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Pre-anaesthesia assessment in cataract surgery: Recommendations from the SEDAR Working Group 白内障手术麻醉前评估:SEDAR 工作组的建议。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2024.02.029
L. Quecedo Gutierrez , E. Alsina , B. del Blanco Narciso , A. Vazquez Lima , M. Zaballos Garcia , A. Abad Gurumeta

Introduction and objectives

Cataract surgery is one of the most common procedures in outpatient surgery units. The use of information and communication technologies (ICT) in clinical practice and the advent of new health scenarios, such as the Covid pandemic, have driven the development of pre-anaesthesia assessment models that free up resources to improve access to cataract surgery without sacrificing patient safety. The approach to cataract surgery varies considerably among public, subsidised and private hospitals. This raises the need for guidelines to standardise patient assessment, pre-operative tests, management of background medication, patient information and informed consent.

Results

In this document, the SEDAR Clinical Management Division together with the Major Outpatient Surgery Division SEDAR Working Group put forward a series of consensus recommendations on pre-anaesthesia testing based on the use of ITCs, health questionnaires, patient information and informed consent supervised and evaluated by an anaesthesiologist.

Conclusions

This consensus document will effectivise pre-anaesthesia assessment in cataract surgery while maintaining the highest standards of quality, safety and legality.

导言和目标:白内障手术是门诊手术室最常见的手术之一。信息和通信技术(ICT)在临床实践中的应用以及新的健康状况(如 Covid 大流行病)的出现,推动了麻醉前评估模式的发展,从而在不牺牲患者安全的前提下释放资源,改善白内障手术的可及性。公立医院、受资助医院和私立医院的白内障手术方法大相径庭。这就需要制定指导方针,对患者评估、术前检查、背景药物管理、患者信息和知情同意进行标准化:在这份文件中,SEDAR 临床管理部门与主要门诊手术部门 SEDAR 工作组共同提出了一系列关于麻醉前检测的共识建议,这些建议基于 ITC、健康问卷、患者信息和知情同意书的使用,并由一名麻醉师进行监督和评估:该共识文件将有效促进白内障手术的麻醉前评估,同时保持最高的质量、安全和合法性标准。
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引用次数: 0
Before diagnosing a SARS-CoV-2-related PRES, alternative diagnoses must be ruled out 在诊断与sars - cov -2相关的PRES之前,必须排除其他诊断。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2023.11.004
J. Finsterer
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引用次数: 0
Post-traumatic pleuro-pulmonary hernia 创伤后胸肺疝。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2024.02.017
S. Esquivel Ramírez, L. Charro Hidalgo, U. Caballero Flores, C. Hernández Gamito
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引用次数: 0
SARS-CoV-2 RT-PCR in the absence of reference standards cannot warrant for a reliable analytical performance 在没有参考标准的情况下,SARS-CoV-2 RT-PCR 无法保证可靠的分析性能。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2023.12.008
Salvatore Chirumbolo
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引用次数: 0
Effectiveness of a specific follow up program for the management of the mental components of post-intensive care syndrome and chronic pain after COVID-19: results from the PAIN-COVID randomized clinical trial 针对 COVID-19 感染后重症监护室后综合征和慢性疼痛的精神因素的特定随访计划的效果:PAIN-COVID 随机临床试验的结果。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2023.12.009
A. Ojeda , A. Calvo , T. Cuñat , R. Mellado-Artigas , A. Costas-Carrera , M.M. Sánchez-Rodriguez , O. Comino-Trinidad , J. Aliaga , M. Arias , G. Martínez-Pallí , C. Dürsteler , C. Ferrando

Background

Critical COVID-19 survivors are at risk of developing Post-intensive Care Syndrome (PICS) and Chronic ICU-Related Pain (CIRP). We determined whether a specific care program improves the quality of life (QoL) of patients at risk of developing PICS and CIRP after COVID-19.

