Consulta de Anestesia

Caja Costarricense del Seguro Social
Hospital San Rafael de Alajuela
Servicio de Anestesiología y Reanimación


Consulta de Anestesia


PROTOCOLO DE PRESENTACIÓN



AUTOR
DR. HERNANDO VANEGAS TOLOZA
MÉDICO Y CIRUJANO
ANESTESIOLOGIA Y REANIMACIÓN




Alajuela, Costa Rica, 2001


CONSULTA DE ANESTESIA

La consulta de anestesia es una consulta externa de la especialidad, la cual completa la estructura óptima de asistencia preoperatoria del paciente quirúrgico en el Hospital. 1

Una de las obligaciones primordiales del anestesiólogo es preparar adecuadamente el paciente para que enfrente el acto anestésico-quirúrgico en mejores condiciones y con mayores probabilidades de éxito, es decir, disminuir la morbimortalidad perioperatorias, determinando los procesos médicos coexistentes con la causa de la cirugía, estableciendo una adecuada relación médico-paciente, y desarrollar una adecuada estrategia o plan anestésico, además de obtener el consentimiento del paciente.

Con la Consulta Anestésica se obtiene una menor estancia hospitalaria, al ser ingresado el paciente programado para cirugía electiva en el momento en que se han completado los estudios que ameriten su caso, así como los que requieran cirugía de urgencia, al ser valorados rápidamente y definidos las pruebas de gabinete adicionales necesarios para solucionar la patología causa de su intervención, al igual que una pronta recuperación posquirúrgica, al disminuir los riesgos de complicaciones perioperatorias que podrían elevar el número de días de hospitalización.

Todo ello implica realizar una evaluación anestésica por medio de una historia clínica completa que haga énfasis en aquellos aspectos realmente importantes desde el punto de vista anestesiológico, como los antecedentes personales (hábitos tóxicos), alérgicos, transfusionales, antecedentes anestésicos y antecedentes patológicos generales -estos últimos nos indicarían si el paciente tiene una enfermedad de base que altere el pronóstico del acto anestésico-quirúrgico – así como la terapéutica recibida. Igualmente, debemos realizar un exhaustivo Exámen Físico integral, sin despreciar ninguna alteración, pero haciendo énfasis en aquellas alteraciones que puedan comprometer una anestesia sin problemas. Punto importante es la realización de los exámenes de laboratorio que se deben realizar teniendo como base la Clasificación del Estado Físico según la ASA, y no olvidando nunca si los exámenes ordenados van o no, y de qué manera, a cambiar la conducta o plan anestésico que se defina para cada caso en particular.

La angustia que padece una persona ante la eventualidad de una operación quirúrgica, es de tal magnitud que altera el normal funcionamiento de su organismo. Está fuera de toda discusión los cambios endocrinos y metabólicos que sufre el paciente ante el temor de la cirugía (tales como desfiguración física, dolor posoperatorio, secuelas, e incluso la muerte) o de la anestesia (pérdida de control de la situación, temor a no despertar, temor a que los “pasen de anestésicos”, náuseas y vómitos, cefalea, parálisis, etc, etc.). La Consulta Anestésica es el espacio ideal para absolver dudas y temores, favorecer la confianza del paciente, y establecer una adecuada relación médico-paciente, para lo cual se debe llevar a cabo:

1. Visita anestésica a pacientes:

• Extrahospitalarios a quienes se les va a practicar cirugías programadas, electivas.
• Hospitalizados de Urgencia, a quienes se les va a practicar cirugías diferidas (lapso de 24-48 horas).
• Los hospitalizados de Emergencia serán valorados por los médicos anestesiólogos del turno correspondiente.

2. Desarrollar una entrevista organizada, sin prisas, transmitiéndole al paciente su interés por él como ser humano y comprendiendo sus temores y preocupaciones, sin burlas ni escarnio. Se definirá el riesgo anestésico-quirúrgico y se informará al paciente, al igual que definir si se realiza la cirugía o ésta se difiere.

3. Indicarle al paciente que permanecerá junta a él en el quirófano. Si será otro anestesiólogo el que administrará la anestesia, se informará de ello al paciente y se le aseverará la idoneidad y capacidad del otro colega.


