Introduction: Monitoring and reversal of neuromuscular blockade are essential to prevent adverse outcomes. Objective: To describe current neuromuscular blockade monitoring and reversal practices and to evaluate adherence to the 2023 American Society of Anesthesiologists (ASA) Task Force guidelines through a survey of anesthesiologists affiliated with the Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.). Methods: A cross-sectional survey was distributed by S.C.A.R.E. to its active members via email between May-July 2024. The primary outcome was to describe neuromuscular blockade monitoring and antagonism practices and adherence to ASA guidelines. Analyses were primarily descriptive, with exploratory bivariate comparisons by years of professional experience and affiliation with residency training centers. Results: A total of 230 responses were collected. Rocuronium was the most used non-depolarizing agent (79.6%), and neostigmine the preferred reversal drug (73.9%). Clinical assessment predominated as the monitoring method (34.4%), while 31.7% lacked access to quantitative monitoring; 36.5% didn’t have access to sugammadex, citing high cost and administrative barriers. Anesthesiologists with ≤10 years of experience used sugammadex more often (54.7% vs. 27.6%, p < 0.001) and reversed minimal blockade with neostigmine at higher rates (57.9% vs. 35.1%, p = 0.001). Practice in training centers was associated with greater use of quantitative monitoring (42.9% vs. 18.0%, p < 0.001) and recognition of a TOF ratio of 0.9 as cutoff for residual blockade (83.9% vs. 63.3%, p = 0.005). Conclusion: Among S.C.A.R.E.-affiliated respondents, adherence to ASA 2023 recommendations remains limited. Improving access to monitoring, reducing barriers to sugammadex, and strengthening education are essential steps towards improving adherence.
A signal of severe neurological injury has been emerging over the past year, describing acute basal ganglia lesions and fatal outcomes in children and young adults exposed to general anesthesia with volatile agents, apparently among a growing number of people of maternal-line Venezuelan descent. Unlike the “classic” chronic and multisystem mitochondrial compromise, these reports suggest an acute phenotype consistent with latent bioenergetic susceptibility triggered by perioperative stress. A mitochondrial mtND4 variant (m.11232T>C) has been identified in a subgroup. It affects complex I, a known target for inhalational anesthetics, with functional findings supporting a pharmacogenetic susceptibility. In view of the uncertainty of the situation, proportional caution is proposed: stronger targeted maternal history-taking, neurological surveillance, standardized reporting, and discussion of anesthetic alternatives in high-risk cases, to avoid stigmatizing nationality-based interpretations.
Introduction: Medical error is one of the main causes of in-hospital mortality. Objective: To determine whether Nontechnical Skills (NTS) training with clinical simulation is superior to conventional training with checklists to reduce medical error in clinical simulation. Methods: A controlled clinical trial of parallel groups was conducted with last-semester medical students who had no previous training in NTS and matched 1:1. The participants were randomly assigned to checklist or NTS training. Dichotomous outcomes were analyzed using relative risk (RR) and absolute risk reduction (ARR), while quantitative outcomes were analyzed using mean differences (MD). The primary outcome was medical error, defined as the omission of at least one required treatment step during the simulated crisis, and analyzed as a dichotomous outcome. Additionally, NTS level was assessed as a secondary outcome using the Ottawa Global Rating Scale. Results: Forty-three participants were assigned to the control group and 43 to the intervention. The intervention was not superior to the control in decreasing errors, with an RR of 0.91 (0.72; 1.16) and an ARR of 7% (-11; 25) p= 0.45. The overall score on the Ottawa NTS scale was higher for the intervention, with a MD of 5.71 (3.02; 8.40) p < 0.001; no differences were found in the other outcomes. There were no adverse events. Conclusion: Among last-semester medical students, NTS training in addition to the checklist-based training was not superior to only checklist-based training in reducing medical errors during simulations. (NCT04621682).
Introduction: Despite being the second most frequent complication of neuraxial blocks, the incidence of post-dural puncture headache (PDPH) and its risk factors show wide variability in the scientific literature. Additionally, there are few studies addressing this issue in our setting. Objective: To determine the incidence, population characteristics, and risk factors associated with PDPH following spinal anesthesia in obstetric and non-obstetric patients at a university hospital in Bogotá, Colombia. Methods: This is a prospective, descriptive, and analytical cohort study conducted in adult patients undergoing spinal anesthesia. The incidence of PDPH was calculated, and its association with risk factors was assessed using descriptive and bivariate analyses. Results: A total of 186 patients were included, with a PDPH incidence of 10.8%. Regarding severity, 10% of the cases were mild, 50% moderate, and 40 % severe. A statistically significant association was found between PDPH and female sex (100% women; p = 0.0067), as well as with preeclampsia (OR 4.3; p = 0.01). No statistically significant differences were observed regarding other comorbidities, procedural characteristics, number of attempts, or operator expertise. Conclusions: Although PDPH is usually self-limiting, the condition carries risks and is associated with reduced patient satisfaction. Institutional protocols should focus on at-risk populations and on implementing safe, evidence-based practices.