Methods

The PAIN-COVID trial was a parallel-group, single-centre, single-blinded, randomized controlled trial. The intervention consisted of a follow up program, patient education on PICS and pain, and a psychological intervention based on Rehm’s self-control model in patients with abnormal depression scores (≥8) in the Hospital Anxiety and Depression Scale (HADS) at the baseline visit. QoL was evaluated with the 5-level EQ 5D (EQ 5D 5 L), mood disorders with the HADS, post-traumatic stress disorder (PTSD) with the PCL-5 checklist, and pain with the Brief Pain Inventory short form, the Douleur Neuropathique 4 questionnaire, and the Pain Catastrophizing Scale. The primary outcome was to determine if the program was superior to standard-of-care on the EQ visual analogue scale (VAS) at 6 months after the baseline visit. The secondary outcomes were EQ VAS at 3 months, and EQ index, CIRP incidence and characteristics, and anxiety, depression, and PTSD at 3 and 6 months after baseline visits.

Conclusions

This program was not superior to standard care in improving QoL in critical COVID-19 survivors as measured by the EQ VAS. However, our data can help establish better strategies for the study and management of PICS and CIRP in this population.

Trial registration

# NCT04394169, registered on 5/19/2020.

背景:COVID-19危重症幸存者有患重症监护后综合征(PICS)和慢性重症监护病房相关疼痛(CIRP)的风险。我们确定了一项特定护理计划是否能改善 COVID-19 病后有可能患重症监护后综合征和慢性重症监护相关疼痛的患者的生活质量(QoL):PAIN-COVID 试验是一项平行组、单中心、单盲、随机对照试验。干预措施包括随访计划、PICS和疼痛方面的患者教育,以及基于雷姆自我控制模型的心理干预,干预对象为基线访问时医院焦虑抑郁量表(HADS)中抑郁评分异常(>=8)的患者。质量生活以 5 级 EQ 5D (EQ 5D 5 L) 进行评估,情绪障碍以 HADS 进行评估,创伤后应激障碍(PTSD)以 PCL-5 核对表进行评估,疼痛以简明疼痛量表简表、Douleur Neuropathique 4 问卷和疼痛灾难化量表进行评估。主要结果是确定该计划在基线访问后 6 个月的 EQ 视觉模拟量表(VAS)上是否优于标准护理。次要结果是 3 个月后的 EQ VAS,基线访问后 3 个月和 6 个月的 EQ 指数、CIRP 发生率和特征,以及焦虑、抑郁和创伤后应激障碍:结论:根据 EQ VAS 测量,该计划在改善 COVID-19 危重症幸存者的 QoL 方面并不优于标准护理。然而,我们的数据有助于为研究和管理该人群中的 PICS 和 CIRP 制定更好的策略:# NCT04394169,注册日期:2020年5月19日。
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引用次数: 0
Association between early manifestations of infection or sepsis and prognosis in a high complexity hospital in the city of Medellín 麦德林市一家高度复杂医院的感染或败血症早期表现与预后之间的关系。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2024.04.001
J.A. Albarracin Duarte , J. Chaparro Hernández , J.A. Rojas Aceros , J.E. Valoyes Gélvez , J. Ascuntar , F. Jaimes

Objective

To identify the first symptoms and signs of patients with suspected infection or sepsis and their association with the composite outcome of admission to the Intensive Care Unit (ICU) or mortality.

Design

Prospective cohort study between June 2019 and March 2020.

Setting

Hospital Universitario San Vicente Fundación, Colombia.

Patients

Over 18 years of age with suspicion or confirmation of sepsis, which required hospitalization.

Interventions

None.

Main variables of interest

Symptoms and signs associated with infection, with their time of evolution, specified in the study.

Results

From 1005 eligible patients, 261 were included. After multivariable adjustment with a logistic regression model, the main factors for ICU admission or mortality were heart rate (OR 1.04 with 95% CI 1.04–3.7), respiratory rate (OR 1.19 with 95% CI 1.0−1.4) and capillary refill time (OR 3.4 with 95% CI 1.9−6.1).

Conclusions

Heart rate, respiratory rate, and capillary refill may behave as early predictors of ICU admission and mortality in cases of sepsis.