4. Informarle de los acontecimientos del período perioperatorio, incluyendo:

a. El tiempo de ayuno (no ingerir líquidos o sólidos).
b. El tiempo promedio de duración de la cirugía.
c. Necesidad de administrar premedicación, continuación o suspensión de medicamentos ingeridos crónicamente.
d. Tipo de anestesia: General, balanceada, general IV., o anestesia regional, o troncular.
e. Complicaciones que pudieran presentarse y riesgos anestésicos.
f. Suministrarle la información adicional necesaria para un buen entendimiento de lo comentado anteriormente, mediante boletines, folletos, etc.



Además, la Consulta Anestésica desarrollaría programas de docencia e investigación del Servicio de Anestesia, lo cual permitirá el conocimiento ya sobre bases estadísticas de las diferentes patologías que se atienden normalmente en el Hospital.

En consecuencia, la Consulta Anestésica se realizará en la consulta externa del Hospital por los siguientes motivos:

1. Normalización de la valoración preoperatoria, centralización y sistematización (garantía de realización homogénea a todos los pacientes quirúrgicos que lo precisen).
2. Valoración del paciente en el momento adecuado, disponiendo del tiempo necesario, sin consumir estancias hospitalarias y sin “sacar” al personal de sus labores cotidianas.
3. Garantizar al máximo las partes programadas, ya que permite que se elaboren cuando se ha completado el estudio preoperatorio, y se ha estabilizado aquellos con patologías asociadas descompensadas, antes de la hospitalización. 1

ESTRUCTURA

A. MEDIOS MATERIALES

 Locales situados en el área de consulta externa.
 Recepción y sala de espera de pacientes
 Consultorio con la dotación normal para la exploración física
 Computador (si las condiciones del hospital lo permiten)

B. RECURSOS HUMANOS

B.1. Personal Médico: 1 médico anestesiólogo por consulta, más 1 residente de 2º ó 3er año.
El número de especialistas en ésta área estará en función de:

 Tiempo medio consumido por paciente (15 a 20 minutos por paciente. En todos los protocolos establecen un tiempo promedio de 18 a 19 minutos). 2 El número de pacientes atendidos será equivalente al número de intervenciones programadas.
 Tiempo medio invertido en las visitas a pacientes hospitalizados que no pueden desplazarse a las consultas externas.

B.2. Personal de Enfermería: debe existir una enfermera encargada de
Colaborar en la realización de la historia y exploración del paciente. Puede
ser común con otras especialidades asignadas a dicho consultorio si así se
requiere.
B.3. Administrativo: Puede ser común con otras especialidades.

C. MEDIOS ORGANIZATIVOS

C.1. ORGANIGRAMA FUNCIONAL

























C.2 NORMAS GENERALES DE FUNCIONAMIENTO

La Consulta de Anestesia está integrada orgánica y funcionalmente en el Servicio de Anestesiología y Reanimación, sujeta a la normatividad vigente del mismo. A pesar de ello, sus objetivos y funciones específicas requieren de una normativa de funcionamiento propia, basada en lo siguiente:

1. La Consulta de Anestesia estará a cargo de un Anestesiólogo responsable. Puede ser desempañado por un médico anestesiólogo nombrado para tal efecto, o puede ser rotatorio entre los médicos anestesiólogos del Servicio de Anestesiología, designados por el Jefe del Servicio de Anestesiología y Reanimación, teniendo en cuenta las calidades y cualidades y preferencias de todos los miembros del Servicio y de acuerdo con ellos.
2. Serán responsabilidades del Anestesiólogo designado a la Consulta de Anestesia:
A. Valorar el riesgo del paciente y su orientación anestésica, respetando siempre la libertad y preferencias del Anestesiólogo que administrará la anestesia. (Optimización asistencial)
B. Informar al paciente y familiares del proceso asistencial (Humanización).
C. Obtener el consentimiento informado para el acto antestésico-quirúrgico.
D. Será el encargado de la docencia y la investigación a desarrollar por el Servicio de Anestesia en el campo de la valoración preanestésica.
E. Cumplir con el horario laboral asignado para el efecto por la Jefatura del Servicio de Consulta Externa Vs Anestesia
F. Seguir las pautas establecidas aplicándolas según cada caso concreto.

