Social determinants for health and neonatal anesthesia in Colombia

Abstract

The social determinants of health are the social characteristics in which people's lives and work develop, giving them the capacity to act in specific contexts and are responsible for the health conditions of individuals and populations.
 Recent World Bank data show that Colombia has made modest progress in terms of social equity. These data reveal that neonatal mortality in remote areas of the country is similar to that found in Sub-Saharan Africa. In these regions, there is no access to specialized neonatal health services. As for anesthesia services, this age group has the highest mortality and perioperative complication rates related to prematurity, the quality of health services and, especially, the expertise of the anesthesiologist.
 In Colombia, efforts to implement formal university programs for sub-specialization in pediatric anesthesiology have not received governmental support. Meanwhile, the Colombian Society of Anesthesiology, through its Committee of Pediatric Anesthesiology, has created ongoing education opportunities, which, although important, are insufficient to meet the needs of the country.
 For this reason, a State policy is required, aimed at meeting its social debt and that considers the specialized training of human resources as a pillar for the promotion of equity in health, so that the surgical neonate does not have to travel in the procurement of services, but rather have the State bring those services to them.

Cetonemia y glicemia en niños con 3 diferentes líquidos claros una hora antes de cirugía

“…Un estudio que comparó los valores de cuerpos cetónicos y glucosa capilar en niños programados para cirugía en horas de la mañana vs en horas de la tarde, reportó una mayor incidencia de cetonemia en el grupo de cirugía en la tarde, a pesar de que el tiempo de ayuno fue menor, (62,5%; IC 95%: 48,1 -82 en el grupo de la tarde vs 38,5%; IC 95% 26,5 -52,5 en el grupo de la mañana; p = 0,02). Estos resultados estuvieron relacionados con un mejor aporte calórico de la cena recibida en la noche previa a la cirugía en los pacientes programados a primeras horas de la mañana, en comparación con una dieta muy restringida en los pacientes programados por la tarde, quienes además tuvieron mayor actividad física y requerimiento energético y al comportamiento según el ciclo circadiano de los niveles de hormonas contrarreguladoras en la noche [15]. Los resultados de estos estudios concuerdan con nuestros hallazgos, y refuerzan las recomendaciones canadienses, europeas y neo zelandesas de ayuno preoperatorio [5]- [8] a favor de dar líquidos claros 1 h antes de cirugía ambulatoria.…”

“…Las bebidas carbohidratadas estimulan la producción de insulina además de disminuir su resistencia a nivel periférico [21]. Los resultados de los estudios que evalúan la glicemia y el tiempo de ayuno preoperatorio en niños son contradictorios [4], [15], [22], [23]. Acorde a nuestros resultados, no existe diferencia significativa en los valores de glucosa capilar tras ofrecer algún tipo de líquido claro 1 h antes de cirugía ambulatoria (x: 79,8 mg/dL, IC95% 77,7-81,9) comparado con no ingerir ningún líquido (x: 80,1 mg/dL, IC95% 76,2-83,9), p: 0,89.…”

“…Este equipo cumple con los requisitos de precisión de la norma internacional ISO 15197:2013 y tiene aprobación de la Agencia de Administración de Medicamentos y Alimentos de Estados Unidos [13]. Dicho instrumento ha sido usado y aprobado para mediciones similares en otros estudios de investigación [11], [14], [15]. En la presente investigación y de acuerdo con reportes de otros estudios en niños un valor mayor de 0,5 mmol/L en los niveles de cuerpos cetónicos se definió como anormal [2], [11], [13].…”

Predictors of postoperative mortality among neonates after major-risk surgery: A one-year experience from a Tunisian hospital

“…However, like many LMICs, we also face a shortage of pediatric anesthesiologists and surgeons with the requisite skills to manage neonates. [15] Challenges in our setting include delays in neonatal surgery due to a lack of specialized anesthesiologists and insufficient devices for difficult intubation [16], ultrasound-guided vascular access [17], and temperature monitoring. [18] We advocate for a multidisciplinary approach involving surgeons, anesthetists, neonatologists, and trained nurses.…”

Estado actual de la formación en anestesiología pediátrica en Colombia

“…Likewise, all anesthesia programs cover pediatric anesthesia: as a one-time course during the entire residency in 91% of the programs; in the form of two different rotations; and even one of them has the training during the entire three-year residency (15). Additionally, the Colombian Society of Anesthesiology and Resuscitation (SCARE) reports that 18% of the anesthesia residency programs include a course on pediatric intensive care, while 40% include neonatal anesthesia courses in their curricula (28). This is similar to the training offered in North America, where students are required to complete a rotation in pediatric anesthesia for a minimum of two to six consecutive or non-consecutive months during their residency.…”