目的 确定疑似感染或败血症患者的首发症状和体征及其与重症监护病房(ICU)入院或死亡的综合结果之间的关系.设计 2019年6月至2020年3月期间的前瞻性队列研究.地点 哥伦比亚圣维森特基金大学医院.患者年龄在18岁以上,怀疑或确认患有败血症,需要住院治疗。干预措施无。主要关注变量与感染相关的症状和体征,以及研究中规定的演变时间。结论心率、呼吸频率和毛细血管再充盈时间可能是脓毒症患者入住 ICU 和死亡的早期预测因素。
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引用次数: 0
In defence of the medical specialty of anaesthesiology: ensuring maximum patient safety 捍卫麻醉医学专科:确保最大程度的患者安全
Pub Date : 2024-04-01 DOI: 10.1016/j.redare.2024.04.018
J.G. Fernández
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引用次数: 0
Dislodgment of continuous suprascapular nerve block catheters after physiotherapy: A cadaver study 物理治疗后连续性肩胛上神经阻滞导管的脱落:尸体研究。
Pub Date : 2024-04-01 DOI: 10.1016/j.redare.2024.02.027
P. Goffin , L. Morales , E. Jorcano , A. Prats-Galino , M.A. Reina , X. Sala-Blanch

Background

Continuous peripheral nerve blocks are commonly used for pain management. However, the incidence of catheter dislodgement or migration is unclear, and may be underestimated and underreported. Our objective was to assess suprascapular catheter tip positioning before and after routine simulated shoulder physiotherapy manipulation in an anatomical cadaver model.

Method

Eight ultrasound-guided continuous suprascapular nerve block catheters were placed in cryopreserved fresh cadavers. Computed tomography (CT) confirmed the location of the catheter tip after injection of 1 ml of contrast medium. We performed a series of standardized shoulder movements during a simulated shoulder physiotherapy session in cadavers. Following this, we administered 1 ml of methylene blue through the catheters, and then performed anatomical dissections to accurately identify the location of the catheter tips and compare them to their placement prior to the 'physiotherapy'.

Result

CT imaging confirmed the location of the catheter tips at the suprascapular notch in all cases. However, following physiotherapy, 2 catheters (25%) were found to have migrated - specifically, 1 was located in the supraspinatus muscle, and the other was located in the trapezius muscle.

Conclusion

Our findings suggest that catheter dislodgement may occur in approximately 25% of cases following simulated physiotherapy manipulation. However, further research is needed to determine the read incidence of catheter dislodgement in clinical practice.

背景:连续性周围神经阻滞常用于疼痛治疗。然而,导管脱落或移位的发生率尚不清楚,可能被低估或漏报。我们的目的是在解剖尸体模型中评估肩胛上导管尖端在常规模拟肩部理疗操作前后的定位情况:方法:在冷冻保存的新鲜尸体中置入 8 根超声引导的连续肩胛上神经阻滞导管。注射 1 毫升造影剂后,计算机断层扫描(CT)确认了导管尖端的位置。在尸体的模拟肩部理疗过程中,我们进行了一系列标准化肩部运动。之后,我们通过导管注入 1 毫升亚甲蓝,然后进行解剖,以准确确定导管尖端的位置,并将其与 "理疗 "前的位置进行比较。 结果:CT 成像证实所有病例的导管尖端都位于肩胛上凹陷处。然而,在物理治疗后,发现有 2 根导管(25%)发生了移位,其中 1 根位于冈上肌,另 1 根位于斜方肌:我们的研究结果表明,约有 25% 的病例可能会在模拟物理治疗操作后发生导管移位。然而,要确定临床实践中导管脱落的发生率,还需要进一步的研究。
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引用次数: 0
Chronic pain after breast surgery: incidence, risk factors and impact on quality of life 乳房手术后的慢性疼痛:发生率、风险因素和对生活质量的影响。
Pub Date : 2024-04-01 DOI: 10.1016/j.redare.2024.01.002
S. Nogueira , D. Rodrigues , M. Barros , J. Menezes , L. Guimarães-Pereira

Introduction and Objectives

Breast cancer is the most frequently diagnosed malignancy, and chronic pain after breast surgery (CPBS) is an increasingly recognized therapy-related problem. We evaluated CPBS incidence, characteristics, associated factors, and impact on patient quality of life (QoL).

