Browsing by Author "Palacios Reinoso, Carlos Santiago"

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Comparación del uso de ecografía vs reparos anatómicos en la realización de bloqueo caudal en pacientes de 3-7 años. Hospital Vicente corral moscoso y Hospital José Carrasco Arteaga. Cuenca 2019 a marzo 2020
(Universidad de Cuenca, 2021-05-19) Lucero Samaniego, Andrea Natali; Palacios Reinoso, Carlos Santiago; Morales Sanmartín, Jaime Rodrigo
Background: The techniques advance in the use of regional anesthesia is a motivation to perform local studies that compare the use of ultrasound guidance and anatomical landmarks. Objective: To compare the benefits of caudal block in patients from 3 to 7 years old who had been subjected surgery in the lower hemi body, both with ultrasound-guided caudal block or with anatomical landmarks. Methodology: Observational and descriptive cross-sectional study, 124 children between 3 and 7 years old, subjected to surgery in whom a caudal block was used to alleviate postoperative pain; After intubation or before awakening, a caudal block was performed guided by ultrasound or by anatomical landmarks. The time used for each technique was measured, and in the postoperative period it was observed: vital signs, additional analgesia, the Wong Baker's Faces scale was also applied to determine the benefits of each technique. Results: The mean age was 4.91 years. In 80.6% of the cases were male and 77.4% presenting normal weight. 55.6% of the population belonged to blockage due to anatomical repairs and 44.4% due to ultrasound guidance. Comparing the results of the 2 groups, there were found statistically significant differences, in the variation of the heart rate in favor of the group that uses ultrasound as a guide and in the duration of the procedure in favor of the group that uses anatomical repairs (less time). Conclusions: the ultrasound-guided technique has better results in terms of analgesia than the anatomical landmarks.
Determinación preanestésica del volumen gástrico por ecografía en apendicectomías. Hospital José Carrasco Arteaga. Cuenca, 2020 – 2021
(Universidad de Cuenca, 2022-03-14) Benavides Calle, Daniela Fernanda; Palacios Reinoso, Carlos Santiago
Background: Breathing of gastric contents into the airways is a serious complication that can occur during local anesthesia; especially in emergency surgeries, such as appendectomies, where preoperative fasting is not always reliable and it is considerade full stomach. Ultrasound is a useful tool to measure gastric volume, predicting the risk of breathing into the airways, and to choose accurate anesthetic management. Objective: To determine the preanesthetic gastric volume by ultrasound in patients who are going to undergo appendectomy at the José Carrasco Arteaga Hospital. Methods: A descriptive observational study. The population consisted of adult patients undergoing appendectomy at the José Carrasco Hospital. The sample was calculated according to an unknown universe, obtaining 174 participants. The results were processed in SPSS V27, and expressed in measures of frequency, central tendency and dispersion according to the type of variable. A histogram was used for a general visualization of the behavior of the gastric volume. Results: the majority of patients were men, between 30 and 39 years old, overweight and ASA 1. The mean gastric volume was 41.88 ± 23.92 ml The average fasting time was 9.5 hours, 42.5% took clear liquids for the last time. 21.3% are considered to have “at risk stomach” condition and 1.7% have high risk of breathing into the airways. There was a change in anesthetic induction in 4.6%. Conclusions: the gastric volume measured by ultrasound was highly variable, the majority of patients had a low risk of aspiration and no association was found with any pharmacological or pathological factors that alter gastric emptying.
Eficacia de analgesia post cesárea con bupivacaína 10 mg + morfina 150 µg vs. bupivacaína 10 mg + morfina 100 µg por via intratecal. hospital vicente corral moscoso. Cuenca – Ecuador. 2013.
