Carlos Fernando Sanabria Botello, A. Fernández Trujillo, I. Palacios, C. Ocampo
Severe asthma affects more than 250 million people and represents high healthcare costs. Bronchial thermoplasty is a relatively new technique in interventional pulmonology for managing this condition. The procedure is done under general anesthesia and the patients are mostly ASA II and III; therefore, the anesthesia plan must be safe. The purpose of the article is to describe the anesthetic technique used (general anesthesia and laryngeal mask) and the immediate and early complications of the procedure. Four patients were included, each undergoing three sessions. The complications during and immediately after the procedure, as well as the early complications (up to seven days post-procedure) that could have required hospital management were discussed. In three of the sessions at least one acute bronchospasm event presented, but only one patient required hospital admission for more than 24 hours. Experience suggests that thermoplasty may be safely conducted under general anesthesia and laryngeal mask.
{"title":"Complications of bronchial thermoplasty using laryngeal mask: case series","authors":"Carlos Fernando Sanabria Botello, A. Fernández Trujillo, I. Palacios, C. Ocampo","doi":"10.5554/22562087.e1008","DOIUrl":"https://doi.org/10.5554/22562087.e1008","url":null,"abstract":"Severe asthma affects more than 250 million people and represents high healthcare costs. Bronchial thermoplasty is a relatively new technique in interventional pulmonology for managing this condition. The procedure is done under general anesthesia and the patients are mostly ASA II and III; therefore, the anesthesia plan must be safe. The purpose of the article is to describe the anesthetic technique used (general anesthesia and laryngeal mask) and the immediate and early complications of the procedure. Four patients were included, each undergoing three sessions. The complications during and immediately after the procedure, as well as the early complications (up to seven days post-procedure) that could have required hospital management were discussed. In three of the sessions at least one acute bronchospasm event presented, but only one patient required hospital admission for more than 24 hours. Experience suggests that thermoplasty may be safely conducted under general anesthesia and laryngeal mask.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44231115","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}
{"title":"Update on the management of local anesthetic systemic toxicity","authors":"M. I. Berrío Valencia, Sebastián Rivera Díaz","doi":"10.5554/22562087.e1007","DOIUrl":"https://doi.org/10.5554/22562087.e1007","url":null,"abstract":"","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43036931","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}
Saúl Álvarez Robles, Claudia Consuelo Torres Contreras, Raquel Rivera Carvajal, Víctor Manuel Lucigniani Ariza, Sonia Margarita Vivas García
Introduction. Endotracheal intubation is a procedure associated with a high level of exposure to the COVID-19 virus. This has led to the search of alternatives to reduce the risk of contamination, including the so-called aerosol box. Objective: To compare time and difficulty of orotracheal intubation when using the aerosol box in a simulated setting. Methodology: Observational study conducted with the participation of 33 anesthetist physicians and anesthesia residents; groups were compared in terms of time and intubation difficulty using a conventional Macintosh laryngoscope and the McGRATH™ MAC (Medtronic) videolaryngoscope with or without aerosol box. In order to determine performance with the intubation maneuver, crude hazard ratios were estimated, and a Cox multivariate regression model was built, adjusted by anesthetist years of experience and difficulties during the procedure. Results: On average, the aerosol box increased intubation time by 7.57 seconds (SD 8.33) when the videolaryngoscope was used, and by 6.62 (SD 5.74) with the Macintosh. Overall, 132 intubations were performed, with 121 successful and 6 failed first-time attempts (4 with the use of the aerosol box); 16 participants (48.48%) reported difficulty handling the box. With the use of the Macintosh, intubation was found to be faster than with the videolaryngoscope (cHR: 1.36 [95% CI 0.64-2.88]; adjusted HR: 2.20 [95% CI 0.73-6.62]). Conclusions: The use of the aerosol box and personal protective equipment in a simulation setting hinders the intubation maneuver and may result in protracted execution time.
