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dc.contributor.advisorPaternina, Oscar de Jesús
dc.contributor.authorGomez, Carlos Andrés
dc.contributor.authorPaternina, Oscar de Jesús
dc.contributor.otherDelgado, Jose
dc.coverage.spatialHospital Universitario Clínica San Rafaelspa
dc.coverage.temporal01/11/2020 al 30/11/2020spa
dc.date.accessioned2021-01-18T16:37:06Z
dc.date.available2021-01-18T16:37:06Z
dc.date.issued2020-12-09
dc.identifier.urihttp://hdl.handle.net/10654/37385
dc.description.abstractIntroducción. El índice biespectral (BIS) se usa ampliamente durante el mantenimiento anestésico de los pacientes sometidos a anestesia general. Estudios previos sugieren que el uso del BIS durante la inducción anestésica disminuye el requerimiento de fármacos hipnóticos y la aparición de inestabilidad hemodinámica. En nuestro medio no es común el uso del BIS durante la inducción anestésica.Objetivo. Comparar el desarrollo de inestabilidad hemodinámica durante la inducción anestésica guiada por BIS y guiada por parámetros clínicos en pacientes sometidos a cirugía cardiovascular en el Hospital Universitario Clínica san Rafael durante el año 2019.Metodología. En una institución universitaria, se revisaron historias clínicas de pacientes ASA 3 y 4, sometidos a cirugía cardiovascular durante el año 2019, se definieron 2 grupos de pacientes de forma no aleatoria; grupo 1 conformado con los pacientes que recibieron inducción con BIS, y grupo 2 constituido por los pacientes sometidos a inducción guía por parámetros clínicos.Resultados, Se encontró que el 23,07% de los pacientes en el grupo sin BIS y el 7,01% de los pacientes en el grupo con BIS desarrollaron hipotensión al momento de la inducción, el 46,15% en el grupo sin BIS presentaron hipotensión a los 5 minutos de la inducción, mientras 22,8% la presentaron en el grupo con BIS. El uso del BIS se asoció con una reducción en la dosis de propofol usado durante la inducción y a un menor requerimiento de fenilefrina. Estas diferencias fueron estadísticamente significativas (p<0.001).Conclusiones. El uso de monitor BIS durante la inducción conlleva a una menor incidencia de inestabilidad hemodinámica, menores dosis de hipnótico y menor requerimiento de vasoactivos.spa
dc.description.tableofcontentsTabla de Contenido 1. Resumen .................................................................................................................................... 1 2. Introducción ................................................................................................................................... 3 3. Justificación ................................................................................................................................... 4 4. Estado del arte ............................................................................................................................. 5 5. Marco Teórico ............................................................................................................................... 6 7. Hipótesis ...................................................................................................................................... 11 8. Metodología ................................................................................................................................ 12 8.1 Tipo de estudio ................................................................................................................. 13 8.2 Definición de la Población .............................................................................................. 14 8.3 Criterios de elegibilidad ................................................................................................... 14 8.4 Tipo de muestreo ............................................................................................................. 14 8.5 Cálculo del tamaño de la muestra ................................................................................. 15 8.7 Definición de inestabilidad hemodinámica ................................................................... 21 8. 8 Análisis estadístico ......................................................................................................... 21 8.9 Definición de los sesgos y control ................................................................................. 23 9. Consideraciones éticas, disposiciones legales vigentes y propiedad intelectual ............ 24 10. Resultados/Productos esperados y potenciales beneficiarios: ........................................ 26 11. Resultados, discusión y conclusiones .................................................................................. 26 11. 1 Resultados ..................................................................................................................... 26 11. 2 Discusión ....................................................................................................................... 35 12.3. Fortalezas y limitaciones ............................................................................................. 41 12.4 Conclusiones .................................................................................................................. 42 Anexos ............................................................................................................................................. 43 Bibliografía. ...................................................................................................................................... 44spa