3. El funcionamiento para la Consulta Anestésica seguirá los
siguientes pasos para la valoración de los pacientes, de acuerdo con los lineamientos establecidos para tal efecto por la normativa del Hospital:

3.1. Pacientes Ambulatorios (Cirugía Programada):

 Consulta de Cirugía: Historia y valoración del paciente.
 Servicio de Admisión de pacientes: Cálculo de la fecha aproximada de intervención según listas de espera. Cita a la consulta anestésica con suficiente tiempo para su estudio y en caso de ser rechazado o diferido, no se vea afectada la programación quirúrgica (15 a 20 días).
 Consulta de Anestesia: Historia y petición de exámenes, pruebas e interconsultas adicionales, en caso de ser necesario.
Conclusiones. Información del riesgo y firma del consentimiento. Información al Servicio de Admisión que se ha completado el proceso.
 Servicio de Admisión: Da la fecha y la hora de ingreso al paciente (Cita para hospitalización). Informa del dato al Servicio de Cirugía y al Servicio de Anestesiología y Reanimación (para programación de las visitas preoperatorias).

3.2. Pacientes ingresados de Urgencia:

 Servicio de Cirugía: Historia y petición de consulta de anestesia de urgencia, con la fecha de intervención prevista.
 Consulta de Anestesia: Desplaza al paciente o se desplaza a la sala de hospitalización con tiempo suficiente. Realiza la Historia y pide los exámenes, pruebas e interconsultas necesarias urgentes. Conclusiones. Información del riesgo y obtención de la firma del consentimiento. Informe inmediato al Servicio de Cirugía.



C.4 DOCUMENTOS

La Historia Clínica es el documento fundamental y se adicionará la
Historia Preoperatoria de Anestesia (Se adjunta una propuesta
sujeta a Revisión). De igual manera se adjuntará la Hoja de
Aceptación de la anestesia).
Se informará al paciente acerca de la anestesia y demás tópicos
relacionados con el acto anestésicos además de la información
verbal brindada en la Consulta Anestésica, con folletos ilustrativos
diseñados especialmente para tal efecto.



BIBLIOGRAFIA

1. Consulta de Anestesia. Protocolo del Hospital Arnau de Vilanova. Valencia, España.
2. Ibarra P. Valoración preoperatoria. Clínica Reina Sofía. Bogotá, Colombia. (Comunicación personal). 2001
3. Zamora R. y col. Evaluación preanestésica en pacientes programados para cirugía laparoscópica. Anestesiología Mexicana en Internet.






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The general complexities of women's and men's style

Both women and men may feel the difficulties of maintaining their wardrobe up-to-date and in time, yet men's fashion often seems a lot easier. Of course, for both sexes, outfits and fashion options can be just as complicated, and there are several'cool'items that could easily become fashion faux pas - who is able to say they often times see people walking on in 70s flames? On the other hand, men's fashion has a few choice goods that can exist eternally - which man is planning to watch out of place with a good-quality, tailored suit, for example? Choose traditional cuts, colours and fabrics and you'll never seem out-of-place.

Why classic men's style is eternal

The traditional man's suit has scarcely changed for over a hundred years. True, there are several varieties for various occasions, but they are all common in their quest for a clever, sharp search for the wearer. The good thing about basic style for men is that it is simply stylish effortlessly neat. A well-groomed man can more often than not look his sharpest in a well-tailored suit, and it is a testament to the style of such apparel. A suit will undoubtedly be worn to work in many jobs due to the professional look it provides to the person, instilling a feeling of respect and trust. Equally a suit will undoubtedly be worn to several social occasions, such as a tuxedo to a black-tie affair. This incredible versatility that allows suits to be utilized in just about all occasions is what gives it its amazing edge and a permanent devote men's fashion.

Contemporary movements in traditional men's style

Though basic men's styles can never be changed, it's interesting to observe that shifts in men's fashion trends have produced certain basic garments back in fashion. The popularity of vintage clothing, specifically, has taken back a wide-variety of classic styles into men's wardrobes, such as that of the dandy gentleman. 'Dandy'is a term used to refer to men who clothe themselves in a classic yet extravagant way, working in a sophisticated manner and placing value on appearance. This development for almost'over-the-top'classic fashion for men is apparent from events like the'Tweed Run', wherever men and girls of all ages dress in significantly Victorian-style clothing and decide to try the roads on vintage bicycles - with most of the men wearing impressive mustaches! This really is only one of several samples of evidence presenting the resurrection of such types. Additionally, there are numerous sites on the web which concentrate on gentlemanly type - such as'The Dandy Project'and'Dandyism'- as well as complete websites such as'The Art of Manliness'focused on giving articles on traditional men's fashion and grooming.

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