Browsing by Author "Espinoza Juela, Miguel Ignacio"

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Incidencia de la hipotermia inadvertida en la sala de recuperación post anestésica en pacientes sometidos a cirugía general. Hospital Vicente Corral Moscoso. Cuenca - 2018
(Universidad de Cuenca, 2020-05-05) Astudillo Aguilera, Johanna Catalina; Espinoza Juela, Miguel Ignacio; Morales Sanmartín, Jaime Rodrigo
Introduction: postoperative inadvertent hypothermia is the parameter with the highest incidence. Hypothermia causes myocardial complications, infection, delayed wound healing, coagulopathy, delayed recovery, prolonged hospitalization. Objective: To determine the incidence and characteristics of inadvertent hypothermia in patients who enter the post anesthetic recovery room of the Vicente Corral Moscoso Hospital. Materials and methods: A prospective, descriptive-longitudinal study was performed in patients on APRS after general anesthesia on admission, 60 and 120 minutes. The sample was 400 patients calculated with the random type probabilistic sampling formula, a value of p ≤ 0.05 will be considered statistically significant. Data were analyzed in the SPSS version 22 statistical program. Results: The incidence of hypothermia on admission was 74.5%, average T 35.53 ° C + - 0.67 ° C, at 60 minutes 31.3%, average T 36.1 ° C + - 0, 55 ° C and at 120 minutes 10.5%, average T 36.5 ° C + - 0.46 ° C. There was hypothermia in patients> 60 years (p: 0.000). It was higher in low weight after 60 minutes at 43.8% and remained at 120 minutes at 18.8%. Gynecological surgery presented hypothermia with 83%, 34% and 25%. Patients with ASA III staging plus hypothermia with 84.6%, 53.8% and 19, 2%. Greater hypothermia in surgeries> 3 hours with 93.5%, 63% and 19.6%, (p: 0.000). ASA III patients p: 0.010. Conclusions: The incidence was higher than the reviewed studies, there is a significant relationship between surgical time, age greater than 60 years and ASA III with hypothermia.
Percepción del dolor a la administración de propofol utilizando: remifentanilo y lidocaína como medidas preventivas. Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca, 2020
(Universidad de Cuenca, 2022-01-31) Pinos Brito, María Carmen; Espinoza Juela, Miguel Ignacio
Introduction Propofol is the most widely used inducer in anesthesia. The pain produced at the time of administration is a frequent complication, therefore several pharmacological interventions are used to prevent it. Objective To measure the response to pain in surgical patients to the administration of propofol using remifentanil and lidocaine as preventive measures. Methodology Descriptive observational study, the study population consisted of patients with scheduled surgeries under general anesthesia at the Vicente Corral Moscoso and José Carrasco Arteaga Hospitals from November 2019 to October 2020. Data was collected according to remifentanil infusion and lidocaine administered before propofol; remifentanil infusion plus lidocaine premixed with propofol and remifentanil infusion. A form and a database were filled out in the SPSS V.15 program, descriptive and inferential statistics were used for the analysis. Results 267 patients were collected, mean 38.41 ± 12.19 years, the majority women. In the remifentanil plus lidocaine group separately there were fewer patients with pain 73.09%, when remifentanil alone was used 8.99% of patients indicated severe pain. There was a higher percentage of female patients with moderate (23.80%) and severe pain (3.10%). When the catheter was in the back of the hand, 36.60% of the patients had moderate pain. Conclusions Pain in the studied population was present in the three types of interventions, the most effective was remifentanil infusion plus propofol with unmixed lidocaine. Female patients, urban residence, secondary studies, peripheral venous catheter in the back of the hand were the groups with the most patients who reported pain.
