{"title":"Spontaneous rupture of hepatocellular carcinoma","authors":"S. Khanna, Roshni Sreedharan, Carlos Trombetta","doi":"10.5554/22562087.e961","DOIUrl":"https://doi.org/10.5554/22562087.e961","url":null,"abstract":"","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43823540","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 S.C.A.R.E. members assembly held on March 31st, 2021, was quite revealing: its leitmotiv was the challenging work situation experienced by the colleagues across the country. The similarity with the very first assembly meeting I attended in Pasto in 1990 as a young anesthetist, invited by the tireless of doctor Jorge Osorio, was mystifying. It is rather striking to see how history repeats itself after 31 years, bringing back times that we thought were something of the past. What happened during this time? Law 6 of 1991 which regulates the anesthesiology specialty, and Law 100 of 1993 were passed. Both laws had a huge impact on the practice of anesthesia. The former saw the light as a result of the hard work of leaders of the specialty and their unfailing lobbying in Congress. It was the first to regulate the practice of any medical specialty in this country, and a true landmark. It was then reinforced by the regulatory decree, basically a reflection of the Minimum Standards published by SCARE in 1992 (1), whose implementation was driven by doctor Manuel Galindo and which were soon adopted by the Government in its licensure decrees. This brought about the transformation of the specialty, as it raised the standards of the practitioners and limited the practice only to specialists. So quick was implementation that within 4 years non-specialists had disappeared from the scene. This, added to improvements in oversight systems, led to a drop in lawsuits related to this medical specialty as an indirect indicator of the enhanced quality of anesthesia practice in the country (2). In turn, Law 100 revolutionized nationwide health coverage, substantially increasing resources for the sector and driving the demand for surgical services previously beyond the reach of many Colombians. This naturally increased the demand for anesthetists, who also benefitted from a system in which all citizens now had a ”payer”. Moreover, the wrongly called “charitable” services together with the human dramas of people having to resort to raffles and other means to collect the money needed for a procedure simply disappeared. This happened in parallel with a weakening of the surgeon’s standing as the “captain of the ship,” as health management organizations or their equivalents took over as “owners” of the patients. The combination of these circumstances born from Laws 6 and 100 led to what was, in my opinion, the blossoming of the specialty as reflected in the creation of FEPASDE and the feverish academic activity within S.C.A.R.E., and in graduate programs and anesthesia departments. The specialty was promoted to such an extent that graduating physicians wanted to become anesthetists, contributing to a thriving specialty. However, victims of our own success, the growing prestige of the specialty led to a big demand for training places, and physicians who could not enroll in national programs left for other countries and, upon graduating, came back to find a place in the labo
{"title":"Colombian anesthesiology at a crossroad?","authors":"P. Ibarra","doi":"10.5554/22562087.e994","DOIUrl":"https://doi.org/10.5554/22562087.e994","url":null,"abstract":"The S.C.A.R.E. members assembly held on March 31st, 2021, was quite revealing: its leitmotiv was the challenging work situation experienced by the colleagues across the country. The similarity with the very first assembly meeting I attended in Pasto in 1990 as a young anesthetist, invited by the tireless of doctor Jorge Osorio, was mystifying. It is rather striking to see how history repeats itself after 31 years, bringing back times that we thought were something of the past. What happened during this time? Law 6 of 1991 which regulates the anesthesiology specialty, and Law 100 of 1993 were passed. Both laws had a huge impact on the practice of anesthesia. The former saw the light as a result of the hard work of leaders of the specialty and their unfailing lobbying in Congress. It was the first to regulate the practice of any medical specialty in this country, and a true landmark. It was then reinforced by the regulatory decree, basically a reflection of the Minimum Standards published by SCARE in 1992 (1), whose implementation was driven by doctor Manuel Galindo and which were soon adopted by the Government in its licensure decrees. This brought about the transformation of the specialty, as it raised the standards of the practitioners and limited the practice only to specialists. So quick was implementation that within 4 years non-specialists had disappeared from the scene. This, added to improvements in oversight systems, led to a drop in lawsuits related to this medical specialty as an indirect indicator of the enhanced quality of anesthesia practice in the country (2). In turn, Law 100 revolutionized nationwide health coverage, substantially increasing resources for the sector and driving the demand for surgical services previously beyond the reach of many Colombians. This naturally increased the demand for anesthetists, who also benefitted from a system in which all citizens now had a ”payer”. Moreover, the wrongly called “charitable” services together with the human dramas of people having to resort to raffles and other means to collect the money needed for a procedure simply disappeared. This happened in parallel with a weakening of the surgeon’s standing as the “captain of the ship,” as health management organizations or their