Browsing by Author "Cevallos Sacoto, Francisco Antonio"

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Beneficios de la infusión intravenosa de lidocaína perioperatoria sobre la función gastrointestinal en pacientes sometidos a cirugía abdominal. Revisión sistemática
(Universidad de Cuenca, 2022-03-11) Jaramillo Monge, Kadir Paul; Cevallos Sacoto, Francisco Antonio
Introduction: The return of gastrointestinal function is a critical determinant in the recovery of patients after surgery. Several studies have determined that lidocaine has several benefits to restore intestinal transit. Objective: to determine the benefits of perioperative lidocaine infusion on bowel function in patients undergoing abdominal surgery, through a systemic review. Methods: observational systematic review study. Articles between quartile one to four of Scimago Journal and Country Rank were included. The information search was carried out in the qualified electronic databases such as: Pubmed, Cochrane, Library Plus, Scielo, Medline, Embase, Scopus, Latindex and academic Google. The search was extended using keywords and Boolean operators "AND", "OR" and "NOT", without language restrictions. For data collection, the PICO strategy was used. Results: there is a significant reduction in postoperative paralytic ileus with the administration of intravenous lidocaine p=0.02. Mean time to first bowel movement after abdominal surgery ranged from 5 to 61.4 hours, and intravenous lidocaine significantly reduced bowel movement p < 0.5. Likewise, the time to the first passage of flatus was shorter p <0.05. There were limited data on the occurrence of first bowel sounds. Conclusions: perioperative intravenous lidocaine is effective in improving the recovery of gastrointestinal function after a surgical procedure, which could promote faster recovery in patients.
Case report: compromise airway and orofacial trauma
(2022) Armijos Quichimbo, Sandra Natividad
Introduction: Facial trauma constitutes a challenge in perioperative management, since this anatomical zone possesses complex vital structures such as important vessel and nerve bundles, as well as the beginning of the upper airway. That is why an injury in this region requires rapid and effective diagnosis and management since ventilation can be seriously compromised by airway obstruction, either due to the object of trauma, or inflammatory reaction and edema; bruises, burns, or direct breakage. The vascular lesion can cause profuse bleeding, as well as aspiration of blood and fragments of tissues that were injured. Choosing the anesthesia technique is usually a challenge when a priori structures such as the mouth and nose are compromised. Method: A clinical case and bibliographic review are presented. Conclusion: Regional facial and neck anesthesia techniques together with adequate sedation are an alternative in the initial management of mild facial trauma. Key words: Facial trauma, regional anesthesia, nerve blocks of the face and neck, sedation.
Caso clínico 1: vía aérea difícil en neonato con síndrome de artrogriposis múltiple congénita, Caso clínico 2: edema agudo de pulmón perioperatorio por asociación de nifedipino y sulfato de magnesio en gestación gemelar
(Universidad de Cuenca, 2023-07-04) Guaman Azuero, Diana Elizabeth; Cevallos Sacoto, Francisco Antonio
Introduction: The association of various drugs is capable of creating both beneficial and counterproductive effects by synergy or addition, factors such as: dose, speed and intervals of administration must be taken into account, since they can trigger complications from mild to severe; Within these, drugs that share similar mechanisms of action deserve special care; In the same way, characteristics of each individual or stages that are taking place, such as gestational, generate physiological changes that must be taken into account since they can precipitate said complications. Materials and methods: The case of a pregnant twin with a threat of preterm labor is presented, who is administered tocolytic treatment with nifedipine, betamethasone for lung maturation, and magnesium sulfate (MgSO4) as a neuroprotectant, which by various mechanisms such as Fluid retention and cardiopulmonary alterations can trigger acute cardiogenic or non-cardiogenic pulmonary edema, a rare complication that puts maternal-fetal well-being at risk. The use of pulmonary ultrasonography in the perioperative period made it possible to make both a rapid diagnosis and to guide an adequate treatment. Conclusions: It is important to take measures to prevent this complication taking into account the independent risk factors for Acute Pulmonary Edema (APE) during pregnancy and thus individualize pharmacotherapy, recommendation of important guidelines is not to use MgSO4 together with nifedipine.
