Proyecto académico sin fines de lucro, desarrollado bajo la iniciativa de acceso abierto r e v c ... more Proyecto académico sin fines de lucro, desarrollado bajo la iniciativa de acceso abierto r e v c o l o m b a n e s t e s i o l. 2 0 1 5;4 3(2):142-146
Background: Cancer patients' end-of-life care may involve complex decision-making processes. Colo... more Background: Cancer patients' end-of-life care may involve complex decision-making processes. Colombia has legislation regarding provision of and access to palliative care and is the only Latin American country with regulation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods: Cancer patients who were at the end-of-life and attended in participating hospitals were identified. When these patients deceased, their attending physician was invited to participate. Attending physicians of 261 cancer patients (out of 348 identified) accepted the invitation and answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the first two decision types, we asked if the decision was fully or partially made with the intention or consideration that it may hasten the patient's death. Results: Decisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids. Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was fulfilled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n = 114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n = 38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied. Conclusions: Decisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance
Introducción. Existen diversos dispositivos para el manejo de la vía aérea, entre los cuales se d... more Introducción. Existen diversos dispositivos para el manejo de la vía aérea, entre los cuales se destaca el fibroscopio retromolar de Bonfils. Se ha demostrado su efectividad y fácil manejo, además del hecho de ser atraumático y útil en pacientes en los cuales la laringoscopia directa es fallida, en pacientes con trauma cervical, o con limitación de la apertura oral, así como en casos de intubación con paciente despierto. Metodología. En este reporte de casos, se describe la técnica de intubación naso traqueal guiada por Bonfils por vía oral, realizada exitosamente en 19 pacientes. Conclusiones. La experiencia adquirida con este dispositivo con más de 300 intubaciones realizadas por vía oral, hace pensar que el fibroscopio retromolar de Bonfils es ideal y superior al laringoscopio convencional en el manejo rutinario de la vía aérea.
Introduction: There is contradictory evidence regarding blood-loss and its aetiology in prostate ... more Introduction: There is contradictory evidence regarding blood-loss and its aetiology in prostate surgery. Objectives: Documenting whether changes in coagulation are associated with prostatectomy by ordinary laboratory tests and comparing them to those obtained in thromboelastography (TEG). Methods: A pilot prospective observational study was thus conducted. 27 patients were included form whom blood samples were taken at three different times (before surgery, 1 hour and 2 hours after surgery). Results: Baseline coagulation profile was normal, but there was a statistically significant rise in D-dimer in the next samples. Ly 30 rose during times 1 and 2, but such rise in absolute numbers was still within normal ranges. No correlation was found between traditional coagulation tests and thromboelastography except for pt and R values; however, although correlation was statistically significant, there was not enough power to affirm that these values were clearly correlated.
Introduction: There is contradictory evidence regarding blood-loss and its aetiology in prostate ... more Introduction: There is contradictory evidence regarding blood-loss and its aetiology in prostate surgery. Objectives: Documenting whether changes in coagulation are associated with prostatectomy by ordinary laboratory tests and comparing them to those obtained in thromboelastography (TEG). Methods: A pilot prospective observational study was thus conducted. 27 patients were included form whom blood samples were taken at three different times (before surgery, 1 hour and 2 hours after surgery). Results: Baseline coagulation profile was normal, but there was a statistically significant rise in D-dimer in the next samples. Ly 30 rose during times 1 and 2, but such rise in absolute numbers was still within normal ranges. No correlation was found between traditional coagulation tests and thromboelastography except for pt and R values; however, although correlation was statistically significant, there was not enough power to affirm that these values were clearly correlated.
Introduction: Obesity has increased in the past few years, more so for the morbidly obese; in who... more Introduction: Obesity has increased in the past few years, more so for the morbidly obese; in whom comorbilities that complicate the perioperative anaesthetic and airway management have been identified. The pre-anaesthetic assessment of the patient includes parameters of physical examination and medical history that predict difficulties when intubating or failure to do so. In such cases, the Bonfils retromolar fibroscope has proven to be a useful tool. Goal: To observe and identify predicting evidence of a difficult airway through physical examination; to revise the incidence of difficult intubation and the use of tools for airway management of obese patients. Methods: This is a descriptive observational study carried out on 352 obese patients who underwent bariatric surgery at Hospital Universitario San Ignacio, Bogotá. On these patients we assessed the following parameters: body mass index (BMI), oral opening, mallampati score, distance between thyroid and chin, neck circumference, use of laryngoscope or Bonfils retromolar fibroscope and the difficulties encountered for both. Conclusions: Intubation with the Bonfils retromolar fibroscope proves successfull in 100% of observed cases of obese patients, and intubation difficulty does not correlate with the parameters considered in our assessment.