Remifentanilo como analgesia complementaria en bloqueo paracervical para aspiración manual endouterina. Hospital Vicente Corral Moscoso. Cuenca, 2013
(2013) Espinoza Juela, Miguel Ignacio; Pacheco Baculima, Juan Pablo; Morocho Malla, Manuel Ismael
Objective. To decrease the pain caused by the the Manual Vacuum Aspiration (MVA) in patients undergoing surgery from paracervical block. Methodology. With a blind randomized controlled trial, eighty patients -two groups of forty- were selected for the treatment of incomplete abortion by Manual Vacuum Aspiration in the Department of Gynecology and Obstretrics in Vicente Corral Moscoso Hospital. Group “B” (n=40) underwent the paracervical block procedure. Besides paracervical block treatment, group “A” (n=40) received 1mcg/kg of intravenous remifentanil as an initial dose followed by 0,5mcg/ kg of bolus every four minutes. Pain intensity was measured using the visual analog scale of 10 points, haemodynamic changes and side effects. Results. There is not a significant difference between the study groups related to age (p=0,118), weight (p = 0,522), height (p = 0,114), IMC (p = 0,668), level of education (p = 0,699). The use of remifentanil decreased the pain according to the visual analog scale (VAS) from 7,58 group “B” to 2,98 in group “A” (p = 0,000). There were not significant changes regarding mean arterial pressure and heart rate (p > 0,05). The side effect that showed a significant difference between the groups was the nausea (p = 0,001) which was higher in group “B” Discussion. The use of remifentanil to paracervical block decresaed the VAS pain by 46% with major changes in hemodynamics and with fewer side effects than the control group having nausea (92.3% with p 0.001) KEY WORDS. INCOMPLETE ABORTION, ANALGESIA, INTERMITTENT BOLUS, REMIFENTANIL, PARACERVICAL BLOCK LIDOCAINE, MVA, VAS PAIN
Remifentanilo como analgesia complementaria en bloqueo paracervical para aspiración manual endouterina. Hospital Vicente Corral Moscoso. Cuenca, 2013
(Universidad de Cuenca. Facultad de Ciencias Médicas, 2015-06) Espinoza Juela, Miguel Ignacio; Pacheco Bacuilima, Juan Pablo; Morocho Malla, Manuel Ismael
OBJECTIVE: To reduce the pain of manual vacuum aspiration (MVA) in patients involved under paracervical block. MATERIALS AND METHODS: In a clinical randomized controlled blind design, 80 patients were included (in two groups of 40) selected for an incomplete treatment of abortion with manual vacuum aspiration, in the Gynecology and Obstetrics Department of the Vicente Corral Moscoso Hospital. The group “A” (n = 40) received additional to the paracervical block 1 mcg / kg intravenous remifentanil as an initial dose followed by 0.5 mcg / kg every 4 minutes and the group “B” (n = 40), the procedure was performed only under paracervical. Pain intensity was determined by visual analog scale of 10 points, hemodynamic changes and side effects. RESULTS: There is no a significant difference in the study groups in both age (p = 0.118), weight (p = 0.522), height (p = 0.114), BMI (p = 0.668), educational level (p = 0.699). The addition of remifentanil, reduced pain according to the EVA of 7.58 group “B” with respect to 2.98 group “A”, (p = 0.000); it had no significant changes in arterial pressure and heart rate (p> 0.05); the side effect was presented with statistically significant difference (p = 0.001) it is nausea which is higher in group “B”. DISCUSSION: The addition of remifentanil to paracervical block, decreased the pain through EVA by 46%, without much change in hemodynamics and with fewer side effects than has the control group (92.3% nausea with p 0.001).
Satisfacción de la recuperación anestésica en pacientes sometidos a anestesia general en el Hospital de Especialidades José Carrasco Arteaga, Cuenca 2023
(Universidad de Cuenca, 2024-08-27) Deleg Guartán, Ruth Carolina; Espinoza Juela, Miguel Ignacio
Background: the quality of anesthetic recovery is a crucial process during the postoperative period, since various complications may occur during this period; its success will depend on operational, physiological and psychological dimensions. Objective: determine the level of satisfaction of anesthetic recovery in patients undergoing general anesthesia, José Carrasco Arteaga Specialty Hospital, Cuenca 2023. Methods: descriptive, cross-sectional study. 275 patients who met the inclusion criteria were surveyed; non-probabilistic convenience sampling was applied. To evaluate anesthetic recovery satisfaction, the validated QoR-40 form was used. Descriptive statistics were used. Results: gynecological surgery was the most frequent with 24%, 64.4% received balanced general anesthesia, 59.6% had surgery lasting between 30 to 60 minutes, 87.3% were categorized as ASA II, 7.6 % present transoperative complications. 38.4% of patients were dissatisfied, 57.8% partially satisfied and only 3.3% satisfied. The highest prevalence of dissatisfied patients was seen in gynecological surgeries, total intravenous anesthesia, with operating time between 30 to 60 min, and ASA II. with 12%, 25.5%, 21.5% and 36.7% respectively. The highest scores according to the QoR40 questionnaire were evident in the dimension of comfort, support received and emotions. According to the perception of the quality of care of all the participants, they indicated that the care was of good quality. Conclusions: according to the QoR-40 assessment, the majority of participants were dissatisfied or partially satisfied with anesthesia care.