Determinación de los niveles basales de Co2 espirado mediante capnografía, en pacientes quirúrgicos. Hospital Vicente Corral Moscoso. Cuenca, 2019-2020
(Universidad de Cuenca, 2021-07-09) Tigre Cuenca, Daniela Soledad; Cevallos Sacoto, Francisco Antonio; Morales Sanmartín, Jaime Rodrigo
Introduction: In anesthesiology and in critically ill patients, it is necessary to maintain the levels of carbon dioxide (CO2) in normal parameters, whose alteration influences morbidity and mortality. The pressure values of CO2 and Exhaled CO2 (ETCO2) have been shown to vary depending on atmospheric pressure. In the city of Cuenca at 2560 meters above sea level (masl), there is still no study that establishes normal values. Objective: To determine the basal levels of expired CO2 in surgical patients at the Vicente Corral Moscoso Hospital. Methodology: An observational, descriptive study with 534 patients without comorbidities, who underwent surgery at the Vicente Corral Moscoso Hospital in Cuenca Ecuador. To collect data, a thermometer, barometer, humidity sensor, vital signs monitor and capnograph were used; they were recorded in a form, they were analyzed in the IBM SPSS version 22 software with descriptive statistics. Results: The mean expired ETCO2 was 28.36 ± 1.81 mmHg, 95% CI (28.277 - 28.434). Alveolar pressure was 68,116 ± 3,897 95% CI (28,277 - 28,435). There was a significant difference (p <0.05) in the CO2 means according to respiratory rate, mean arterial pressure and whether it was elective or emergency surgery. Conclusions: There is agreement with other studies that indicate that the higher the ETCO2 levels are lower, the range obtained could be taken into account as a reference for the adequate management of ETCO2 in the inhabitants of this geographical area.
Determinación del diámetro traqueal con ultrasonido y su relación con la fórmula de cálculo del tubo en niños de 1 a 12 años. Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca, 2020-2021
(Universidad de Cuenca, 2022-03-10) Serrano Oleas, María José; Cevallos Sacoto, Francisco Antonio
Background: formulas used to determine the number of ETT are inaccurate, using new methods such as US seems promising. Objectives: to determine the tracheal diameter by ultrasound in children aged 1-12 years and its relationship with the formulas. Methods: observational, descriptive and cross-sectional study, January 2020 to December 2021, 140 patients aged 1 to 12 years undergoing scheduled and emergency surgery. The sample was based on: confidence level 95%, precision 5%, variance 0.2, inclusion criteria were met, sociodemographic and clinical variables were analyzed and as a result variable the correlation between the tracheal diameter determined by US with determined by formulas, the data were analyzed by descriptive statistics, using the mean, standard error, CI, standard deviation, Pearson's correlation and Pearson's r coefficient. Results: the following variables prevailed: age 3, 11 and 12 years (12.9%), male sex (69.3%), ASA I (73.6%), normal nutritional status (70.7%), showed that in the following groups there was no linear increase in tracheal diameter by US with respect to their age: 0-11 months 4.58 mm, with CI between 3.60 - 5.56 mm, 6 years 6.58 mm , with a CI between 5.67-7.49 mm, at 7 years 7.14 mm, with a CI between 6.24-8.05 mm and at 9 years 8.21 mm, with a CI between 7.67 -8.77mm It was correlated with the formulas and a Pearson's r coefficient of 82.2% was obtained. Conclusions: very high correlation.