{"title":"Aerosol box for intubation of patients with suspected COVID-19: simulation study","authors":"Saúl Álvarez Robles, Claudia Consuelo Torres Contreras, Raquel Rivera Carvajal, Víctor Manuel Lucigniani Ariza, Sonia Margarita Vivas García","doi":"10.5554/22562087.e1006","DOIUrl":"https://doi.org/10.5554/22562087.e1006","url":null,"abstract":"Introduction. Endotracheal intubation is a procedure associated with a high level of exposure to the COVID-19 virus. This has led to the search of alternatives to reduce the risk of contamination, including the so-called aerosol box. \u0000Objective: To compare time and difficulty of orotracheal intubation when using the aerosol box in a simulated setting. \u0000Methodology: Observational study conducted with the participation of 33 anesthetist physicians and anesthesia residents; groups were compared in terms of time and intubation difficulty using a conventional Macintosh laryngoscope and the McGRATH™ MAC (Medtronic) videolaryngoscope with or without aerosol box. In order to determine performance with the intubation maneuver, crude hazard ratios were estimated, and a Cox multivariate regression model was built, adjusted by anesthetist years of experience and difficulties during the procedure. \u0000Results: On average, the aerosol box increased intubation time by 7.57 seconds (SD 8.33) when the videolaryngoscope was used, and by 6.62 (SD 5.74) with the Macintosh. Overall, 132 intubations were performed, with 121 successful and 6 failed first-time attempts (4 with the use of the aerosol box); 16 participants (48.48%) reported difficulty handling the box. With the use of the Macintosh, intubation was found to be faster than with the videolaryngoscope (cHR: 1.36 [95% CI 0.64-2.88]; adjusted HR: 2.20 [95% CI 0.73-6.62]). \u0000Conclusions: The use of the aerosol box and personal protective equipment in a simulation setting hinders the intubation maneuver and may result in protracted execution time.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47043886","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}
Juan Sebastián Parada Zuluaga, Diego Alejandro Bastidas Palacios, Yerlin Andrés Colina Vargas, Nury Isabel Socha García, J. G. Barrientos Gómez, Ancízar Joaquín De la Peña Silva
Introduction: The duration of labor and the immediate puerperium are affected by obstetric and maternal-fetal factors. Interventions to provide obstetric analgesia may prolong the hospital stay. Objective: To characterize the procedure for obstetric analgesia and describe the time elapsed between analgesia and delivery and postpartum surveillance in healthy mothers. Methods: Observational, descriptive trial. The time elapsed between analgesia and delivery, and postpartum surveillance were measured in healthy pregnant women with vaginal delivery and a prescription of a neuraxial analgesia technique. Results: 226 patients were included. The mean time elapsed between analgesia an delivery was 4 hours (IQR 3-7). 50.7 % (n = 114) received early analgesia (neuraxial technique with ≤ 4 centimeters of cervical dilatation), of which 48.2 % (n = 109) experienced a duration of analgesia until delivery longer than expected. The mean cervical dilatation at the time of the neuraxial approach was 4 centimeters (IQR 4-6) and the epidural technique was the most frequently used – 92.9 % (n = 210). The mean postpartum surveillance was 20 hours (IQR 15-27). Conclusions: Half of the patients included received early analgesia and around fifty percent of them took longer than expected in completing delivery. The postpartum surveillance time was consistent with the provisions of the Ministry of Health and with the current trend of a short postpartum surveillance aimed at early hospital discharge and the benefits thereof.