Tabaquismo, características socioeconómicas y culturales, en la parroquia Hermano Miguel de la ciudad de Cuenca 2002-2003
(2004) Cueva Noriega, Diego Fernando; Espinoza Juela, Miguel Ignacio; Guerrero Mogrovejo, Juan Carlos; Mosquera Vallejo, Lorena Elizabeth
It is part of a project on: Tobacco, poverty and disease in the city of Cuenca, of the University of Cuenca. It has the overall objective to try to determine the relationship between smoking and socioeconomic conditions (related apobreza), and what are the risks in smokers Hermano Miguel parish of the city of Cuenca. Among its specific objectives establish what social conglomerate either of its middle and lower level there most smokers. The methodology for this research a quantitative study of epidemiological descrptivo type used, as it takes the urban population of the aforementioned parish universe, whose significant type stratified random sample taken at 1of families using key variables such as personal, social and economic characteristics, cultural and cigarette consumption. The main results obtained lead to the conclusion wanted the vast majority no smoking and that in smokers the myoría belong to the social conglomerate under, are men, started the habit in adolescence (15 to 19) are married, Catholic, incomplete higher education, taught their friends, smoke anytime, anywhere, for pleasure, drawn by one to four cigarettes a day, brand Lark respect to smoking at all, know their warnings and risks, most have no symptoms, have wanted and tried to quit using self-help and have felt reassured when they have done.
Test predictivos para intubación orotraqueal difícil en laringoscopia directa. Revisión sistemática
(Universidad de Cuenca, 2022-01-28) Montes Fernández, Bety Belén; Espinoza Juela, Miguel Ignacio
Background: The difficult intubation is a clinically relevant scenario in the field of health, due to the impact of its possible negative consequences. Despite a great deal of information on models and prediction scales for difficult intubation, a synthesis of this information has not been carried out. Objective: To determine the prognostic performance of the different predictive tests to identify the existence of difficult intubation in direct laryngoscopy in adults. Materials and methods: A systematic review was carried out, based on the PRISMA, STARD and QUADAS guidelines of publications in English and Spanish, using different databases such as: LILACS, Pubmed, ClinicalKey, ScienceDirect, Scopus, Dynamed, Scielo, EMBASE, Medline , Springer Link, Virtual Health Library, EBSCO, UpToDate, MEDION, Cochrane, and Google Scholar for the past five years. The studies were: prosthetic, cohort and analytical and included an adult population without anatomical malformations of the airway with difficult orotracheal intubation before direct laryngoscopy. Summary measures were used such as: percentages, p-value, relative risk, ods ratio, sensitivity, specificity, positive and negative predictive values. Results: In the 8 articles analyzed, a significant difference was found in Cormack-Lehane grades III/IV, with the tests: upper lip bite (p=0.001), Wilson scale (p=0.001), thyromental height (p =0.002), Mallampati (p=0.009). Most of the predictive tests obtained results with little sensitivity to identify difficult intubation, except for the tests: thyromental height (84.95%) and Mallampati (S: 72.16%). Conclusions: Predictive models are still imperfect as they have a low discriminative capacity. The limitations for this study were: restricted accessibility to articles by economic items for admission. Great variability in studied populations, statistical data by model not evidenced, little information of models in relation to direct laryngoscopy.
Variabilidad de la presión arterial en pacientes hipertensos durante colecistectomía laparoscópica. Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca, 2019
(Universidad de Cuenca, 2021-05-18) Pesantes Solórzano, Gema Tatiana; Espinoza Juela, Miguel Ignacio
Background: Laparoscopic cholecystectomy is a common procedure and arterial hypertension is a pathology with a high prevalence; when both conditions are found in an individual, morbidity and mortality increases in the perioperative period. Objective: To describe the variability of blood pressure in hypertensive patients during laparoscopic cholecystectomy, at the Vicente Corral Moscoso and José Carrasco Arteaga hospitals. Methodology: descriptive observational study from January to December 2019. The population consisted of patients with a diagnosis of hypertension treated or not, undergoing scheduled and emergency surgery with general anesthesia for laparoscopic cholecystectomy who met the inclusion criteria (n=361). Results: The mean age of the people who underwent the procedure was 58 years, with respect to sex, 72.9% were women. 43.2% of those examined were overweight, 87% ASA II, with a time of HT greater than or equal to 5 years for 55.7% of those studied, with an adherence of 78.9%. According to the SBP, a statistically significant difference was obtained between baseline and that during induction, a similar behavior with respect to DBP and mean arterial pressure. Likewise, a significant variability was reported between SBP, DBP and MAP taken at the beginning and at the end of the surgical procedure. Finally, with regard to the treatment for hypotension, fluid therapy was applied in 47.9% of the people, ephedrine was administered in 30.5% of the patients, and 24.4% had adjustments made in the sevoflurane. Conclusions: Systolic, diastolic and mean blood pressure varied in all BP measurements taken throughout the surgical act.