Determinación del nivel cognitivo en pacientes mayores de 60 años sometidos a anestesia general balanceada y total intravenosa en los hospitales José Carrasco Arteaga y Vicente Corral Moscoso, Cuenca 2019
(Universidad de Cuenca, 2021-03-29) Sánchez Correa, María Rosa; Cevallos Sacoto, Francisco Antonio; Morales Sanmartín, Jaime Rodrigo
Introduction: Brain function is affected in the perioperative period, the symptoms manifest during the postoperative period, with depression of the level of consciousness, impaired attention, memory, reaction time, and amnesia, which can last several hours later. General anesthesia, anesthetic drugs, and age are associated factors. Older adults can develop from cognitive deficits and postoperative delirium, which often go unnoticed. Research in recent years seeks solutions to mitigate these pathologies; it is important to determine the associated and aggravating factors such as the type and duration of anesthesia, type of surgery, pathological history, alterations in perioperative homeostasis, among others. Objective: To determine the cognitive alterations that occur in the post-anesthetic of patients undergoing balanced or intravenous general anesthesia. Material and Methods: Analytical and cross-sectional observational study, in 258 patients over 60 years of age, scheduled for elective surgical procedures, from the José Carrasco Arteaga and Vicente Corral Moscoso Hospitals in the city of Cuenca, from January to December of 2019, who were operated with balanced general anesthesia or total intravenous, to whom the minimental test was applied to evaluate the cognitive state.. Descriptive results are shown using absolute and percentage frequency measures, measures of central tendency and dispersion. To determine the degree of association between risk factors and cognitive impairment, the prevalence ratio and confidence intervals were applied. The sample was calculated with a confidence level of 95%, taking into account the prevalence of 20% described in other studies, with a margin of error of 0.05. Results: 258 patients between 60 and 91 years old were studied, with a mean of 70.7, obtaining a prevalence of postoperative cognitive impairment (PDD) of 37.6%, associated with factors such as female sex, age over 80 years, patients classified according to the American Society Anesthesia Physical Status (ASA PS) III and patients who presented complications during surgery. Conclusions: The decrease in cognitive capacity was significantly more notable in: women, long-lived adults, those with an ASA III classification and in patients with complications during the intraoperative period; It is important to identify these factors and take prior measures such as multidisciplinary evaluations that help prevent their appearance or reduce its severity.
Insuficiencia cardíaca aguda tras administración de propofol y fentanilo en pacientes sin enfermedad cardíaca estructural: reporte de dos casos
(1999) Puga Bravo, Cristina Evelyn
Acute heart failure occurs exceptionally in patients without structural heart disease. Two clinical cases with heart failure after surgical intervention were presented, in which doses of propofol and fentanyl were administered, drugs related to cardiovascular depressant effect; a sudden hemodynamic deterioration is observed, with a decrease in the ejection fraction, which in the monitoring would return to normal parameters. When discarding orga-nic pathology of heart, the use of these drugs is related to the development of heart failure, so it is proposed to take it into account in the differential diagnosis of this condition.
Medición de los niveles y curva de Co2 con el uso de máscara laríngea y tubo endotraqueal en pacientes de 14 a 60 años del Hospital Vicente Corral Moscoso, Cuenca 2018
(Universidad de Cuenca, 2020-11-13) Peñafiel Encalada, Alicia Monserrath; Cevallos Sacoto, Francisco Antonio; Morales Sanmartín, Jaime Rodrigo
Introduction: there are few studies about the variability that exists between capnography and capnometry during the use of the laryngeal mask and endotracheal tube, that’s why it has been considered important to perform this research. Objective: to determine the changes in the levels and curve of expired carbon dioxide (EtCO2) referring to the use of the laryngeal mask (LMA) and the endotracheal tube (ET). Methodological design: a descriptive cross-sectional study was carried out from january to december 2018. The population was made up of a representative sample of patients undergoing balanced general anesthesia procedures. Data from 180 patients were analyzed with the Statistical Package for the Social Sciences (SPSS).Results: in the analysis of the capnography, there was no difference between the two evaluated groups, 2 patterns of bronchospasm were found during the fifth- and thirtieth-minute during surgery with values of p = 0.363 in both cases. Capnometry averages were obtained in the TET group and LMA, with the following results: at minute 5 an average of 36 ± 4 mmHg and 36 ± 3 mmHg with p = 0.324, at minute 30 a value of 35 ± 4 mmHg and 35 ± 3 mmHg with p = 0.517 and at minute 60 a value of 35 ± mmHg and 34 ± 3 mmHg with p = 0.84 respectively. Conclusions: it was concluded that the results of capnography and capnometry do not vary depending on the use of the laryngeal mask and endotracheal tube.