Materials and Methods

Six-month observational prospective study conducted in patients undergoing breast surgery in a tertiary university hospital. Data were collected using several questionnaires: Pain Catastrophizing Scale, Brief Pain Inventory-Short Form, Douleur Neuropathique 4 Questionnaire, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module.

Results

A total of 112 patients completed the study. Approximately, one third (34.8%) developed CPBS, and almost all with potentially neuropathic pain. CPBS interfered with patients’ daily life and reduced their QoL. Diabetes (p = 0.028), catastrophizing (p = 0.042), and acute postoperative pain severity (p < 0.001) were associated with CPBS.

Conclusions

This study broadens our understanding of CPBS and shows the impact of this syndrome. Healthcare workers need to be aware of CPBS and take steps to prevent and treat it, and provide patients with adequate information.

导言和目标:乳腺癌是最常见的恶性肿瘤,而乳腺癌术后慢性疼痛(CPBS)是一个日益受到重视的治疗相关问题。我们评估了 CPBS 的发生率、特征、相关因素以及对患者生活质量(QoL)的影响:一项为期 6 个月的前瞻性观察研究,对象是在一家三级甲等大学医院接受乳腺手术的患者。采用多种问卷收集数据:结果:共有 112 名患者完成了研究:共有 112 名患者完成了研究。约有三分之一(34.8%)的患者出现了 CPBS,几乎所有患者都有潜在的神经病理性疼痛。CPBS 影响了患者的日常生活,降低了他们的生活质量。该研究发现,CPBS 与糖尿病(p = 0.028)、灾难化(p = 0.042)和急性术后疼痛严重程度(p 结论:CPBS 会影响患者的生活质量:本研究拓宽了我们对 CPBS 的认识,并显示了该综合征的影响。医护人员需要了解 CPBS,采取措施预防和治疗 CPBS,并为患者提供足够的信息。
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引用次数: 0
Neuraxial anaesthesia in patients with cerebrospinal fluid shunts: A descriptive review 脑脊液分流患者的神经麻醉:描述性综述。
Pub Date : 2024-04-01 DOI: 10.1016/j.redare.2024.02.010
P. García Casas, M. Echevarría Moreno

Neuraxial anesthesia in patients with cerebrospinal fluid (CSF) shunt devices has traditionally been associated with a high risk of complications. In order to gather all available evidence, a structured search was conducted to include published studies involving users of these devices, undergoing any form of neuraxial technique for obstetric or surgical procedures unrelated to them. Effectiveness of the technique and perioperative complications were assessed. Only case series and case reports (n = 72) were identified. One patient was found to have insufficient anesthetic coverage, necessitating a modification of the technique, and another one had an intraoperative complication which compromised the subject’s safety. No infection events or postoperative device dysfunction related to the anesthetic method were described. The evidence found is scarce and of low quality, preventing the establishment of significant conclusions. Nevertheless, patients may obtain benefit from an individualized evaluation.

使用脑脊液(CSF)分流装置的患者进行神经麻醉历来具有较高的并发症风险。为了收集所有可用的证据,我们进行了一次结构化检索,以纳入已发表的研究,这些研究涉及这些设备的使用者,他们在与这些设备无关的产科或外科手术中接受了任何形式的神经麻醉技术。对技术的有效性和围手术期并发症进行了评估。结果只发现了系列病例和病例报告(n = 72)。发现一名患者的麻醉覆盖面不足,需要修改技术,另一名患者术中出现并发症,危及受试者的安全。没有发现与麻醉方法有关的感染事件或术后设备功能障碍。所发现的证据很少且质量不高,因此无法得出重要结论。不过,患者可以从个性化评估中获益。
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引用次数: 0
期刊
Revista espanola de anestesiologia y reanimacion
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