{"title":"Assessing the duration of obstetric analgesia and the time elapsed between analgesia and delivery. Observational trial","authors":"Juan Sebastián Parada Zuluaga, Diego Alejandro Bastidas Palacios, Yerlin Andrés Colina Vargas, Nury Isabel Socha García, J. G. Barrientos Gómez, Ancízar Joaquín De la Peña Silva","doi":"10.5554/22562087.e1005","DOIUrl":"https://doi.org/10.5554/22562087.e1005","url":null,"abstract":"Introduction: The duration of labor and the immediate puerperium are affected by obstetric and maternal-fetal factors. Interventions to provide obstetric analgesia may prolong the hospital stay. \u0000Objective: To characterize the procedure for obstetric analgesia and describe the time elapsed between analgesia and delivery and postpartum surveillance in healthy mothers. \u0000Methods: Observational, descriptive trial. The time elapsed between analgesia and delivery, and postpartum surveillance were measured in healthy pregnant women with vaginal delivery and a prescription of a neuraxial analgesia technique. \u0000Results: 226 patients were included. The mean time elapsed between analgesia an delivery was 4 hours (IQR 3-7). 50.7 % (n = 114) received early analgesia (neuraxial technique with ≤ 4 centimeters of cervical dilatation), of which 48.2 % (n = 109) experienced a duration of analgesia until delivery longer than expected. The mean cervical dilatation at the time of the neuraxial approach was 4 centimeters (IQR 4-6) and the epidural technique was the most frequently used – 92.9 % (n = 210). The mean postpartum surveillance was 20 hours (IQR 15-27). \u0000Conclusions: Half of the patients included received early analgesia and around fifty percent of them took longer than expected in completing delivery. The postpartum surveillance time was consistent with the provisions of the Ministry of Health and with the current trend of a short postpartum surveillance aimed at early hospital discharge and the benefits thereof.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42962770","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}
Danny Steven Castiblanco-Delgado, Daniela Seija-Butnaru, Bilena Margarita Molina-Arteta
Introduction: Administering systemic lidocaine has been shown to deliver effective analgesia for both cancer-related and non-cancer pain. Adverse effects and toxicity are rare with controlled administration. Objective: To report the results obtained after the indication to manage with IV lidocaine infusion to control neuropathic pain flares in 9 cancer patients. Methodology: Observational, descriptive, case series-type study. A search was conducted in the files of the Pain and Palliative Care Service of the National Cancer Institute - Instituto Nacional de Cancerología - in Bogotá. Patients over 18 years old diagnosed with cancer, who experienced high intensity neuropathic pain and with the cognitive ability to rate their pain in a numerical analogue scale (NAS), without any absolute contraindications for the use of IV lidocaine were included; patients were assessed between September 27 and November 21, 2019. Results: 9 patients experiencing a pain flare-up which was characterized as neuropathic were registered, of which 89 % had some improvement following the administration of an initial lidocaine bolus. After one hour, 60 % reported over 40% improvement in the initial NAS. After 24 hours all patients had experienced some improvement, with a reduction of 46% in the pain scale as compared to the baseline. Conclusions: In this series of cases, the intravenous infusion of lidocaine as an option for the management of neuropathic pain flares seems to reduce pain intensity following the initial bolus administration.
简介:系统给予利多卡因已被证明提供有效的镇痛癌症相关和非癌症疼痛。在控制用药的情况下，不良反应和毒性是罕见的。目的:报告9例肿瘤患者静脉输注利多卡因控制神经性疼痛发作后的适应证。方法:观察性、描述性、病例系列研究。在波哥大国立癌症研究所(Instituto Nacional de Cancerología)疼痛和姑息治疗服务中心的档案中进行了搜索。患者年龄超过18岁，诊断为癌症，经历高强度神经性疼痛，有认知能力在数值模拟量表(NAS)中评估他们的疼痛，没有使用静脉注射利多卡因的绝对禁忌症;在2019年9月27日至11月21日期间对患者进行评估。结果:9例患者经历了以神经性疾病为特征的疼痛发作，其中89%的患者在给予初始利多卡因后有所改善。一小时后，60%的患者报告初始NAS改善超过40%。24小时后，所有患者都有一定的改善，与基线相比，疼痛程度降低了46%。结论:在这一系列病例中，静脉输注利多卡因作为治疗神经性疼痛发作的一种选择，似乎可以在最初的大剂量给药后减轻疼痛强度。
