Browsing by Author "Altermatt Couratier, Fernando René"

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    Anestesia espinal parte III. Mecanismos de acción
    (Wiley, 2021) Lacassie Quiroga, Héctor; Altermatt Couratier, Fernando René; Irarrázaval Mainguyague, María Jesús; Kychenthal Loyola, Catalina Sofía; Cuadra F., Juan Carlos de la
    La anestesia espinal es una técnica ampliamente utilizada en la práctica clínica. Por lo general, el bloqueo nervioso está determinado por tres factores principales. El primero es la distribución del anestésico local en el líquido cefalorraquídeo (LCR), que a su vez se ve afectado por una gran variedad de factores, destacando entre estos el volumen de LCR. El segundo es la absorción, la cual es mayor en los sitios en donde la concentración del fármaco también lo es: para esto afecta la accesibilidad, el contenido lipídico y la irrigación vascular de cada zona. El último factor es la eliminación, mediada principalmente por la irrigación de los distintos compartimentos, y cuyo orden es distinto a la imagen especular del inicio de acción. Los factores mencionados son los principales determinantes de los tiempos de demora de los bloqueos, el orden en el que se logra su acción en las distintas fibras y el bloqueo diferencial. Este texto pretende describir los principales mecanismos de acción mediante los cuales actúa la anestesia espinal y los factores que pueden determinar diferencias en los resultados de esta.
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    Anestesia espinal parte IV. Técnica de la anestesia espinal y sus variaciones
    (2021) Altermatt Couratier, Fernando René; Cuadra F., Juan Carlos de la; Kychenthal Loyola, Catalina Sofía; Irarrázaval Mainguyague, María Jesús; Lacassie Quiroga, Héctor
    La anestesia espinal es una técnica ampliamente utilizada hoy en día. Para obtener resultados exitosos y evitar complicaciones, es fundamental una buena técnica a la hora de realizarla. Debe contarse con un buen conocimiento basal del método a utilizar y una preparación adecuada según el paciente, incluyendo en esto tanto los materiales como los fármacos de elección en cada caso. Es fundamental reducir los riesgos tanto locales como sistémicos del procedimiento, lo cual se logra con la preparación mencionada y una adecuada monitorización del paciente. Una vez listo esto, debe posicionarse al paciente de manera que quede sentado, en decúbito lateral o decúbito prono. El abordaje es elegido principalmente según los reparos anatómicos de cada caso particular y puede ser medio, paramediano o de Taylor. Se debe seleccionar una aguja adecuada, las cuales se dividen principalmente entre aquellas que cortan y aquellas que separan las fibras de la duramadre. En esta revisión se expone la técnica adecuada para realizar el procedimiento de anestesia espinal, junto con algunas de sus variaciones principales como lo son la anestesia sectorizada, la anestesia espinal continua y la anestesia combinada espinal epidural.
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    Anestesia espinal parte V. Efectos fisiológicos
    (2021) Lacassie Quiroga, Héctor; Cuadra F., Juan Carlos de la; Kychenthal Loyola, Catalina Sofía; Irarrázaval Mainguyague, María Jesús; Altermatt Couratier, Fernando René
    La anestesia espinal es una técnica ampliamente utilizada hoy en día en contextos intraoperatorios. Esta posee efectos fisiológicos característicos en los diferentes sistemas corporales, los cuales son esenciales de conocer a la hora de utilizar este método anestésico. Dichos efectos pueden cobrar principal relevancia en ciertos pacientes según sus requerimientos, comorbilidades o el procedimiento al cual serán sometidos. En esta revisión se destacan los efectos que la anestesia espinal produce en los principales sistemas del organismo. En el sistema nervioso autonómico, los efectos dependerán de la regulación de los sistemas simpático y parasimpático secundaria al nivel de bloqueo, el cual puede ser estimado mediante el nivel de discriminación térmica. El bloqueo simpático producido se traduce en vasodilatación arterial y venosa sistémica, lo que a su vez causa una disminución de la resistencia vascular periférica, retorno venoso, frecuencia cardiaca y contractilidad miocárdica. En cuanto al sistema nervioso central, la anestesia espinal causaría un efecto sedante mediante distintas teorías. En condiciones normales, la función ventilatoria no resulta significativamente afectada, pero podría volverse insuficiente en ciertos pacientes o verse afectada en cuanto a la regulación de la broncodilatación. Debido a la redistribución de flujo, se ve afectada la termorregulación, presentando disminuciones en la temperatura corporal. Otros sistemas que pueden verse afectados por la regulación del sistema nervioso autonómico son el gastrointestinal y el excretor urinario, además de producirse un eventual bloqueo adrenal que llevaría a una menor respuesta metabólica de estrés.