Prevención de la hipotermia perioperatoria en anestesia general. Revisión sistemática
(Universidad de Cuenca, 2022-02-04) Salazar Cornejo, Carlos Andrés; Cevallos Sacoto, Francisco Antonio
Introduction: Hypothermia is defined at a body temperature below 36 ° C, it is considered the "hidden enemy" of surgical procedures, its incidence ranges from 20% to 70%, it has a direct impact on perioperative morbidity and mortality, for this reason strategies have been established for its prevention. Objective: To determine the best strategies to prevent perioperative hypothermia. Methodology: Systematic review without meta-analysis, based on the prism statement. The studies were obtained from electronic databases: Pubmed, Cochrane Library Plus (English, Portuguese and Spanish), maximum 5 years old, acquiring the information according to the PICO strategy, it was registered in a database, author, journal, quintile, year and place of publication. To assess the risk of bias of the studies, the criteria of the CONSORT guide were used. Results: 18 studies that met the eligibility criteria were analyzed; 16 controlled clinical trials and 2 systematic reviews published by Cochrane. Comparisons were made, either of 2 groups (strategy versus control) or of 3 groups (control-strategy 1-strategy 2), only one study analyzed an entire comprehensive heating system. Conclusion: This systematic review showed that forced air heating is one of the most used strategies and the benchmark for comparison, even though the self-heating blanket and active heating were statistically better. It should be noted that the studies do not analyze applicability criteria, so these strategies must be reviewed and evaluated in each of the contexts.
Sección de catéter epidural durante técnica anestésica espinal epidural combinada.
(2022) Cevallos Sacoto, Francisco Antonio
The use of epidural catheters is a fundamental pillar of anesthesia. These have been safely employed for several decades; however, some complications usually occur. A rare one is its section, which if not properly managed generates significant morbidity. It is presented the case of a patient receiving combined epidural spinal anesthesia. The technique used, both for the placement of the catheter and for its removal, was apparently correct; however, it suffered a section when removed. In the subsequent images it was evident that the catheter was accidentally placed in the paravertebral space. A mechanism of rupture not yet described in the literature is theorized. It is published with the aim of showing the need for individualization in the management of this accident, whether expectant or surgical according to the clinical conditions of each patient.
Variación de signos vitales en pacientes sometidos a anestesia general balanceada y anestesia total intravenosa en el Hospital Vicente Corral Moscoso, Cuenca, 2019
(Universidad de Cuenca, 2021-12-03) Trochez Alvarado, Amy Yamileth; Cevallos Sacoto, Francisco Antonio
Introduction: few studies describe the existing variability in vital signs when using total intravenous anesthesia (TIVA) and balanced general anesthesia (BGA), being necessary to obtain these data to avoid adverse events. Objective: to describe the variation of vital signs in patients undergoing BGA and TIVA at the Vicente Corral Moscoso Hospital, 2019. Methodology: descriptive observational study, 384 patients, from January to December 2019. The population consisted of patients under BGA or TIVA. Data was transcribed from the clinical history forms and analyzed with the SPSS 22.0 system. Results: 48.20% of the patients were aged between 26 and 45 years, 55.50% were female, and 67.20% belonged to ASA I (classification used by the American Society of Anesthesiologists), 50% to TIVA and 50% to BGA. As for the extubation time with TIVA, 64.06% were extubated between 0 to 5 minutes, and 27.6% with BGA. Comparing the mean blood pressure variability of TIVA (70.80 ± 6.32 mmHg) and AGB (67.80 ± 4.92 mmHg), a significant difference was found with a p < 0.05. When comparing medians of heart rates at all surgical times between the two types of anesthesia, no statistically significant difference was found with p > 0.05. At 32.81% of the patients received inotropic drugs, the majority was with AGB with 27.86%. Conclusions: hemodynamic variability determined by heart rate and blood pressure, the TIVA group showed fewer alterations than the AGB group, in agreement with international studies.