{"title":"Intravenous lidocaine in cancer-related neuropathic pain: case series","authors":"Danny Steven Castiblanco-Delgado, Daniela Seija-Butnaru, Bilena Margarita Molina-Arteta","doi":"10.5554/22562087.E1004","DOIUrl":"https://doi.org/10.5554/22562087.E1004","url":null,"abstract":"Introduction: Administering systemic lidocaine has been shown to deliver effective analgesia for both cancer-related and non-cancer pain. Adverse effects and toxicity are rare with controlled administration. \u0000Objective: To report the results obtained after the indication to manage with IV lidocaine infusion to control neuropathic pain flares in 9 cancer patients. \u0000Methodology: Observational, descriptive, case series-type study. A search was conducted in the files of the Pain and Palliative Care Service of the National Cancer Institute - Instituto Nacional de Cancerología - in Bogotá. Patients over 18 years old diagnosed with cancer, who experienced high intensity neuropathic pain and with the cognitive ability to rate their pain in a numerical analogue scale (NAS), without any absolute contraindications for the use of IV lidocaine were included; patients were assessed between September 27 and November 21, 2019. \u0000Results: 9 patients experiencing a pain flare-up which was characterized as neuropathic were registered, of which 89 % had some improvement following the administration of an initial lidocaine bolus. After one hour, 60 % reported over 40% improvement in the initial NAS. After 24 hours all patients had experienced some improvement, with a reduction of 46% in the pain scale as compared to the baseline. \u0000Conclusions: In this series of cases, the intravenous infusion of lidocaine as an option for the management of neuropathic pain flares seems to reduce pain intensity following the initial bolus administration.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47745987","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}
Ana Pérez, A. López, Borja Mugabure Bujedo, Berta Castellano Paulis, Manuel Azcona Andueza, Edurne Lodoso Ochoa, Nuria González Jorrin
Introduction: Robot-assisted laparoscopic surgery is currently the surgical treatment of choice for small renal masses. Objective: Reviewing the anesthetic management and perioperative morbidity of patients undergoing robotic-assisted laparoscopic partial nephrectomy (RALPN) from 2009 to 2019 at Hospital Universitario Donostia. Material and methods: Retrospective, descriptive, observational study involving 343 patients. Results: 95 % of the patients were ASA II-III. Transient renal artery clamping was performed in 91 %, with a mean ischemia time of 17.79 minutes. The mean duration of the procedure under balanced general anesthesia was 184 min. Standard monitoring was performed along with invasive arterial pressure monitoring (IAP), central venous catheter (CVC) and EV1000 platform (Edwards®) for complex patients. Complications were recorded in 40 patients (11.67 %). Patients under anti-aggregation therapy experienced more bleeding than non-anti-aggregation patients (p 0.04) but did not require more transfusions. Patients with a higher anesthetic risk did not experience more complications. No statistically significant association was found between worsening renal function and the occurrence of intraoperative complications. 21 patients (6 %) were readmitted due to complications; the most frequent complication was renal artery pseudoaneurysm that required endovascular embolization. Conclusions: It should be highlighted that after ten years of experience with this technique, the patients with a higher anesthetic risk have not experienced serious perioperative complications. RALPN is a safe technique that demands a careful anesthetic support. A robot-assisted approach alone is not a guarantee for success without strong teamwork.
{"title":"Robotic-assisted laparoscopic partial nephrectomy. Retrospective descriptive study over a 10-year period. Anesthetic experience","authors":"Ana Pérez, A. López, Borja Mugabure Bujedo, Berta Castellano Paulis, Manuel Azcona Andueza, Edurne Lodoso Ochoa, Nuria González Jorrin","doi":"10.5554/22562087.E1001","DOIUrl":"https://doi.org/10.5554/22562087.E1001","url":null,"abstract":"Introduction: Robot-assisted laparoscopic surgery is currently the surgical treatment of choice for small renal masses. \u0000Objective: Reviewing the anesthetic management and perioperative morbidity of patients undergoing robotic-assisted laparoscopic partial nephrectomy (RALPN) from 2009 to 2019 at Hospital Universitario Donostia. \u0000Material and methods: Retrospective, descriptive, observational