(2014) Sánchez Jiménez, Mónica Patricia; Palacios Reinoso, Carlos Santiago; Morocho Malla, Manuel Ismael
Introduction: The use of Intrathecal morphine is very effective as post-cesarean section analgesia. However, the optimal dose is not determined yet. The objective of this study was to evaluate the efficacy of intrathecal bupivacaine 10 mg + 150 µg of morphine vs intrathecal bupivacaine 10 mg + 100 µg of morphine as an analgesic method in patients after caesarean section at the Vicente Corral Moscoso Hospital of the city of Cuenca – Ecuador in 2013. Methods: A controlled blind clinical trial. 64 Patients who were treated with bupivacaine 10 mg + 150 µg of morphine and 64 who received bupivacaine 10 mg + 100 µg of morphine were studied. The quality of analgesia, efficacy and side effects of the two techniques were also studied. Results: The dose of 150 µg morphine + 10 mg of bupivacaine was more effective than the 100 µg + 10 mg of bupivacaine in the evaluation of analgesia between 12 and 24 hours after the surgery. There were no differences in the hemodynamic behavior between the two groups. Conclusions: The group that received the treatment based on bupivacaine 10mg + 150 µg of morphine had better results in the analgesic control after the surgery. Only one patient suffered vomiting as a secondary effect. Key words: MORPHINE CESAREAN SECCION, POSTOPERATIVE PAIN, ANALGESIA.
Estado nutricional y crecimiento físico en niños escolares de estrato sociales altos, medios y bajos de la ciudad de Cuenca
(1996) Escobar Escobar, Félix Antonio; Guallpa Guamán, Víctor Jaime; Molina Carrión, Luis Enrique; Molina Carrión, Marjorie Lorena; Pacheco Saltos, Hernán Patricio; Palacios Reinoso, Carlos Santiago; Quesada Riera, Diego Marcelo; Quintuña Carvajal, Marcelo; Reiban Hurtado, John Walter; Sacaquirin Wazhima, Diego Olmedo; Verdugo García, Milton Vicente; Verdugo Guzmán, Carlos Enrique; Quizhpe Peralta, Arturo Octavio; Cañizares Aguilar, Aurelio Ernesto
Evaluación de la disfunción cognitiva posoperatoria en pacientes adultos mayores sometidos a anestesia general en los Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca 2013 – 2015
(2016) Suárez Sevilla, María de Lourdes; Palacios Reinoso, Carlos Santiago; Arévalo Peláez, Carlos Eduardo
Introduction: The postoperative cognitive dysfunction, confusion and delirium are common after general anesthesia in the elderly, with symptoms that persist for months or years in some patients. The prevalence of cognitive impairment differs to a greater or lesser frequency depending on the test employee of the studied population. Objective: To determine the prevalence of postoperative cognitive dysfunction in older adult patients having surgery under general anesthesia in hospitals Vicente Corral Moscoso and José Carrasco Arteaga, Cuenca 2013-2015. Material and methods: We performed a cross-sectional observational study. With a sample of 249 elderly patients undergoing general anesthesia in hospitals Vicente Corral Moscoso and José Carrasco Arteaga. Univariate analysis was performed to describe the characteristics of the sample and the prevalence of cognitive impairment using absolute and relative frequencies. To determine the association between these variables with cognitive impairment was bivariate analysis . Chi squared and p value <0.05 was used to value as statistically significant ; the odds ratio with a confidence interval of 95% Results: The observed prevalence of postoperative cognitive dysfunction in elderly patients undergoing general anesthesia in Hospitals Vicente Corral Moscoso and Jose Carrasco Arteaga is 40.9 %, with 95% CI: 31.7 - 50.1. The highest frequency (52.3 %) corresponds to cognitive impairment patients between 69 and 99 years. Primary was the most common instruction level (57%). According to the physical status of patients (41.2 %) they were assessed as ASA II (50 %) as ASA III and IV. By the time of anesthetic exposure, cognitive impairment was more common in patients who were 90 to 360 minutes of exposure (41%). It was identified that as the age of patients increases the risk of cognitive impairment increases. Chi square 8.54, OR 3.39 with 95% CI: 1.47 to 7.82
Incidencia de complicaciones durante la ventilación e intubación y su relación con el índice de masa corporal, Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca, 2017-2018
(2019) Cajamarca Bermeo, Vilma Adriana; Naranjo Bernal, Ligia Elena; Palacios Reinoso, Carlos Santiago
Background: Basic airway management includes evaluating and managing airway patency, oxygen administration and ventilation. In these processes complications can occur that can increase the morbidity and mortality of patients. Methodology: a cohort study was carried out with a sample of 390 patients scheduled for surgery under general anesthesia. Validated tests were used for preanesthetic assessment and prediction of ventilation, difficult intubation and complications. For the hypothesis test, the relative risk was applied with its 95% confidence interval. Statistically significant results were considered at values of p <0.05. Results: 25.10% of complications related to ventilation were observed, 8.5% with intubation and 9.20% of both types. 26.9% of obese patients had difficult predictors. The difficulty to ventilation was greater in patients with obesity 20.5%. The risk factors for difficult intubation in overweight patients were: the tiromentonian distance (TMD) <6.5cm RR: 1.95 (95% CI: 1.03-3.70). In obese patients there was an increased risk of observing a grade III-IV in Mallampati RR 4.54 (95% CI: 2.34-8.79), RRT RR 3.64 (95% CI: 1.97-6.72), sternomental distance (DEM) <-12.5cm RR 6.57 (95% CI: 3.14-13.75), cervical diameter >42cm RR 2.94 (IC95%: 2.42-3.57). Conclusions: patients with overweight and obesity have a higher frequency of signs of ventilatory difficulty and risk of complications during intubation and later in ventilatory parameters.