equivalents took over as “owners” of the patients. The combination of these circumstances born from Laws 6 and 100 led to what was, in my opinion, the blossoming of the specialty as reflected in the creation of FEPASDE and the feverish academic activity within S.C.A.R.E., and in graduate programs and anesthesia departments. The specialty was promoted to such an extent that graduating physicians wanted to become anesthetists, contributing to a thriving specialty. However, victims of our own success, the growing prestige of the specialty led to a big demand for training places, and physicians who could not enroll in national programs left for other countries and, upon graduating, came back to find a place in the labo","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42913058","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":"Malignant hyperthermia: what we may need to have at hand","authors":"M. I. Berrío Valencia, Carlos A Ibarra","doi":"10.5554/22562087.e993","DOIUrl":"https://doi.org/10.5554/22562087.e993","url":null,"abstract":"","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47003852","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}
Roshni Sreedharan, Faith Factora, Carlos Trombetta, S. Khanna
{"title":"Hypercoagulability resulting in adrenal hemorrhage in COVID-19","authors":"Roshni Sreedharan, Faith Factora, Carlos Trombetta, S. Khanna","doi":"10.5554/22562087.E992","DOIUrl":"https://doi.org/10.5554/22562087.E992","url":null,"abstract":"","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41269716","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 SARS-CoV-2 pandemic has infected over 95 million people worldwide and over 2 million in Colombia. The healthcare personnel (HCP) in our country account for more than 3,800 cases and 197 deaths until January 2021 (1). Being a highly contagious virus, it has changed medical practice and exposed HCP who are at risk of becoming victims with every patient they see. The primary routes of transmission of SARS-CoV-2 are through respiratory droplets and contact with infected patients or any nearby surfaces or objects which the patient has used. Airborne transmission of the virus is possible when conducting aerosol generating procedures (2). Among HCP, those who are more exposed to aerosols are more vulnerable to get the disease: anesthesiologists, emergency physicians, internists and intensivists, as well as ENT doctors, ophthalmologists, maxillofacial surgeons, head and neck surgeons, dentists, gastroenterologists, pulmonologists, respiratory therapists, scrub nurses, nursing staff, inter alia. SARS-CoV-2 had a strong affinity for angiotensin II converting enzyme (ACE2) which is mainly present in the nasal and oral mucosae, where it initially replicates before invading the lung (3). The nasalpulmonary axis has been suggested as the route for the development of pneumonia in patients. The saliva is the primary reservoir, with a high viral load of COVID-19 (1.2x108 infectious copies /mL). The virus may be detected in the saliva in 91.7 % of the patients. A key factor to fight the disease is to reduce the viral load in the saliva and nasal secretions, in order to reduce the transmission of the disease; hence, the potential use of povidoneiodine has been suggested (3-5). Since 1800 iodine has been recognized as an effective bactericidal agent. Then povidone-iodine was discovered in 1955, as an ideal and less toxic alternative for surgical asepsis, with a gram-positive, gramnegative, spores, fungal, viral and protozoa germicidal effect. Among the oral antiseptic agents, it has the broadest spectrum to reduce any bacterial, viral or fungal load, and more effective virucidal action than chlorhexidine or benzalkonium chloride (6). Povidone-iodine disrupts the metabolic pathways in the cell wall of microorganisms causing irreversible damage. It is a potent virucidal agent, which inhibits neuraminidase and hemagglutinin, blocking the attachment of the virus to the cell receptors and preventing the release and spread of the virus from the infected cells. Its efficacy has been assessed in similar coronaviruses such as SARS and MERS (7). In vitro studies have shown that it also destroys SARS-CoV-2 when used for gargling or as mouth rinse at 0,23 %, for 15 seconds, reducing the viral activity by 99.99 %. Experimental models have shown that povidone-iodine at a concentration of 1,25 % does not alter the ciliary motility and is well tolerated by the nasal epithelium (8). Povidone-iodine has been well tolerated in the upper airway at a dose range between 1 % to 10 %,
{"title":"Povidone-iodine: The “new-old” ally against COVID-19","authors":"Alex Castro-Gómez","doi":"10.5554/22562087.E991","DOIUrl":"https://doi.org/10.5554/22562087.E991","url":null,"abstract":"The SARS-CoV-2 pandemic has infected over 95 million people worldwide and over 2 million in Colombia. The healthcare personnel (HCP) in our country account for more than 3,800 cases and 197 deaths until January 2021 (1). Being a highly contagious virus, it has changed medical practice and exposed HCP who are at risk of becoming victims with every patient they see. The primary routes of transmission of SARS-CoV-2 are through respiratory droplets and contact with infected patients or any nearby surfaces or objects which the patient has used. Airborne transmission of the virus is possible when conducting aerosol generating procedures (2). Among HCP, those who are more exposed to aerosols are more vulnerable to get the disease: anesthesiologists, emergency physicians, internists and intensivists, as well as ENT doctors, ophthalmologists, maxillofacial surgeons, head and neck surgeons, dentists, gastroenterologists, pulmonologists, respiratory therapists, scrub nurses, nursing