monte Carlo simulation. Results: The average total cost per case for the different anesthetic techniques was COP 126381 for sevoflurane, COP 97706 for isoflurane, COP 288605 for desflurane and COP 222 960 for TIVA. Conclusions: Balanced general anesthesia with desflurane is the most costly alternative, 1.2 times more expensive than TIVA, and 2 and 3 times more costly than balanced anesthesia with sevoflurane and isoflurane, respectively. TIVA ranks second with a cost 1.8 times higher than balanced anesthesia with sevoflurane and 2.5 times higher than balanced anesthesia with isoflurane.
{"title":"Comparison of direct costs associated with the use of balanced general anesthesia and total intravenous anesthesia (TIVA) techniques","authors":"Jairo C. Guevara-Farias, D. Rincón-Valenzuela, Ciro Gómez-Ardila","doi":"10.5554/22562087.e1021","DOIUrl":"https://doi.org/10.5554/22562087.e1021","url":null,"abstract":"Introduction: Healthcare costs are increasing against the backdrop of scarce resources. Surgical procedures are an important part of healthcare spending, and the cost of anesthetic techniques is relevant as part of the total cost of care and it is a potential target for expenditure optimization. Although important economic differences have been reported internationally for general anesthesia options, there are no publications in Colombia that compare current costs and allow for informed and financially responsible decision-making. \u0000Objective: To quantify and compare direct costs associated with the various general anesthesia options most frequently used at the present time. \u0000Methods: Cost minimization analysis based on a theoretical model of balanced general anesthesia using isoflurane, sevoflurane, desflurane in combination with remifentanil, and TIVA (propofol and remifentanil). Initial results were obtained using a deterministic simulation method and a sensitivity analysis was performed using a Monte Carlo simulation. \u0000Results: The average total cost per case for the different anesthetic techniques was COP 126381 for sevoflurane, COP 97706 for isoflurane, COP 288605 for desflurane and COP 222 960 for TIVA. \u0000Conclusions: Balanced general anesthesia with desflurane is the most costly alternative, 1.2 times more expensive than TIVA, and 2 and 3 times more costly than balanced anesthesia with sevoflurane and isoflurane, respectively. TIVA ranks second with a cost 1.8 times higher than balanced anesthesia with sevoflurane and 2.5 times higher than balanced anesthesia with isoflurane.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49450209","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}
Carlos Eriel Largo-Pineda, Daniela González-Giraldo, Mario A. Zamudio-Burbano
The erector spinae plane (ESP) block is an interfascial block described in 2016 by Forero and collaborators, with wide clinical uses and benefits when it comes to analgesic control in different surgeries. This block consists of the application of local anesthetic (LA) in a deep plane over the transverse process, anterior to the erector spinae muscle in the anatomical site where dorsal and ventral branches of the spinal nerve roots are located. This review will cover its clinical uses according to different surgical models, the existing evidence and complications described to date.
{"title":"Erector Spinae Plane Block. A narrative review","authors":"Carlos Eriel Largo-Pineda, Daniela González-Giraldo, Mario A. Zamudio-Burbano","doi":"10.5554/22562087.e1020","DOIUrl":"https://doi.org/10.5554/22562087.e1020","url":null,"abstract":"The erector spinae plane (ESP) block is an interfascial block described in 2016 by Forero and collaborators, with wide clinical uses and benefits when it comes to analgesic control in different surgeries. This block consists of the application of local anesthetic (LA) in a deep plane over the transverse process, anterior to the erector spinae muscle in the anatomical site where dorsal and ventral branches of the spinal nerve roots are located. \u0000This review will cover its clinical uses according to different surgical models, the existing evidence and complications described to date.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43827567","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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