Prevalencia de complicaciones y factores asociados a la colocación de catéter venoso central ecoguiado y por reparos anatómicos. Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca 2017
(2019) García Orellana, Paola Andrea; Caraguay Aguinsaca, Diana Elizabeth; Palacios Reinoso, Carlos Santiago
Central venous catheters are devices that are inserted into main venous vessels to administer drugs, fluids, parenteral nutrition, or determine physiological constants. Complication rates between 5% and 19% are reported. Objective: Know the prevalence of complications and associated factors when placing an echoguided central venous catheter and for anatomical landmarks at the Hospitals Vicente Corral Moscoso and José Carrasco Arteaga. Methodology: An analytical cross-sectional study was designed. Universe: Patients undergoing Central Venous Catheter placement in the operating room of the Hospitals Vicente Corral Moscoso and José Carrasco Arteaga from June 2017 to May 2018. Inclusion criteria: Patients older than 18 years who were placed Central Venous Catheter in Operating Room. Exclusion criteria: Patients that doesn`t accept the study. Variables: Age, Sex, BMI, ASA, Pathology, Neck diameter, Neck length, Number of punctures, Procedure duration, Technique, Location, Complications. In the hypothesis test, the relative risk was calculated with the 95% confidence interval and value of p <0.05. Results: The study was performed in 460 patients, with 15.9% of complications. Under ultrasound supervision, 86% of catheters were placed and 14% by anatomical repairs. The technique with the highest prevalence of complications is due to anatomical repairs (32.8%) compared to ultrasound (13.1%). The most common complication was arterial puncture with 6.5%. Conclusions: The ultrasound-guided technique is more successful with a single puncture, and a lower prevalence of complications.
Relación entre distancia pretraqueal y circunferencia del cuello como predictores de vía aérea difícil en pacientes con sobrepeso y obesidad, Hospital José Carrasco Arteaga. Cuenca, 2018
(Universidad de Cuenca, 2020-03-09) Arízaga Arce, Leonardo Santiago; Palacios Reinoso, Carlos Santiago
INTRODUCTION: The prevalence of the obese population has increased in recent times and we know the incidence of difficult airway in obese people in increased up to three times compared to people with normal weight. In obese people, a neck circumference greater than 40 cm has been associated with a difficult intubation. Several studies have relied on ultrasound to predict difficult intubation. OBJECTIVE: To determine if there is a relationship between pre-tracheal distance and cervical circumference as predictors of difficult airway in patients who are overweight and obese. METHODS: An observational, cross-sectional and analytical study was carried out. The universe was made up of all overweight and obese patient undergoing elective surgery under general anesthesia. The sample was 182 patient of both sexes with BMI > 25 undergoing elective surgery under general anesthesia at the José Carrasco Arteaga Hospital, who in the preoperative period were measured cervical circumference and pre-tracheal distance by ultrasound, subsequently orotracheal intubation was performed by laryngoscopy to determine the existence of a difficult airway with the Cormack scale. A confidence level of 95%, margin of error of 5%, probability of occurrence of 13.8 % was used. The data were obtained from the medical record using the respective form and analyzed with the SPSS 22.0 program, free version. RESULTS: In this study the incidence of difficult airway was 14.8% in overweight and obese patients; 22.9% in the cervical girth group of ≥ 40 cm; 92.3% in the pre-tracheal distance group of ≥ 72.7% in patients of morbid obesity group (BMI ≥ 40). The results indicate that at a measure of pre-tracheal fat ≥ 28mm, and cervical circumference ≥ 40 cm, increase the difficulty in intubation, a statistical test was performed using Xi2 which concludes that the association is statistically significant for both variables with p 0.000.