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    Anestesia espinal. Parte II: Importancia de la anatomía, indicaciones y drogas más usadas
    (Wiley, 2021) Lacassie Quiroga, Héctor; Cuadra F., Juan Carlos de la; Kychenthal Loyola, Catalina Sofía; Irarrázaval Mainguyague, María Jesús; Altermatt Couratier, Fernando René
    El bloqueo espinal requiere de un conocimiento acabado de la anatomía de las partes involucradas, así como de sus variaciones con la posición y posibles estructuras a lesionar. La anestesia espinal está indicada cuando el procedimiento quirúrgico puede lograrse con un nivel sensitivo de anestesia que no afecte el bienestar del paciente. Sus contraindicaciones absolutas son el rechazo de la técnica por el paciente, la infección en el sitio de la inyección, sepsis y otros estados de insuficiencia circulatoria, diagnóstico de hipertensión endocraneana y la existencia de coagulopatía severa. El éxito de esta técnica depende en parte de la correcta elección del anestésico local; lo más comúnmente utilizados son lidocaína y bupivacaína.
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    Anestesia espinal: Parte I. Historia
    (Wiley, 2021) Cuadra F., Juan Carlos de la; Altermatt Couratier, Fernando René; Kychenthal Loyola, Catalina Sofía; Irarrázaval Mainguyague, María Jesús; Lacassie Quiroga, Héctor
    La anestesia espinal es una forma de anestesia regional fundamental en lapráctica clínica. Para llegar a la técnica segura y ampliamente difundida que hoyse conoce, han sucedido diversos eventos a lo largo de la historia. Numerososavances en cuanto a conocimiento anatómico, fisiología, farmacología, desarrollo de agujas y otros, dieron paso a la primera anestesia espinal en 1898 y atodo el avance que desde entonces se ha logrado. Múltiples descubrimientos yadaptaciones se han hecho desde entonces, alcanzando finalmente la técnicautilizada por anestesistas hoy en día.
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    Anestesia espinal: Parte I. Historia
    (2021) Cuadra F., Juan Carlos de la; Altermatt Couratier, Fernando René; Kychenthal Loyola, Catalina Sofía; Irarrázaval Mainguyague, María Jesús; Lacassie Quiroga, Héctor
    La anestesia espinal es una forma de anestesia regional fundamental en lapráctica clínica. Para llegar a la técnica segura y ampliamente difundida que hoyse conoce, han sucedido diversos eventos a lo largo de la historia. Numerososavances en cuanto a conocimiento anatómico, fisiología, farmacología, desarrollo de agujas y otros, dieron paso a la primera anestesia espinal en 1898 y atodo el avance que desde entonces se ha logrado. Múltiples descubrimientos yadaptaciones se han hecho desde entonces, alcanzando finalmente la técnicautilizada por anestesistas hoy en día.