Point-of-care ultrasound (POCUS) enables clinicians to perform real-time diagnostic and monitoring assessments at the bedside. Its portability, safety, and repeatability have facilitated widespread adoption in critical care. Among its applications, diaphragmatic ultrasound has emerged as a clinically relevant tool for evaluating respiratory muscle function in patients receiving mechanical ventilation. This narrative review summarizes the principal ultrasound techniques used to assess diaphragmatic function, the supporting evidence, and their clinical applications. A structured search of PubMed, Embase, Web of Science, Scopus, and Google Scholar was performed to identify relevant studies in adult critically ill patients. The most clinically useful parameters are diaphragmatic excursion (DE) and diaphragmatic thickening fraction (TFdi). These measurements assist in detecting diaphragmatic dysfunction, identifying patient–ventilator asynchrony, titrating ventilatory support, and predicting weaning outcomes. Reported cut-off values vary across studies; therefore, measurements should be interpreted within the broader clinical context and integrated with physical examination, ventilator waveforms, laboratory findings, and other imaging modalities.
Introduction: The internal dimensions of the infraglottic airway can be determined accurately by CT scans. Although height is the primary determinant of airway size, no tool exists to predict the narrowest dimension of the infraglottic central airway in adults. Objectives: This study measured Antero Posterior Diameter (APD), and Transverse Diameter (TD) of the infraglottic airway in adult patients from CT scans, and correlated these with the demographic characteristics to develop a prediction model for narrowest dimension of the infraglottic central airway in adults. Methods: This retrospective cross-sectional study analyzed CT scan images of the neck and thorax in 200 adult onco-surgical patients. The APD and TD of the infraglottic airway were measured at eight levels below the vocal cords. A statistical model for predicting the narrowest dimension of the infraglottic central airway based on gender and height was developed. Results: The smallest TD was recorded at 5 mm below the vocal cords for both males and females. Gender and height were the most significant predictors of these internal dimensions. The linear regression model based on approximation of the Random Forest and tuned XGBoost models demonstrated high accuracy predictive performance, with an R² of 0.9993 and a root mean squared error (RMSE) value of 0.00275 mm. Conclusion: The narrowest infraglottic airway diameter can be reliably estimated from patient height and sex using the derived linear model. These findings provide a basis for anatomical prediction of tracheal dimensions and may support future development of individualized airway assessment tools.
Right ventricular perforation is a rare but potentially fatal complication of central venous catheterization using guidewires. Rapid recognition is critical to prevent hemodynamic collapse due to cardiac tamponade. We report a case of cardiac tamponade following guidewire-induced right ventricular perforation in a patient recovering in the post-anesthesia care unit. The patient developed sudden hypotension and tachycardia, without classical signs of Beck’s triad. Prompt point-of-care ultrasound (POCUS) revealed pericardial effusion with right atrial and ventricular diastolic collapse, confirming cardiac tamponade. Immediate pericardiocentesis stabilized the patient hemodynamically, highlighting the life-saving potential of bedside imaging. This case underscores the importance of maintaining a high index of suspicion for cardiac tamponade in the post-anesthesia period, even when traditional clinical signs are absent. It also emphasizes the critical role of POCUS as a rapid, non-invasive diagnostic tool that can facilitate timely intervention and improve outcomes in perioperative and critical care settings. Awareness of guidewire-related complications and proficiency in POCUS assessment are essential for anesthesiologists and critical care providers to prevent morbidity and mortality associated with iatrogenic cardiac injuries.