staff, inter alia. SARS-CoV-2 had a strong affinity for angiotensin II converting enzyme (ACE2) which is mainly present in the nasal and oral mucosae, where it initially replicates before invading the lung (3). The nasalpulmonary axis has been suggested as the route for the development of pneumonia in patients. The saliva is the primary reservoir, with a high viral load of COVID-19 (1.2x108 infectious copies /mL). The virus may be detected in the saliva in 91.7 % of the patients. A key factor to fight the disease is to reduce the viral load in the saliva and nasal secretions, in order to reduce the transmission of the disease; hence, the potential use of povidoneiodine has been suggested (3-5). Since 1800 iodine has been recognized as an effective bactericidal agent. Then povidone-iodine was discovered in 1955, as an ideal and less toxic alternative for surgical asepsis, with a gram-positive, gramnegative, spores, fungal, viral and protozoa germicidal effect. Among the oral antiseptic agents, it has the broadest spectrum to reduce any bacterial, viral or fungal load, and more effective virucidal action than chlorhexidine or benzalkonium chloride (6). Povidone-iodine disrupts the metabolic pathways in the cell wall of microorganisms causing irreversible damage. It is a potent virucidal agent, which inhibits neuraminidase and hemagglutinin, blocking the attachment of the virus to the cell receptors and preventing the release and spread of the virus from the infected cells. Its efficacy has been assessed in similar coronaviruses such as SARS and MERS (7). In vitro studies have shown that it also destroys SARS-CoV-2 when used for gargling or as mouth rinse at 0,23 %, for 15 seconds, reducing the viral activity by 99.99 %. Experimental models have shown that povidone-iodine at a concentration of 1,25 % does not alter the ciliary motility and is well tolerated by the nasal epithelium (8). Povidone-iodine has been well tolerated in the upper airway at a dose range between 1 % to 10 %, ","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43717195","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. Romero, David Fernández-Morales, Marysol Echeverri Vélez, Laura Mínguez Lujan, M. P. Argente Navarro
We present the case of a patient intervened for mechanical mitral replacement, tricuspid annuloplasty, and correction of a total anomalous pulmonary venous return, which required Extracorporeal Membrane Oxygenation (ECMO) in the immediate postoperative period because of refractory cardiogenic shock. After withdrawal of the arterial cannula, the patient developed compartment syndrome of the right lower limb, requiring urgent intervention. Also, the patient went into respiratory failure, requiring support with high flow oxygen cannula. Given the patient’s condition, general anesthesia was discarded. An ultrasound-guided popliteal block and sedation with dexmedetomidine and ketamine was performed instead, maintaining the high flow nasal cannula. Regional anesthesia along with dexmedetomidine and ketamine could be an alternative for a surgical procedure in patients with high risk of cardiovascular and respiratory complications.
{"title":"Regional anesthesia for compartment syndrome as a complication of ECMO. Case report","authors":"J. Romero, David Fernández-Morales, Marysol Echeverri Vélez, Laura Mínguez Lujan, M. P. Argente Navarro","doi":"10.5554/22562087.E990","DOIUrl":"https://doi.org/10.5554/22562087.E990","url":null,"abstract":"We present the case of a patient intervened for mechanical mitral replacement, tricuspid annuloplasty, and correction of a total anomalous pulmonary venous return, which required Extracorporeal Membrane Oxygenation (ECMO) in the immediate postoperative period because of refractory cardiogenic shock. After withdrawal of the arterial cannula, the patient developed compartment syndrome of the right lower limb, requiring urgent intervention. Also, the patient went into respiratory failure, requiring support with high flow oxygen cannula. Given the patient’s condition, general anesthesia was discarded. An ultrasound-guided popliteal block and sedation with dexmedetomidine and ketamine was performed instead, maintaining the high flow nasal cannula. \u0000Regional anesthesia along with dexmedetomidine and ketamine could be an alternative for a surgical procedure in patients with high risk of cardiovascular and respiratory complications.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41492571","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}
Francisco Javier Camargo Cárdenas, Alejandra Valencia Cataño, J. F. Vargas
The use of advanced invasive techniques for the control of chronic pain in patients with multiple comorbidities is becoming increasingly common. Neuromodulation offers a new management alternative involving the infusion of one or more drugs into the epidural or intrathecal space through a fully implantable infusion pump. It also involves spinal stimulation, a minimally invasive technique in which electrodes are positioned in the epidural space and connected to a pulse generator that is implanted subcutaneously and generates pulses designed to suppress the noxious stimulus. This article will describe the anesthetic considerations in cases of implantable drug delivery systems, and spinal and peripheral nerve stimulation devices. Additionally, patients with electrical or drug neuromodulation devices may present to anesthetic practice for surgical indications unrelated to their chronic pain pathology. Hence the importance of being familiar with the basic components of these devices, how they work, what drugs they use and the potential associated complications in the perioperative context, in order to ensure proper management and patient safety.
