Objetivo: Este estudio tiene como objetivo el identificar las fuentes de estrés y observar la evolución de la intensidad con que afectan a los alumnos de enfermería a lo largo de los tres años de carrera. Material y método: Estudio observacional, longitudinal y de carácter prospectivo de una cohorte de alumnos de enfermería a los que se investigó para observar y medir los factores causantes de estrés (estresores) que se generaron durante sus prácticas clínicas, y la evolución de los mismos a lo largo de sus tres años de carrera. Se utilizó el cuestionario KEZKAK, cuestionario bilingüe de estresores de los estudiantes de enfermería en las prácticas clínicas. Se trata de un cuestionario validado para medir específicamente los estresores que aparecen en los estudiantes de enfermería durante su formación práctica. Resultados y discusión: La incidencia de mayor a menor preocupación de los alumnos en sus prácticas clínicas en relación con los 9 factores o subescalas como fuentes generadoras de estrés fue: F1-falta de competencia, F4-impotencia e incertidumbre, F2-contacto con el sufrimiento, F5-no controlar la relación con el enfermo, F7-dañarse en la relación con el enfermo, F9-sobrecarga, F3-relación con tutores y compañeros. Así mismo, la evolución de la intensidad en la afectación, en términos generales, aumentó desde primero a tercero debido a la distribución de los rotatorios de prácticas ya que, los servicios especiales se concentraron durante el último curso académico. Conclusión: Las principales fuentes de estrés que afectan a los alumnos de nuestra escuela coinciden en cuanto a intensidad y prioridad con los estudios precedentes usados como referencia. Sin embargo, en general, difieren de los mismos, en cuanto a que van aumentando en intensidad al transcurrir cada curso como consecuencia de la distribución de los rotatorios de prácticas a lo largo de los tres años de carrera, ya que los rotatorios por los servicios que podían generar más tensiones en los alumnos (oncología, urgencias, coronarias, UCI, psiquiatría) se realizan en el último año; cosa que no ocurre en los estudios con los que se comparan nuestros resultados.

Objectives. To determine the pericapsular nerve group (PENG) block’s postoperative analgesic efficacy and safety compared to the suprainguinal fascia iliaca (SFI) block in patients undergoing primary hip arthroplasty using the same injectate volume. Material and Methods. Between January 2021 and March 2022, American Society of Anesthesiologists Physical Status (ASA-PS) classification I–III patients scheduled for hip arthroplasty were included in this study. After standard monitoring and subarachnoid anesthesia, an ultrasound-guided PENG or SFI block with 20 ml of 0.25% levobupivacaine was performed for postoperative analgesia. All patients were assessed with a numerical rating scale (NRS) at presurgery, upon arrival at the postanesthesia care unit (PACU), and in the postoperative period at 2, 4, 12, and 24 hours. The need for analgesic rescue and adverse effects was also assessed. Results. A total of 130 patients were included in the study (62 PENG block and 68 SFI block). Both blocks were equally effective in managing postoperative pain without any statistically significant differences except at 12 h ( ), where the deviation found was not clinically relevant. The median total morphine consumption was 0 mg [0–2] in the PENG block group and 0 mg [0–2] in the SFI block group. A more significant motor block was found in the first 6 hours in the SFI block group ( ). There was no significant difference in the ease of performing PENG (79%) or SFI (85%) blocks. No major complications were recorded in both groups, and patient satisfaction was high (83.9% for the PENG block group vs. 91.2% for the SFI block group). Discussion. Both blocks have been demonstrated to be effective for postoperative analgesia in hip arthroplasty and should be integrated as a multimodal analgesic strategy. The lesser degree of motor block recorded in the first hours with the PENG block makes it the most suitable option for early recovery. Both techniques were easy and safe to perform.

(1) Introduction: The aim was to describe the anesthetic and surgical technique of eversion carotid endarterectomy performed under intermediate-deep cervical block with sedation, and to analyze the intraoperative and postoperative results. (2) Material and Methods: Thirty cases of unilateral eversion carotid endarterectomy (n = 30), performed between 2019–2020 in a tertiary center under intermediate-deep ultrasound-guided cervical plexus block and sedation, were prospectively observed and analyzed. Hemodynamic (blood pressure, heart rate) and neurological (cerebral oximetry) variables were measured in four intraoperative phases: at the beginning of the operation, prior to carotid clamping, after unclamping and at the end of the operation. We assessed acute postoperative pain in a numerical rating scale at 6, 12 and 24 h, early and 30-day complications, and length of stay. (3) Results: Baseline mean arterial pressure values were 100.4 ± 18 mmHg, pre-clamping 95.8 ± 14 mmHg, post-clamping 94.9 ± 11 mmHg, and at the end of the operation 102.4 ± 16 mmHg. Cerebral oximetry values were 61.7 ± 7/62.7 ± 8, 68.5 ± 9.6/69.1 ± 11.7 and 68.1 ± 10/68.1 ± 10 for the left and right hemispheres at baseline, pre- and post-clamping, respectively. The pain assessment showed a score less than or equal to 3. The incidence of residual nerve block, early complications, and major complications in the first 30 days was 40%, 16.7% and 3.3%, respectively. (4) Conclusions: The combination of intermediate-deep cervical plexus block and low-dose sedation is an effective and safe alternative in awake eversion carotid endarterectomy.

Electrical storm (ES) is a life-threatening clinical condition characterized by recurrent ventricular arrhythmias within a 24 h period, carrying a high mortality rate. Despite conventional therapies, including hemodynamic optimization, antiarrhythmic drugs, implantable cardioverter-defibrillator (ICD) reprogramming, and catheter ablation, a subset of patients develop refractory ventricular arrhythmias. In this setting, cardiac sympathetic neuromodulation can interrupt arrhythmic circuits by reducing efferent sympathetic outflow to the myocardium. Stellate ganglion block (SGB) with local anaesthetic (LA) is a temporary pharmacological blockade used as rescue therapy; in the largest prospective series (the STAR study), 92% of treated patients achieved at least a 50% reduction in arrhythmic events in the 12 h following the procedure. Because the effect of anaesthetic blockade is transient, more durable interventions have been explored, including percutaneous radiofrequency or chemical neurolysis and surgical cardiac sympathetic denervation (CSD), although current evidence is largely confined to small, uncontrolled case series. This narrative review synthesizes the available evidence on cardiac sympathetic neuromodulation—spanning SGB, percutaneous neurolysis, and surgical CSD—in refractory ES, positioning these interventions primarily as a means of stabilizing patients and bridging to definitive therapy rather than as established survival-modifying treatments. Furthermore, this review describes the primary anatomical foundations of the cervicothoracic sympathetic nervous system and the various techniques for SGB, along with their most relevant clinical indications. The risks and complications associated with these interventions are also addressed. Finally, clinical implications and potential future research directions in this field are discussed, with the aim of providing guidance for the comprehensive management of critically ill patients with refractory ES.

Article: Use of endovascular catheters and guidewires for endotracheal tube uniblocker replacement in thoracoabdominal aneurysm open surgical repair - Minerva Anestesiologica 2022 Jan 24 - Minerva Medica - Journals