Introduction: Postoperative pain relief is essential in anesthetic practice. Regional analgesia is an emerging tool, and its performance has drawn interest among the cardiac surgical population. Objective: To describe the benefits and safety of regional analgesia of the anterior thorax in cardiac surgery. Methods: A case series study including records of adult patients undergoing cardiac surgery between July 1, 2024, and January 31, 2025, who received superficial parasternal intercostal plane block (SPIPB) or interpectoral/pectoserratus block (PECS II). Postoperative opioid requirements during the first 48 hours, time to extubation, and length of stay in the intensive care unit (ICU) were described. Results: Data from 60 patients were included, of whom 88.3% received SPIPB and 11.7% PECS II. The median ICU stay was three days, and extubation occurred at 180 minutes. Hydromorphone consumption was 0.1, 0.4, 0.7, and 0.8 mg at 6, 12, 24, and 48 hours, respectively. Hydromorphone consumption was higher in overweight and obese patients. Forty-two patients had extracorporeal circulation times under 90 minutes and were extubated within six postoperative hours. Postoperative complications were rare, with none related to regional analgesia. Conclusion: Anterior thoracic wall blocks tend to reduce postoperative opioid requirements and may contribute to early extubation and ICU discharge in line with ERAS and Fast Track protocols.
Introduction: Device-associated infections (DAIs) are preventable adverse events that represent a critical issue for patient safety. These infections, including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP), can be influenced by geographic factors, insurance schemes, sex, and age, leading to differential risks and creating another form of health inequity. Objective: To explore and measure inequities in patient safety associated with DAIs in Colombia, using data from the SIVIGILA system (2012–2022). Methods: This observational, analytical study analyzed data on CLABSI, CAUTI, and VAP reported in SIVIGILA. Incidence rates were estimated using random-effects metamodels adjusted for region, year, and device-days. Inequities were formally assessed using coefficients of variation, group deviations, risk differences, and relative risks across comparison groups (region, age group, municipalities). Results: A total of 750 aggregate reports covering over 49,101 DAI events from 2012 to 2022 were analyzed. CLABSI accounted for 44.4% of events. DAIs were more frequent among men (55.2%), in the contributory insurance scheme (49.3%), followed by the subsidized scheme (42.1%), with only 3% occurring in individuals without affiliation to the general social security system (SGSSS). Mortality associated with these events was 19.9%. Bivariate analyses and metamodels revealed inequities in DAI occurrence, particularly in areas with lower access and resources. DAIs showed disparities across departments, regions, sexes, and age groups. Most municipalities and departments reported rates below 3 cases per 1,000 device-days for CLABSI and VAP, but some departments exhibited risks up to four times higher. CAUTI showed a more homogeneous risk distribution. Conclusions: The study highlights significant inequities in the occurrence of DAIs in Colombia. These findings underscore the need for regional and targeted strategies to enhance patient safety and reduce disparities in healthcare.
Introduction: Reverse triggering (RT) is a frequent type of patient-ventilator asynchrony (PVA). Despite the potential complications associated with this type of asynchrony, there is a scarcity of literature regarding the effects of training programs aimed at developing the necessary competencies among healthcare professionals to help them identify and resolve this type of PVA.Objective: To assess the effect on Chilean intensive care professionals of an education program specifically focusing on RT detection and management using ventilation graph analysis, both immediately as well as after 30 days.Methods: A secondary analysis based on the data used in a quasi-experimental study was conducted. The study applied an education program to improve detection and management of various types of PVA by healthcare staff working in critical care, using ventilation graph analysis. Assessments were conducted before (T0), immediately after (T1) a six-hour online session, and 30 days later (T2). Information from the questions designed to identify the ability to recognize and resolve RT was extracted.Results: In total, 49 healthcare professionals were included, 94% of them physical therapists, with a mean experience of three years (IQR 0.9 to 4). At T0, 20% answered the three questions correctly, with a significant increase at T1 (73.47%) and at T2 (69.39%) (p < 0.001).Conclusions: In Chile, attending a specific education program focused on PVA recognition and resolution could result in an improved ability among critical care staff to identify and resolve RT based on ventilation graph analysis.
Introduction: Pain in the pediatric population is still underdiagnosed and inadequately managed. Children often receive less intensive analgesic treatment than adults, with negative effects for their wellbeing. Objective: To characterize acute pain in pediatric patients hospitalized in three high-complexity institutions in Bogotá. Methods: Cross-sectional study which included patients aged 8 to 17 years admitted to the hospital for more than 72 hours. Collected data included pain intensity at the time of admission, etiology, type of pain and management during the hospital stay. Data were analyzed using descriptive statistics. Results: Overall, 361 patients with a mean age of 13 years were included. Median pain intensity was 6; 63.2% of the patients were females. There was a prevalence of surgical abdominal pain (19.1%), followed by non-surgical abdominal pain (16.1%). Pain characteristics were unknown in 62.6% of cases. The most frequently prescribed medication was metamizole (76.7%), followed by paracetamol (68.1%) and opioids (23%). Conclusions: Hospitalized children experience moderate-to-intense acute pain, predominantly associated with surgical and non-surgical abdominal conditions. Metamizole and paracetamol were found to be used frequently, with limited opioid prescription. It is important to improve pain documentation and management in this population, and also to standardize clinical practice around comprehensive multimodal management.