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    Asystole With Propofol and Remifentanil
    (2001) Muñoz Letelier, Hernán Rodrigo; Altermatt Couratier, Fernando René
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    Biomechanical analysis of expert anesthesiologists and novice residents performing a simulated central venous access procedure
    (2021) Villagrán Gutiérrez, Ignacio Andrés; Moenne Vargas, Cristóbal Matías; Aguilera Siviragol, Victoria Ignacia; Garcia, Vicente; Reyes, Jose Tomas; Rodriguez, Sebastian; Miranda Mendoza, Constanza; Altermatt Couratier, Fernando René; Fuentes López, Eduardo; Delgado Bravo, Mauricio Antonio; Neyem, Andrés
    Background Central venous access (CVA) is a frequent procedure taught in medical residencies. However, since CVA is a high-risk procedure requiring a detailed teaching and learning process to ensure trainee proficiency, it is necessary to determine objective differences between the expert’s and the novice’s performance to guide novice practitioners during their training process. This study compares experts’ and novices’ biomechanical variables during a simulated CVA performance. Methods Seven experts and seven novices were part of this study. The participants’ motion data during a CVA simulation procedure was collected using the Vicon Motion System. The procedure was divided into four stages for analysis, and each hand’s speed, acceleration, and jerk were obtained. Also, the procedural time was analyzed. Descriptive analysis and multilevel linear models with random intercept and interaction were used to analyze group, hand, and stage differences. Results There were statistically significant differences between experts and novices regarding time, speed, acceleration, and jerk during a simulated CVA performance. These differences vary significantly by the procedure stage for right-hand acceleration and left-hand jerk. Conclusions Experts take less time to perform the CVA procedure, which is reflected in higher speed, acceleration, and jerk values. This difference varies according to the procedure’s stage, depending on the hand and variable studied, demonstrating that these variables could play an essential role in differentiating between experts and novices, and could be used when designing training strategies.
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    Bloqueio perioperatório do plexo lombar e isquemia cardíaca em pacientes com fratura de quadril: ensaio clínico randomizado
    (2018) Altermatt Couratier, Fernando René; Echevarría, Ghislaine C.; Cuadra F., Juan Carlos de la; Baeza Vergara, Ricardo Gabriel; Ferrada, Marcela; De La Cuadra Fontaine, Juan Carlos; Corvetto Aqueveque, Marcia Antonia
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    Boundary integral formulation and semi-implicit scheme coupling for modeling cells under electrical stimulation
    (2017) Henríquez F.; Jerez Hanckes, Carlos F.; Altermatt Couratier, Fernando René
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    Boundary integral formulation for the electrical response of a nerve to an extracellular stimulation
    (IEEE, 2013) Henriquez Barraza, Fernando Jose; Jerez Hanckes, Carlos F.; Altermatt Couratier, Fernando René
    We present a two-dimensional boundary integral formulation of nerve impulse propagation. A nerve impulse is a potential difference across the cellular membrane that propagates along the nerve fiber. The traveling transmembrane potential is produced by the transfer of ionic species between the intra- and extra-cellular mediums. This current flux across the membrane-composed of conduction, diffusion and capacitive terms- is regulated by passive and active mechanisms that are highly complicated to describe mathematically from a microscopic point of view. Based on the Hodgkin and Huxley axon model, we propose a well-posed integral formulation based on a quasi-static approximation amenable to time-stepping schemes and discuss first results.
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    Clinical Research Ethics: Critical and Qualitative Analysis of Facilitators and Barriers
    (2020) Valera, Luca; González, Karla; Ramos, Paulina; Altermatt Couratier, Fernando René
    To analyze the ethical challenges dealing with clinical research, we carried out a systematic review of the literature and qualitative research, determining facilitators, barriers, and ethical paradigms perceived by Chilean clinical researchers. Through the analysis of the literature, we identified the main ethical challenges involved “in” clinical research (hic et nunc) and those that arise “from” clinical research itself (ex post). Semi-structured interviews showed four critical knots associated with clinical research (founding, legislation, multi-center research, and the relationship with regulatory entities), together with facilitating aspects and barriers when implementing researches.