Sedo-analgesia para colonoscopía. Comparación entre midazolam + fentanil versus propofol + fentanil. Hospital Vicente Corral Moscoso y Hospital José Carrasco Arteaga, Cuenca 2014
(2016) Vanegas Mendieta, Gabriela Vanessa; Palacios Reinoso, Carlos Santiago; Arévalo Peláez, Carlos Eduardo
Introduction. Colonoscopy is the endoscopic examination of the large intestine, a procedure that is usually performed on an outpatient basis and it is unpleasant and painful. Commonly, is performed with general anesthesia or with sedatives or over-the-counter pain relievers which separately do not guarantee benefit for the patient. Objective. Compare the sedative and analgesic effect of midazolam/fentanyl versus propofol/fentanyl in colonoscopy. Methodology. Controlled clinical trial randomized single-blind study that included 216 patients randomly assigned to two equal groups. Group A (n = 108) received midazolam plus fentanyl and group B (n = 108) propofol more fentanyl. Assessed the degree of sedation with the scale of Ramsay and the pain through indirect parameters such as blood pressure and heart rate. Other parameters assessed were the saturation of oxygen. Averages were compared using analysis of variance, was considered to be statistically significant values of p<0.05. Results: The degree of sedation valued by the scale of Ramsay-Hunt , demonstrated statistically significant differences in the 5 minutes, not as well, 15, 30 and 45 minutes. The biggest differences between the two groups are for grade IV sedation was obtained after 5 minutes in 2 patients in group A, unlike the group B, where 18 patients had a higher level of the desired sedation (Ramsay 2 or 3). No significant differences were observed in the values of the arterial blood pressure, heart rate, oxygen saturation and respiratory rate, p-values>0.05 . Conclusions: With the use of midazolam are fewer cases of deep sedation, without which there are significant differences in cardiovascular and respiratory parameters among the groups studied
Variación de la tensión arterial en pacientes hipertensos en anestesia neuroaxial, hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca, 2019
(Universidad de Cuenca, 2021-05-10) Zumba Villavicencio, Sandra Patricia; Palacios Reinoso, Carlos Santiago
Introduction: Hypertensive patients scheduled for surgery are more likely to suffer side effects of spinal anesthesia, especially post-block hypotension, a frequent complication that occurs when performing this procedure, in addition the negative effects of hypotension will occur more easily in this group of chronically ill people. Objective: To determine the variation of blood pressure in hypertensive patients in neuraxial anesthesia, José Carrasco Arteaga and Vicente Corral Moscoso hospitals. Cuenca 2019. Methods and materials: An observational and descriptive study was carried out in 2019. The population included 270 hypertensive patients scheduled for surgery with neuraxial anesthesia; the calculation of the sample was based on the following criteria: 95% confidence level, 20% probability, 5% margin of error. Each one met the inclusion criteria, sociodemographic and clinical variables were analyzed, as a result variable the frequency in percentage of post-block hypotension was observed. The data were analyzed by descriptive statistics, using the mean, standard deviation, range, minimum value, maximum value and percentages. Results: Women represent 51.9%, the mean age was 62.45 years SD ± 14.9. The most widely used antihypertensive treatment ARA 2, the highest percentage variation in blood pressure was evidenced at 5 minutes, with a value of 14.78%, 20% of the patients who had beta-blockers or ARA 2 as antihypertensive treatment presented post-blockade hypotension moderate. Ephedrine was used as a treatment. Conclusions: The frequency of post-block arterial hypotension that occurred was 31.48%.