Relación entre la farmacocinética y los cambios hemodinámicos durante la inducción y posicionamiento en pacientes quirúgicos anestesiados con propofol

Tesis por compendio de publicaciones[EN]For long years, it was thought that anaesthetic management did not influence patient’s outcome. Surgical morbidity and long-term mortality were attributed to patient’s comorbidity, malignance of the disease, risk infection and type of surgery. Nowadays, there is an increasing evidence that intraoperative anaesthetic management can influence long-term patient outcomes. In the last two decades, surgical mortality rates have been falling and, in part, this is due to a huge improvement in anaesthesia related factors and safety. For an anaesthesiologist, perioperative care is no longer the simple fact of administrating the anaesthetic drug and maintaining the patient “asleep”. Direct-guided fluid therapy, maintaining intraoperative normothermia, minimizing blood transfusion and avoiding low mean arterial pressure and deep hypnotic level are additional procedures the anaesthesiologist is responsible for and that will probably improve patient’s outcome and decrease surgical mortality. Hypotension after induction of anaesthesia is quite common and more prevalent during the late post-induction period and before skin incision (5-10 minutes after), generally thought to be clinically irrelevant. Nowadays, there is some evidence that small haemodynamic changes, such as hypotension, even for small periods, are associated with poor patient outcomes, because they have the potential to cause an ischemia–reperfusion injury which may be manifested as dysfunction of any vital organ, like acute kidney and myocardial injury. Intra-operative management of hypotension is usually guided by conventional monitoring (systolic blood pressure and MAP) but these parameters could mask low levels of blood flow and oxygen delivery, even for short periods, leading to major surgical complications and longer hospital stays

Non-technical skills assessment scale in nursing: Construction, development and validation

© 2018 Revista Latino-Americana de Enfermagem. The introduction of non-technical skills during nursing education is crucial to prepare nurses for the clinical context and increase patient safety. We found no instrument developed for this purpose. Objectives: to construct, develop and validate a non-technical skills assessment scale in nursing. Method: methodological research. Based on the literature review and experience of researchers on non-technical skills in healthcare and the knowledge of the principles of crisis resource management, a list of 63 items with a five-point Likert scale was constructed. The scale was applied to 177 nursing undergraduate students. Descriptive statistics, correlations, internal consistency analysis and exploratory factor analysis were performed to evaluate the psychometric properties of the scale. Results: scale items presented similar values for mean and median. The maximum and the minimum values presented a good distribution amongst all response options. Most items presented a significant and positive relationship. Cronbach alpha presented a good value (0.94), and most correlations were significant and positive. Exploratory factor analysis using the Kaiser-Meyer-Olkin test showed a value of 0.849, and the Bartlett’s test showed adequate sphericity values (χ2=6483.998; p=0.000). One-factor model explained 26% of the total variance. Conclusion: non-technical skills training and its measurement could be included in undergraduate or postgraduate courses in healthcare professions, or even be used to ascertain needs and improvements in healthcare contexts

Escala de avaliação de habilidades não técnicas em enfermagem: construção, desenvolvimento e validação

The introduction of non-technical skills during nursing education is crucial to prepare nurses for the clinical context and increase patient safety. We found no instrument developed for this purpose. Objectives: to construct, develop and validate a non-technical skills assessment scale in nursing. Method: methodological research. Based on the literature review and experience of researchers on non-technical skills in healthcare and the knowledge of the principles of crisis resource management, a list of 63 items with a five-point Likert scale was constructed. The scale was applied to 177 nursing undergraduate students. Descriptive statistics, correlations, internal consistency analysis and exploratory factor analysis were performed to evaluate the psychometric properties of the scale. Results: scale items presented similar values for mean and median. The maximum and the minimum values presented a good distribution amongst all response options. Most items presented a significant and positive relationship. Cronbach alpha presented a good value (0.94), and most correlations were significant and positive. Exploratory factor analysis using the Kaiser-Meyer-Olkin test showed a value of 0.849, and the Bartlett’s test showed adequate sphericity values (χ2=6483.998; p=0.000). One-factor model explained 26% of the total variance. Conclusion: non-technical skills training and its measurement could be included in undergraduate or postgraduate courses in healthcare professions, or even be used to ascertain needs and improvements in healthcare contexts.publishe