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    Clinical research in Chile: do not block the way of inquiry
    (2020) Valera, Luca; Ramos Vergara, Paulina Cecilia; Barrientos Zamorano, Marcelo; Altermatt Couratier, Fernando René; Ruiz Poblete, Sergio Marcelo; Von Bernhardi Montgomery, Rommy Edth B.; Cuello Fredes, Mauricio Arturo
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    Comparison of Continuous Popliteal Nerve Blocks Using Lidocaine versus Bupivacaine Infusions for Ambulatory Foot Surgery: A Randomized, Double-blind, Noninferiority Trial
    (2023) Echevarría, Ghislaine; Altermatt Couratier, Fernando René; Miranda Hiriart, Pablo; Araneda Vilches, Andrea Lucía; Corvetto Aqueveque, Marcia Antonia; De La Fuente Sanhueza, René Francisco; Cuadra F., Juan Carlos de la
    Background and objectives: Continuous sciatic popliteal nerve block effectivelymanages pain after ankle and foot surgery. Most studies on continuous infusionof local anesthetics by perineural catheters have been made with bupivacaine,levobupivacaine, and ropivacaine, but lidocaine has not been used. The mainobjective of this study was to compare the quality of analgesia, motor function,and side effects between lidocaine and bupivacaine infusions in bilateralcontinuous popliteal nerve blocks for foot surgery.Methods: This was a prospective, double-blind, randomized, parallel-group,noninferiority study. We enrolled 70 patients undergoing bilateral foot or anklesurgery that could be performed under general anesthesia and continuous regionalanalgesia using sciatic popliteal nerve blocks. During their postoperative care, theywere randomized into 2 groups: group lidocaine (lidocaine 0.5%, 5 ml/h) or groupbupivacaine (bupivacaine 0.1%, 5 ml/h), administered through elastomeric pumps.The primary outcome was pain at 24 h after surgery, assessed by a verbal numericrating scale (ranging from 0 to 10). A pre-specified non-inferiority margin of 1.5 wasdefined. Secondary outcomes were the degree of motor and sensitive block, totalopioid use, and difficulties with pump or catheter management.Results: The mean postoperative pain at 24 h of surgery was 2.06 (95% bootstrapconfidence interval bCI 1.29, 2.83) and 1.82 (95% bCI 1.02, 2.62) in the lidocaineand bupivacaine group, respectively. The upper limit of the 95% bCI for the meandifference between lidocaine and bupivacaine was 0.82, declaring non-inferiority.No differences in the postoperative rescue analgesia use and satisfaction withcare were found. No differences in postoperative NRS, sensory block and motorblock were seen between groups.Conclusions: Lidocaine 0.5% and bupivacaine 0.1% provide similar postoperativeanalgesia through a sciatic popliteal catheter in ambulatory bilateral foot surgery patients.
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    Comparison of Plasma Concentrations of Levobupivacaine With and Without Epinephrine for Transversus Abdominis Plane Block
    (2012) Corvetto Aqueveque, Marcia Antonia; Echevarria, Ghislaine C.; Fuente Lopez , Natalia Francisca de la; Mosqueira Podesta, Loreto Alejandra; Solari Gajardo, Sandra; Altermatt Couratier, Fernando René
    "Background and Objectives: The pharmacokinetics for levobupivacaine in transversus abdominis plane (TAP) blocks has not been previously reported. We aimed to determine the extent of the block and the effect on plasma concentrations of levobupivacaine with the addition of epinephrine.", "Methods: We enrolled 11 healthy volunteers in this double-blind, 2-intervention, 2-period crossover study. The intervention periods were defined as a unilateral left TAP block with 20 mL of 0.25% levobupivacaine with (E) or without (no E) 5 mu g/mL epinephrine. Subjects were randomized to E, followed by no E or no E followed by E, with 2-week washout period. Sensory dermatomal anesthesia was recorded. Blood samples were obtained for the measurement of plasma levobupivacaine levels.", "Results: The median cranial-to-caudal spread of sensory blockade for sharp touch was T9 (interquartile range [IQR], T7-T10) to L1 (IQR, T12-L1) with epinephrine and T9 (IQR, T8-T10) to T12 (IQR, T11-L1) without epinephrine (P > 0.05). The mean maximum arterial levobupivacaine concentrations with epinephrine were 0.36 (95% bootstrap confidence interval [95% CI], 0.30-0.42) mu g/mL and 0.63 (95% CI, 0.49-0.85) mu g/mL without epinephrine (P = 0.014, difference in means of 0.27 [95% CI, 0.12-0.46]). The mean maximal venous levobupivacaine concentration was 0.32 (95% CI, 0.28-0.39) mu g/mL and 0.49 (95% CI, 0.37-0.68) mu g/mL, with and without epinephrine, respectively (P = 0.006, difference in means of 0.17 [95% CI, 0.08-0.33]). The mean duration of the blockade was 10.2 hours (95% CI, 8.5-12.5 hours) with epinephrine and 10.3 hours (95% CI, 8.7-12.4 hours) without epinephrine (P = 1.000).", "Conclusions: Adding epinephrine to levobupivacaine reduces its peak plasma concentration after unilateral TAP blocks, with no remarkable effects on block characteristics or duration."]