study involving 343 patients. \u0000Results: 95 % of the patients were ASA II-III. Transient renal artery clamping was performed in 91 %, with a mean ischemia time of 17.79 minutes. The mean duration of the procedure under balanced general anesthesia was 184 min. Standard monitoring was performed along with invasive arterial pressure monitoring (IAP), central venous catheter (CVC) and EV1000 platform (Edwards®) for complex patients. Complications were recorded in 40 patients (11.67 %). Patients under anti-aggregation therapy experienced more bleeding than non-anti-aggregation patients (p 0.04) but did not require more transfusions. Patients with a higher anesthetic risk did not experience more complications. No statistically significant association was found between worsening renal function and the occurrence of intraoperative complications. 21 patients (6 %) were readmitted due to complications; the most frequent complication was renal artery pseudoaneurysm that required endovascular embolization. \u0000Conclusions: It should be highlighted that after ten years of experience with this technique, the patients with a higher anesthetic risk have not experienced serious perioperative complications. RALPN is a safe technique that demands a careful anesthetic support. A robot-assisted approach alone is not a guarantee for success without strong teamwork.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42680990","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. Khanna, Roshni Sreedharan, Carlos Trombettaa, S. Bustamante
P-waves represent atrial depolarization and appear upright in electrocardiographic leads I, II and V3-6, when they originate from the sinoatrial-node. New onset inverted P-waves, may result from benign or potentially life-threatening conditions. Anesthesiologists often have to decide if further work up is necessary in such circumstances, especially in symptomatic patients. We present two examples. Image A, an electrocardiogram from a patient who developed nausea while recovering in the post-anesthesia-care-unit after undergoing an uneventful cystoscopy, demonstrates inverted P-waves in lead I (red-arrows) and upright P-waves in lead V6 (bluearrows). As P-wave polarity should be similar in leads I and V6, the inconsistency in Image-A suggests reversal of left-arm and rightarm electrode positions.(1) Correct electrode placement rectified P-wave inversion and ondansetron administration ameliorated nausea. Image B demonstrates prominent inverted P-waves in inferiorleads II, III, aVF and precordial-leads V3-6 (red-arrows). This suggests retrograde atrial depolarization and in conjunction with a heartrate <70 beats/min, this pattern represents an atrioventricularjunctional-rhythm. Atrioventricular-junctional-rhythm may be a manifestation of sinus-node-dysfunction, myocardial-infarction, or digoxin-toxicity.(2) The electrocardiogram presented in Image B is from a patient who endorsed feeling nauseated in the postanesthesia-care-unit after undergoing an endoscopy under propofol-anesthesia. This patient accidentally continued his oral digoxin therapy while completing a clarithromycin-based Helicobacter-Pylori eradication regimen. Clarithromycin-induced inhibition of P-glycoprotein, an efflux pump that influences digoxin pharmacokinetics, results in increased gut absorption and decreased renal excretion of digoxin. This drug interaction can potentially precipitate digoxin-toxicity. As patients often present with non-specific symptoms such as nausea, abdominal pain, confusion, headache or dizziness, diagnosis of digoxin-toxicity necessitates a high index of suspicion. Electrocardiographic manifestations include severe bradyarrythmias and ventricular tachyarrhyhtmias. Although digoxin serum levels do not correlate with severity of toxicity, they help corroborate the diagnosis. In addition to atropine administration and institution of inotropic support, symptomatic and hemodynamically unstable digoxin-induced Received: 10 June, 2021 ▶ Accepted: 19 June, 2021 ▶ Online first: 9 September, 2021