dc.format.mimetypeapplicaction/pdfspa
dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.titleComparación en el desarrollo de inestabilidad hemodinámica durante la inducción anestésica guiada por BIS y guiada por parámetros clínicos en pacientes sometidos a cirugía cardiovascular en el Hospital Universitario Clínica san Rafael-año 2019spa
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.type.localTesis/Trabajo de grado - Monografía - Especializaciónspa
dc.description.abstractenglishIntroduction. The bispectral index (BIS) is widely used during anesthetic maintenance of patients undergoing general anesthesia. Previous studies suggest that the use of BIS during anesthetic induction decreases the requirement for hypnotic drugs and the appearance of hemodynamic instability. In our setting, the use of BIS during anesthetic induction is not common. Objective. To compare the development of hemodynamic instability during anesthetic induction guided by BIS and guided by clinical parameters in patients undergoing cardiovascular surgery at the Hospital Universitario Clínica San Rafael during 2019. Methodology. In a university institution, the medical records of ASA 3 and 4 patients who underwent cardiovascular surgery during 2019 were reviewed, 2 groups of patients were defined in a non-random way; group 1 made up of patients who received induction with BIS, and group 2 made up of patients subjected to induction guided by clinical parameters Results. It was found that 23.07% of the patients in the group without BIS and 7.01% of the patients in the group with BIS developed hypotension at the time of induction, 46.15% in the group without BIS presented hypotension 5 minutes after induction, while 22.8% presented it in the group with BIS. The use of BIS was associated with a reduction in the dose of propofol used during induction and a lower requirement for phenylephrine. These differences were statistically significant (p <0.001). Conclusions. The use of a BIS monitor during induction leads to a lower incidence of hemodynamic instability, lower doses of hypnotics and a lower requirement for vasoactive agents.spa
dc.title.translatedComparison in the development of hemodynamic instability during anesthetic induction guided by BIS and guided by clinical parameters in patients undergoing cardiovascular surgery at the Hospital Universitario Clínica San Rafael-year 2019spa
dc.subject.keywordsBISspa
dc.subject.keywordsAnesthetic inductionspa
dc.subject.keywordsHemodynamic instabilityspa
dc.subject.keywordsHypnoticsspa
dc.publisher.programAnestesiologíaspa
dc.creator.degreenameEspecialista en Anestesiologíaspa
dc.subject.decsANESTESIOLOGIAspa
dc.subject.decsHEMODINAMICAspa
dc.subject.decsSistema cardiovascularspa
dc.subject.decsMonitoreo hemodinámicospa
dc.description.degreelevelEspecializaciónspa
dc.publisher.facultyFacultad de Medicinaspa
dc.type.driverinfo:eu-repo/semantics/bachelorThesisspa
dc.rights.creativecommonsAttribution-NonCommercial-NoDerivatives 4.0 Internationalspa
dc.relation.references1. Arya S, Asthana V. Clinical vs . bispectral index ‑ guided propofol induction of anesthesia : A comparative study. Saudi Journal of Anaesthesia. 2013;7(1):75–9. 2. Mi W. Haemodynamic and electroencephalograph. Canadian Journal Anaesthesia. 1998;45(1):19–22. 3. Luginbuhl M, Wuthrich S. Different benefit of bispectal index (BIS). Anaesthesioly Act of Scandinavian. 2003;47:165–73. 4. Martin I. Modelling propofol pharmacodynamics using BIS-guided anaesthesia. Anaesthesia. 2013;68(11):1132–40. 5. Hudetz AG. General Anesthesia and Human Brain Connectivity. 2012;2(6). 6. Therapy I, Szpital W. Abnormally low bispectral index and isoelectric electroencephalogram observed after administration of small doses of propofol during induction of anesthesia. Journal Anesthesiology. 2005;19(4):339–42. 7. Reich DL, Hossain S, Krol M, Bernstein A, Bodian CA. Predictors of Hypotension After Induction of General Anesthesia. Anesthesiology y Analgesia. 2005;101(3):622–8. 8. Ramirez Hernandez JM. Bispectral monitoring in the intensive care unit: clinical application and current evidence. Journal of the Mexican Association of Chronic Medicine and Intensive Therapy . 2004;18(6):192–8. 9. Guy L L. Relation between Brain Concentrations, Electroencephalogram, Middle Cerebral Artery Blood Flow Velocity, and Cerebral Oxygen Extraction during Induction of Anesthesia. Anesthesiology. 