Introducción. Existen diversos dispositivos para el manejo de la vía aérea, entre los cuales se d... more Introducción. Existen diversos dispositivos para el manejo de la vía aérea, entre los cuales se destaca el fibroscopio retromolar de Bonfils. Se ha demostrado su efectividad y fácil manejo, además del hecho de ser atraumático y útil en pacientes en los cuales la laringoscopia directa es fallida, en pacientes con trauma cervical, o con limitación de la apertura oral, así como en casos de intubación con paciente despierto. Metodología. En este reporte de casos, se describe la técnica de intubación naso traqueal guiada por Bonfils por vía oral, realizada exitosamente en 19 pacientes. Conclusiones. La experiencia adquirida con este dispositivo con más de 300 intubaciones realizadas por vía oral, hace pensar que el fibroscopio retromolar de Bonfils es ideal y superior al laringoscopio convencional en el manejo rutinario de la vía aérea.
Métodos. Se diseño un estudio prospectivo observacional en el cual se recolectó información de 55... more Métodos. Se diseño un estudio prospectivo observacional en el cual se recolectó información de 550 pacientes, 200 procedimientos de anestesia general, 200 de anestesia regional central o del neuroeje, 100 procedimientos de anestesia regional periférica y 50 procedimientos de anestesia combinada (general más regional del neuroeje). Para la medición de la satisfacción se diseñó una encuesta que fue diligenciada por personal ajeno al estudio y al procedimiento anestésico, en
This reflective article presents the current state of cardiopulmonary resuscitation (CPR) and rev... more This reflective article presents the current state of cardiopulmonary resuscitation (CPR) and reviews it from a bioethical standpoint. It starts with the ineffectiveness of CPR and the reasons why today it is a universally applied procedure, sometimes without taking into consideration the wishes or condition of the patient. Possible courses of action for the continuous improvement of cardiopulmonary resuscitation are proposed, especially from the humanistic point of view. Greater involvement of patients and their families in medical decisions, particularly in the planning of medical management rather than in the acute phase of the disease-as is the case for CPR-is encouraged.
Background: Cancer patients' end-of-life care may involve complex decision-making processes. Colo... more Background: Cancer patients' end-of-life care may involve complex decision-making processes. Colombia has regulations regarding palliative care and is the only Latin American country with legislation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods: Attending physicians of 261 cancer patients in participating hospitals answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the rst two decision types, we asked if the decision was (partially) made with the intention or consideration that it may hasten the patient's death. Results: Decisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids. Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was ful lled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n=114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n=38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied. Conclusions: Decisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance care directives and potentially life-shortening effects of treatment decisions. Speci c end-of-life procedures, patients' wishes and availability of palliative care should be further investigated.
Proyecto académico sin fines de lucro, desarrollado bajo la iniciativa de acceso abierto r e v c ... more Proyecto académico sin fines de lucro, desarrollado bajo la iniciativa de acceso abierto r e v c o l o m b a n e s t e s i o l. 2 0 1 5;4 3(2):142-146
Background: Cancer patients' end-of-life care may involve complex decision-making processes. Colo... more Background: Cancer patients' end-of-life care may involve complex decision-making processes. Colombia has legislation regarding provision of and access to palliative care and is the only Latin American country with regulation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods: Cancer patients who were at the end-of-life and attended in participating hospitals were identified. When these patients deceased, their attending physician was invited to participate. Attending physicians of 261 cancer patients (out of 348 identified) accepted the invitation and answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the first two decision types, we asked if the decision was fully or partially made with the intention or consideration that it may hasten the patient's death. Results: Decisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids. Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was fulfilled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n = 114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n = 38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied. Conclusions: Decisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance
Introducción. Existen diversos dispositivos para el manejo de la vía aérea, entre los cuales se d... more Introducción. Existen diversos dispositivos para el manejo de la vía aérea, entre los cuales se destaca el fibroscopio retromolar de Bonfils. Se ha demostrado su efectividad y fácil manejo, además del hecho de ser atraumático y útil en pacientes en los cuales la laringoscopia directa es fallida, en pacientes con trauma cervical, o con limitación de la apertura oral, así como en casos de intubación con paciente despierto. Metodología. En este reporte de casos, se describe la técnica de intubación naso traqueal guiada por Bonfils por vía oral, realizada exitosamente en 19 pacientes. Conclusiones. La experiencia adquirida con este dispositivo con más de 300 intubaciones realizadas por vía oral, hace pensar que el fibroscopio retromolar de Bonfils es ideal y superior al laringoscopio convencional en el manejo rutinario de la vía aérea.
Introduction: There is contradictory evidence regarding blood-loss and its aetiology in prostate ... more Introduction: There is contradictory evidence regarding blood-loss and its aetiology in prostate surgery. Objectives: Documenting whether changes in coagulation are associated with prostatectomy by ordinary laboratory tests and comparing them to those obtained in thromboelastography (TEG). Methods: A pilot prospective observational study was thus conducted. 27 patients were included form whom blood samples were taken at three different times (before surgery, 1 hour and 2 hours after surgery). Results: Baseline coagulation profile was normal, but there was a statistically significant rise in D-dimer in the next samples. Ly 30 rose during times 1 and 2, but such rise in absolute numbers was still within normal ranges. No correlation was found between traditional coagulation tests and thromboelastography except for pt and R values; however, although correlation was statistically significant, there was not enough power to affirm that these values were clearly correlated.