{"title":"Inverted P waves: harmless or harbinger of doom?","authors":"S. Khanna, Roshni Sreedharan, Carlos Trombettaa, S. Bustamante","doi":"10.5554/22562087.E1002","DOIUrl":"https://doi.org/10.5554/22562087.E1002","url":null,"abstract":"P-waves represent atrial depolarization and appear upright in electrocardiographic leads I, II and V3-6, when they originate from the sinoatrial-node. New onset inverted P-waves, may result from benign or potentially life-threatening conditions. Anesthesiologists often have to decide if further work up is necessary in such circumstances, especially in symptomatic patients. We present two examples. Image A, an electrocardiogram from a patient who developed nausea while recovering in the post-anesthesia-care-unit after undergoing an uneventful cystoscopy, demonstrates inverted P-waves in lead I (red-arrows) and upright P-waves in lead V6 (bluearrows). As P-wave polarity should be similar in leads I and V6, the inconsistency in Image-A suggests reversal of left-arm and rightarm electrode positions.(1) Correct electrode placement rectified P-wave inversion and ondansetron administration ameliorated nausea. Image B demonstrates prominent inverted P-waves in inferiorleads II, III, aVF and precordial-leads V3-6 (red-arrows). This suggests retrograde atrial depolarization and in conjunction with a heartrate <70 beats/min, this pattern represents an atrioventricularjunctional-rhythm. Atrioventricular-junctional-rhythm may be a manifestation of sinus-node-dysfunction, myocardial-infarction, or digoxin-toxicity.(2) The electrocardiogram presented in Image B is from a patient who endorsed feeling nauseated in the postanesthesia-care-unit after undergoing an endoscopy under propofol-anesthesia. This patient accidentally continued his oral digoxin therapy while completing a clarithromycin-based Helicobacter-Pylori eradication regimen. Clarithromycin-induced inhibition of P-glycoprotein, an efflux pump that influences digoxin pharmacokinetics, results in increased gut absorption and decreased renal excretion of digoxin. This drug interaction can potentially precipitate digoxin-toxicity. As patients often present with non-specific symptoms such as nausea, abdominal pain, confusion, headache or dizziness, diagnosis of digoxin-toxicity necessitates a high index of suspicion. Electrocardiographic manifestations include severe bradyarrythmias and ventricular tachyarrhyhtmias. Although digoxin serum levels do not correlate with severity of toxicity, they help corroborate the diagnosis. In addition to atropine administration and institution of inotropic support, symptomatic and hemodynamically unstable digoxin-induced Received: 10 June, 2021 ▶ Accepted: 19 June, 2021 ▶ Online first: 9 September, 2021","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48491291","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}
L. A. Tafur Betancourt, Adriana Sofía Rosero Cundar, Sergio Andrés Remolina Granados, Marcela Arévalo, María del Mar Millán G., Eduardo Lema Flórez, Andrés Zorrilla Vacca, Víctor Hernán Ruiz Holguín, Catalina Ceballos, Jaime Quintero Soto
Introduction: The SARS-CoV-2 pandemic has led to the cancellation of non-emergent surgeries in order to optimize the use of resources. Once the elective medical services are restored, a technical and ethical strategy becomes critical to select candidate patients for elective surgery. Objective: To describe the results from the implementation of MeNTS (Medically Necessary Time-sensitive Procedures), FI-CGA, and survey on COVID-19 symptoms Scales, as methods for the selection of patients who were candidates for elective surgery during the SARS-CoV-2 pandemic, in a third level institution in Cali, Colombia. Methodology: The databases of the results on the administration of MeNTS, frailty index (FI-CGA) and COVID 19 symptoms scales in patients who were candidates for elective surgery in a third level clinic in Cali city, between March 1st and August 31st, 2020 were reviewed. Results: A total of 1,044 patients were included, of which 647 (62.0 %) were females, with a mean age of 52 years (interquartile range [IQR] 38-62). 98 % of the patients were asymptomatic, the overall median score for MeNTS was 48 (IQR 44-52) and the average for FI-CGA was 0.0 (standard deviation 0.1). Conclusions: MeNTS, FI-CGA and the Symptoms Survey are easily accessible scales amidst the pandemic and are helpful to select patients with intermediate and low risk of perioperative morbidity in elective surgery during the SARS-CoV-2 pandemic. Further studies are required to confirm these findings and to clarify the potential of these tools in the selection of patients that meet the criteria to be identified as high risk.