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    Comparison of the effectiveness of peripheral nerve blockers made with neurostimulator versus ultrasound: Systematic review and meta-analysis
    (2008) Cabrera Viera, Francisca; Torres Perez, David; Altermatt Couratier, Fernando René
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    Congreso LASRA 2023, Lima, Perú. Delegación Chilena
    (2023) Aliste, Julián; Altermatt Couratier, Fernando René; Atton, Rousmery; Carrasco, Cristóbal; Cuadra F., Juan Carlos de la; Pesce, Ítalo
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    Control-flow analysis of procedural skills competencies in medical training through process mining
    (2020) Fuente Sanhueza, René Francisco de la; Fuentes Henríquez, Ricardo Sergio; Muñoz Gama, Jorge; Riquelme Pérez, Arnoldo; Altermatt Couratier, Fernando René; Pedemonte Trewhela, Juan Cristóbal; Corvetto Aqueveque, Marcia Antonia; Sepúlveda Fernández, Marcos Ernesto
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    Cross-cultural adaptation and validation of the Spanish version of the Anesthetists' Non-Technical Skills (ANTS) assessment tool
    (2023) Delfino Yurin, Alejandro Eugenio; Fuentes López, Eduardo A.; De La Fuente Sanhueza, René Francisco; Altermatt Couratier, Fernando René
    Study objective: Establish the transcultural validity of Anesthetists Non-Technical Skills (ANTS) in a Spanish-speaking country. Design: Prospective cohort. Setting: Clinical simulation center. Subjects: Forty-two Anesthesia PY2 and PY3 residents participated in the study. Interventions: Four clinical scenarios simulating anesthesia crises were assessed with a Spanish version of ANTS. Every simulated scenario was run twice with a time span of 3 to 4 months between them. Measurements: Two anesthesiologists independently assessed all simulated sessions using ANTS. The ANTS indicators of construct validity were obtained by confirmatory factor analysis. Various goodness-of-fit indices of the factorial model were calculated: Comparative Fit Index (CFI); Tucker-Lewis Adjustment Index (TLI) and Root Mean Square Error of Approximation (RMSEA). The standardized factor loadings and the determination coefficient (R2) was also estimated. Main results: A total of 212 clinical scenarios were analyzed. The specified factorial model had the same grouping of elements in four domains as the original version of ANTS. The CFI index and the TLI were 0.99 and the RMSEA reached 0.07 (95% CI 0.06–0.08). All the standardized factor loadings were found to be >0.4. Also, the elements obtained an R2 value that fluctuated between 0.54 and 0.92. Conclusions: The Spanish version of ANTS is a valid, reliable and a useful tool to assess non-technical skills in Spanish-speaking countries. The applicability of the instrument was comparable to the original setting. The high reliability of ANTS in our setting allows us to propose its use not just in an educational and research setting; it can be used as an assessment tool of non-technical skills.