Introduction: There is contradictory evidence regarding blood-loss and its aetiology in prostate ... more Introduction: There is contradictory evidence regarding blood-loss and its aetiology in prostate surgery. Objectives: Documenting whether changes in coagulation are associated with prostatectomy by ordinary laboratory tests and comparing them to those obtained in thromboelastography (TEG). Methods: A pilot prospective observational study was thus conducted. 27 patients were included form whom blood samples were taken at three different times (before surgery, 1 hour and 2 hours after surgery). Results: Baseline coagulation profile was normal, but there was a statistically significant rise in D-dimer in the next samples. Ly 30 rose during times 1 and 2, but such rise in absolute numbers was still within normal ranges. No correlation was found between traditional coagulation tests and thromboelastography except for pt and R values; however, although correlation was statistically significant, there was not enough power to affirm that these values were clearly correlated.
Introduction: Obesity has increased in the past few years, more so for the morbidly obese; in who... more Introduction: Obesity has increased in the past few years, more so for the morbidly obese; in whom comorbilities that complicate the perioperative anaesthetic and airway management have been identified. The pre-anaesthetic assessment of the patient includes parameters of physical examination and medical history that predict difficulties when intubating or failure to do so. In such cases, the Bonfils retromolar fibroscope has proven to be a useful tool. Goal: To observe and identify predicting evidence of a difficult airway through physical examination; to revise the incidence of difficult intubation and the use of tools for airway management of obese patients. Methods: This is a descriptive observational study carried out on 352 obese patients who underwent bariatric surgery at Hospital Universitario San Ignacio, Bogotá. On these patients we assessed the following parameters: body mass index (BMI), oral opening, mallampati score, distance between thyroid and chin, neck circumference, use of laryngoscope or Bonfils retromolar fibroscope and the difficulties encountered for both. Conclusions: Intubation with the Bonfils retromolar fibroscope proves successfull in 100% of observed cases of obese patients, and intubation difficulty does not correlate with the parameters considered in our assessment.
Introducción. Existen diversos dispositivos para el manejo de la vía aérea, entre los cuales se d... more Introducción. Existen diversos dispositivos para el manejo de la vía aérea, entre los cuales se destaca el fibroscopio retromolar de Bonfils. Se ha demostrado su efectividad y fácil manejo, además del hecho de ser atraumático y útil en pacientes en los cuales la laringoscopia directa es fallida, en pacientes con trauma cervical, o con limitación de la apertura oral, así como en casos de intubación con paciente despierto. Metodología. En este reporte de casos, se describe la técnica de intubación naso traqueal guiada por Bonfils por vía oral, realizada exitosamente en 19 pacientes. Conclusiones. La experiencia adquirida con este dispositivo con más de 300 intubaciones realizadas por vía oral, hace pensar que el fibroscopio retromolar de Bonfils es ideal y superior al laringoscopio convencional en el manejo rutinario de la vía aérea.
Métodos. Se diseño un estudio prospectivo observacional en el cual se recolectó información de 55... more Métodos. Se diseño un estudio prospectivo observacional en el cual se recolectó información de 550 pacientes, 200 procedimientos de anestesia general, 200 de anestesia regional central o del neuroeje, 100 procedimientos de anestesia regional periférica y 50 procedimientos de anestesia combinada (general más regional del neuroeje). Para la medición de la satisfacción se diseñó una encuesta que fue diligenciada por personal ajeno al estudio y al procedimiento anestésico, en
This reflective article presents the current state of cardiopulmonary resuscitation (CPR) and rev... more This reflective article presents the current state of cardiopulmonary resuscitation (CPR) and reviews it from a bioethical standpoint. It starts with the ineffectiveness of CPR and the reasons why today it is a universally applied procedure, sometimes without taking into consideration the wishes or condition of the patient. Possible courses of action for the continuous improvement of cardiopulmonary resuscitation are proposed, especially from the humanistic point of view. Greater involvement of patients and their families in medical decisions, particularly in the planning of medical management rather than in the acute phase of the disease-as is the case for CPR-is encouraged.
Background: Cancer patients' end-of-life care may involve complex decision-making processes. Colo... more Background: Cancer patients' end-of-life care may involve complex decision-making processes. Colombia has regulations regarding palliative care and is the only Latin American country with legislation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods: Attending physicians of 261 cancer patients in participating hospitals answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the rst two decision types, we asked if the decision was (partially) made with the intention or consideration that it may hasten the patient's death. Results: Decisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids. Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was ful lled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n=114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n=38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied. Conclusions: Decisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance care directives and potentially life-shortening effects of treatment decisions. Speci c end-of-life procedures, patients' wishes and availability of palliative care should be further investigated.
Uploads
Papers by Fritz Gempeler