{"title":"Use of MeNTS, Frailty and Symptom Scales for selecting surgical patients during the SARS-CoV-2 pandemic: A retrospective study","authors":"L. A. Tafur Betancourt, Adriana Sofía Rosero Cundar, Sergio Andrés Remolina Granados, Marcela Arévalo, María del Mar Millán G., Eduardo Lema Flórez, Andrés Zorrilla Vacca, Víctor Hernán Ruiz Holguín, Catalina Ceballos, Jaime Quintero Soto","doi":"10.5554/22562087.e999","DOIUrl":"https://doi.org/10.5554/22562087.e999","url":null,"abstract":"Introduction: The SARS-CoV-2 pandemic has led to the cancellation of non-emergent surgeries in order to optimize the use of resources. Once the elective medical services are restored, a technical and ethical strategy becomes critical to select candidate patients for elective surgery. \u0000Objective: To describe the results from the implementation of MeNTS (Medically Necessary Time-sensitive Procedures), FI-CGA, and survey on COVID-19 symptoms Scales, as methods for the selection of patients who were candidates for elective surgery during the SARS-CoV-2 pandemic, in a third level institution in Cali, Colombia. \u0000Methodology: The databases of the results on the administration of MeNTS, frailty index (FI-CGA) and COVID 19 symptoms scales in patients who were candidates for elective surgery in a third level clinic in Cali city, between March 1st and August 31st, 2020 were reviewed. \u0000Results: A total of 1,044 patients were included, of which 647 (62.0 %) were females, with a mean age of 52 years (interquartile range [IQR] 38-62). 98 % of the patients were asymptomatic, the overall median score for MeNTS was 48 (IQR 44-52) and the average for FI-CGA was 0.0 (standard deviation 0.1). \u0000Conclusions: MeNTS, FI-CGA and the Symptoms Survey are easily accessible scales amidst the pandemic and are helpful to select patients with intermediate and low risk of perioperative morbidity in elective surgery during the SARS-CoV-2 pandemic. Further studies are required to confirm these findings and to clarify the potential of these tools in the selection of patients that meet the criteria to be identified as high risk.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43380231","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}
José Manuel Quintero-Castellanos, Ángela Hernández, Tania Parra
Introduction: The pain prevalence in hospitalized infants and preschool children has not been accurately identified in high-income countries, and in low and medium-income countries it has not been extensively studied. The assessment instruments are limited. Objective: To describe the prevalence and management of pain in infants and preschool children during the first 24 hours of hospitalization in a third level institution in Colombia, using the CRIES scale. Methods: An observational study was conducted during the first 24 hours of hospitalization. Demographic information was recorded, pain was assessed at admission, after 4, and 24 hours using the CRIES scale. Pharmacological therapy was also documented. Results: 250 children between one month and 5 years old were studied. The pain prevalence at admission was 12 %. The pain prevalence per subgroups was higher among the surgical patients, as compared to the clinical patients (35.9 % vs. 7.6 %). The pharmacological analysis revealed that 70.8 % of patients received treatment; the most widely used medications were oral acetaminophen and intravenous dipyrone. Conclusions: Pain prevalence was lower than the levels described for the general pediatric population. This result may be due to the sensitivity of the CRIES instrument, or to a particular pain behavior. Further studies are needed to identify the sensitivity of the assessment instruments in early life and to accurately investigate any associated phenomena.
{"title":"Pain prevalence in infants and preschool children in a Colombian hospital","authors":"José Manuel Quintero-Castellanos, Ángela Hernández, Tania Parra","doi":"10.5554/22562087.e1000","DOIUrl":"https://doi.org/10.5554/22562087.e1000","url":null,"abstract":"Introduction: The pain prevalence in hospitalized infants and preschool children has not been accurately identified in high-income countries, and in low and medium-income countries it has not been extensively studied. The assessment instruments are limited. \u0000Objective: To describe the prevalence and management of pain in infants and preschool children during the first 24 hours of hospitalization in a third level institution in Colombia, using the CRIES scale. \u0000Methods: An observational study was conducted during the first 24 hours of hospitalization. Demographic information was recorded, pain was assessed at admission, after 4, and 24 hours using the CRIES scale. Pharmacological therapy was also documented. \u0000Results: 250 children between one month and 5 years old were studied. The pain prevalence at admission was 12 %. The pain prevalence per subgroups was higher among the surgical patients, as compared to the clinical patients (35.9 % vs. 7.6 %). The pharmacological analysis revealed that 70.8 % of patients received treatment; the most widely used medications were oral acetaminophen and intravenous dipyrone. \u0000Conclusions: Pain prevalence was lower than the levels described for the general pediatric population. This result may be due to the sensitivity of the CRIES instrument, or to a particular pain behavior. Further studies are needed to identify the sensitivity of the assessment instruments in early life and to accurately investigate any associated phenomena.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46042652","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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