{"title":"Anesthetic considerations in patients with implantable devices and chronic pain surgery","authors":"Francisco Javier Camargo Cárdenas, Alejandra Valencia Cataño, J. F. Vargas","doi":"10.5554/22562087.E989","DOIUrl":"https://doi.org/10.5554/22562087.E989","url":null,"abstract":"The use of advanced invasive techniques for the control of chronic pain in patients with multiple comorbidities is becoming increasingly common. Neuromodulation offers a new management alternative involving the infusion of one or more drugs into the epidural or intrathecal space through a fully implantable infusion pump. It also involves spinal stimulation, a minimally invasive technique in which electrodes are positioned in the epidural space and connected to a pulse generator that is implanted subcutaneously and generates pulses designed to suppress the noxious stimulus. This article will describe the anesthetic considerations in cases of implantable drug delivery systems, and spinal and peripheral nerve stimulation devices. Additionally, patients with electrical or drug neuromodulation devices may present to anesthetic practice for surgical indications unrelated to their chronic pain pathology. Hence the importance of being familiar with the basic components of these devices, how they work, what drugs they use and the potential associated complications in the perioperative context, in order to ensure proper management and patient safety.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48313826","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}
Cristina Isabel Osorio-Gutiérrez, Guillermo Alberto Ortiz-Gómez, Juan Felipe Valencia-Ríos, Fernando Arango-Gómez
{"title":"Reply to the letter to the Editor","authors":"Cristina Isabel Osorio-Gutiérrez, Guillermo Alberto Ortiz-Gómez, Juan Felipe Valencia-Ríos, Fernando Arango-Gómez","doi":"10.5554/22562087.e988","DOIUrl":"https://doi.org/10.5554/22562087.e988","url":null,"abstract":"","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42974693","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}
. Toward the “next normal”: An opportunity to unlearn and reflect about life, death, and our mental health during the pandemic
． 迈向“下一个正常”:在大流行期间忘却和反思生命、死亡和我们的心理健康的机会
{"title":"Toward the “next normal”: An opportunity to unlearn and reflect about life, death, and our mental health during the pandemic","authors":"J. Calvache, A. Jadad","doi":"10.5554/22562087.E987","DOIUrl":"https://doi.org/10.5554/22562087.E987","url":null,"abstract":". Toward the “next normal”: An opportunity to unlearn and reflect about life, death, and our mental health during the pandemic","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45080769","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}
Sandra Viviana Amaya Vanegas, Omar Fernando Gomezese Ribero
Life support withdrawal can be a challenging decision, but it should be considered as an option when death is inevitable or recovery to an acceptable quality of life is not possible. The process is beset by obstacles that must be overcome to finally offer patients comfort and a peaceful death.In this article, we offer a series of tools that seek to solve the challenges of palliative extubation, as well as a protocol that could facilitate the decision to withdraw life support, making palliative extubation an alternative to consider instead of artificially prolonging life at the expense of unacceptable human and economic costs.
{"title":"Palliative extubation: obstacles, challenges and solutions","authors":"Sandra Viviana Amaya Vanegas, Omar Fernando Gomezese Ribero","doi":"10.5554/22562087.E986","DOIUrl":"https://doi.org/10.5554/22562087.E986","url":null,"abstract":"Life support withdrawal can be a challenging decision, but it should be considered as an option when death is inevitable or recovery to an acceptable quality of life is not possible. The process is beset by obstacles that must be overcome to finally offer patients comfort and a peaceful death.In this article, we offer a series of tools that seek to solve the challenges of palliative extubation, as well as a protocol that could facilitate the decision to withdraw life support, making palliative extubation an alternative to consider instead of artificially prolonging life at the expense of unacceptable human and economic costs.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48060276","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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