Introduction: Tracheostomy is a procedure commonly performed in critically ill patients, using one of two techniques: open (OT) or percutaneous (PT). PT is performed in the intensive care unit (ICU) by intensive care physicians, while OT is performed in the operating room by otolanryngologists or surgeons. Objective: To determine if there are any differences in mortality, complications or hospital length of stay between the two techniques. Methods: Descriptive retrospective cohort study in adult patients undergoing tracheostomy, hospitalized in an ICU of a Level III hospital in Antioquia between January 1, 2020 and December 31, 2022. Results: The study evaluated the clinical records of 116 patients who met the inclusion criteria, 84 with PT and 32 with OT. Overall mortality was 44%, with no significant differences found between the two groups (OT 43.8% and PT 44%), or when controlling for other variables (OR = 0.848, 95% CI: 0.35-2.02); there were no procedure-related deaths. No differences were found in the percentage of hospitalization complications by tracheostomy type. Differences were found in terms of duration of orotracheal intubation: OT 18 (15-21) days and PT 12 (8-15) days (p < 0.001); mechanical ventilation: OT 32 (22-36) days and PT 23 (15-38) days (p = 0.046); and ICU length of stay: OT 36 (27-43) days and PT 28 (18-41) days (p = 0.038). Conclusions: Performance of PT in the ICU was not associated with increased mortality or major complications when compared to OT; moreover, it was associated with shorter duration of orotracheal intubation and mechanical ventilation, as well as ICU length of stay.
Introduction: Including the voice of patients and caregivers is essential when it comes to analyzing reportable events with undesired effects (REUEs), in order to develop safety policies and strategies adapted to the realities of those who must be at the center of the healthcare system. Objective: To understand, from the perspective of patients and caregivers, the experiences and meanings associated with REUEs attributable to the interaction with healthcare services. Methods: Qualitative interpretive study, phenomenological approach. Interviews were used to explore how patients or caregivers perceive and experience REUEs, identifying social determinants that influence safety. The study explored how the determinants affect access in the care environment and how they contribute to the chain of events that culminate in an adverse event. Results: Overall, 31 interviews were conducted. All the events analyzed were serious REUEs. The deficiencies reported by patients and caregivers included breakdowns in access, timeliness, quality and continuity of care and combinations thereof. Contributing factors included the lack or shortage of financial means, distance to care sites, social situations such as a poor support network or absence of caregivers, and problems of public unrest and insecurity in some regions. Conclusions: Limited access and delays in care are reported factors and result in REUEs, greater burden of disease and complications, disproportionately affecting the most vulnerable populations. The perspective of the participants underscores the urgency of addressing these problems if safety in healthcare is to be improved, and points to the importance of incorporating those perspectives into the design of policies and interventions that address structural inequities in health systems.
Introduction: The incidence of anemia in neurosurgical procedures varies depending on the population and type of surgery. In elective cranial surgery, the prevalence of moderate to severe anemia reaches up to 2.7%. Anemia has been associated with worse outcomes in terms of 30-day morbidity and mortality, as well as increased need for blood transfusions, particularly in emergency interventions. Objective: To assess the prevalence of preoperative anemia and the occurrence of postoperative complications in patients undergoing resection of supratentorial tumors. Method: Observational study analyzing patients who underwent resection of supratentorial tumors at Fundación Santa Fe de Bogotá, Colombia. Consecutive sampling was used for patients meeting inclusion criteria, and descriptive results were reported through a prevalence study. The association between preoperative anemia and the proposed outcomes was analyzed using frequency measures such as mean, median, and percentages. Results: A total of 295 patients were analyzed between 2019 and 2023, with a prevalence of preoperative anemia of 38.3% (adjusted for the city’s altitude). When analyzing anemia severity, a significant crude association was observed with renal failure and surgical site infection. Conclusion: Preoperative anemia was common in patients with supratentorial tumors and was significantly associated with acute kidney injury and surgical site infection, particularly in moderate to severe cases. Its impact on postoperative morbidity highlights the need for preoperative optimization strategies.