2002;97(6):1363–70. 10. Ebert TJ. sympathetic responses to induction of anesthesia in humans with propofol or etomidate. Anesthesiology. 1992;5(76):725–33. 11. Bailey PL, D M. Pharmacodynamics and Pharmacokinetics of Propofol in a Medium-Chain Triglyceride Emulsion. Anesthesiology. 2002;97(6):1401–8. 12. Rieke H. Effects of propofol on cardiovascular dynamics and coronary blood flow in geriatric patients. 1988;43:25–31. 13. Bruhn J, Myles PS, Sneyd R, Struys MMRF. Depth of anaesthesia monitoring : what is available , what is validated and what is next ? 2006;97(1):85–94. 14. Gu E, Tomatir E, Dogan H. Assessing Propofol Induction of Anesthesia Dose Using. 2004;128–31. 15. Tardio flores RA. Usefulness of the Bispectral Index in the Monitoring of Consciousness During General Anesthesia. 2010;13(2):69–72. 16. Liu N, Lory C, Assenzo V, Cocard V, Chazot T, Guen M Le, et al. Feasibility of closed-loop co-administration of propofol and remifentanil guided by the bispectral index in obese patients : a prospective cohort comparison 2014;1–10. 17. Rosow C, Manberg PJ. Bispectral index monitoring. North American Anesthesiology Clinics. 2001;19(4):947–66. 18. Adachi YU, Watanabe K, Satoh T, Higuchi H. The Determinants of Propofol Induction of Anesthesia Dose. Korean Journal Anesthesiology. 2001;65(2):656–61. 19. Takamatsu I, Ozaki M, Kazama T. Entropy indices vs the bispectral index TM for estimating nociception during sevoflurane anaesthesia. Br J Anaesth [Internet]. 2006;96(5):620–6. 20. Wil W, Bu H, Bied A, Alt S, Lar R, Kreu S. A gender flow in suggested consumption and awakening times with an approach that is constantly presented to you. 2005;(April):567–74. 21. Kamenik M, Mo A. Bispectral index-guided induction of general anaesthesia in patients undergoing major abdominal surgery using propofol or etomidate : a double-blind , randomized , clinical trial. british journal of anesthesia 2013;110(3):388–96. 22. Dahaba AA, Mattweber M, Fuchs A. The Effect of Different Stages of Neuromuscular Block on the Bispectral Index and the Bispectral Index-XP Under Remifentanil/Propofol Anesthesia. Anesthesiology Analgesia. 2004;7(5):781–7. 23. Barbato M, Barclay G, Potter J, Yeo W, Chung J. Correlation between observational scales of sedation and comfort and Bispectral Index scores (BIS). Journal Pain Symptom Manage 2017. 24. Johansen JW, Sebel PS. The Influence of Gender on Loss of Consciousness with Sevoflurane or Propofol. 2005;(10). 25. White PF. Intravenous ( non-opioid ) anesthesia. Anesthesiology, perioperatory and pain medicine Seminar. 2005;24(2):101–7. 26. Manzini JL. Statement of Helsinki: Ethical Principles for Medical Research on Human Subjects. Bioethics Act 2000;6(2):321–34.27. National Commission for the protection of human subjects of biomedical and behavioral research. Belmont Report Ethical Principles and Guidelines for the Protection of Human Research Subjects Natl Institutes Heal [Internet]. 2003;12. Available from: https://www.etsu.edu/irb/Belmont Report in Spanish.pdf 28. Republic of Colombia. National statute for the protection of animals Law 84 of 1989. Congress of Colombia [Internet]. 1989;5:14. 29. Statutory LAW, Regulated P, Constitutional C, C- S, Congress E. Statutory Law 1266 of 2008. Department of Public Function Administration.. :1–9. 30. Republic of Colombia. Statutory Law 1581 of 2012. National Congress :51–68. 31. Republic of Colombia. Article 15. Colombian Political Constitution. 1991;1. 32. Republic of Colombia. Article 20. Colombian Political Constitution.. 1991;1. 33. Department of International Law of the Secretariat for Legal Affairs. Preliminary principles and recommendations on data protection. Cons Perm la Organ los estados Am. 2011;33. 34. Organization for Economic Cooperation and Development. Principles of corporate governance of the OCDE y del G20. Editions OCDE, Paris. 2016. 64 p. 35. Singh H, Sakai T, Matsuki A. Movement response to skin incision: Analgesia vs. bispectral index and 95% spectral edge frequency. European journal Anaesthesiol. 1999;16(9):610–4. 36. Frakes MA. Rapid Sequence Induction Medications: An Update. 2003;(December):533–40.spa
dc.subject.proposalBISspa
dc.subject.proposalInducción anestésicaspa
dc.subject.proposalInestabilidad hemodinámicaspa
dc.subject.proposalHipnóticosspa
dc.publisher.grantorUniversidad Militar Nueva Granadaspa
dc.type.coarhttp://purl.org/coar/resource_type/c_7a1f*
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersionspa
dc.identifier.instnameinstname:Universidad Militar Nueva Granadaspa
dc.identifier.reponamereponame:Repositorio Institucional Universidad Militar Nueva Granadaspa
dc.identifier.repourlrepourl:https://repository.unimilitar.edu.cospa
dc.rights.localAcceso abiertospa
dc.coverage.sedeMedicinaspa
dc.rights.coarhttp://purl.org/coar/access_right/c_abf2


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