Browsing by Author "Fuentes, Ricardo"

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    Development of a comprehensive Percutaneous Dilatational Tracheostomy process model for procedural training: A Delphi-based experts consensus
    (2021) Fuente Sanhueza, René Francisco de la; Kattan Tala, Eduardo José; Muñoz Gama, Jorge; Puente, Ignacio; Navarrete, Matías; Kychenthal, Catalina; Fuentes, Ricardo; Bravo Morales, Sebastián; Gálvez Yanjari, Víctor Andrés; Sepúlveda Cárdenas, Marcos Daniel
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    Differential effects of propofol anaesthesia across three amplitude-defined electroencephalographic states in sedated critically ill term neonates
    (European Society of Anaesthesiology and Intensive Care, 2025) Boncompte Lezaeta, Gonzalo Nicolas; Cortinez Fernández, Luis Ignacio; Toso Milos, Alberto Antonio; Giordano Villatoro, Ady Iveth; Cruzat Riquelme, Francisco Javier; Fuentes, Ricardo; Pedemonte Trewhela, Juan Cristóbal; Contreras Ibacache, Víctor Eliseo; Biggs Muñoz, Daniela Paola; Chiu, Esteban; Ibacache Figueroa, Mauricio Enrique
    The developing neonatal brain displays different electroencephalographic (EEG) responses to GABAergic anaesthetics than adults. Evidence suggests the importance of isoelectric-like activity patterns. However, markers of hypnotic depth are currently lacking for this population. OBJECTIVE To explore potential EEG markers of propofol-induced hypnosis in sedated critically ill term neonates. DESIGN Observational exploratory cohort study. PATIENTS Twenty critically ill term neonates (postmenstrual age 37 to 44 weeks) undergoing intensive care and requiring anaesthesia for noncardiac surgery. Patients with perinatal asphyxia, neurological pathology, brain malformations and metabolic or haemodynamic instability were excluded. INTERVENTION(S) Frontal EEG (Sedline) was recorded before induction and during a 20-min continuous rate propofol infusion. MAIN OUTCOME MEASURES Depending on peak amplitude, segmented EEG signals (1 s epochs) were classified as either isoelectric (<10 μV), low-voltage 10 to 25 μV), or high-voltage (>25 μV). Propofol effects were evaluated in terms of time occupancy and spectral properties within these EEG states. Correlations between clinical variables and EEG states were explored. RESULTS The EEGs of 17 neonates were analysed. Most showed periods of low-voltage (16/17, 94%) and isoelectric states (2/17, 70.5%) before anaesthesia. The time spent in these EEG states increased significantly during propofol infusion; 17/17 (100%), P < 0.001 and 16/17 (94.1%), P = 0.016, respectively. Propofol increased the mean [95% confidence interval (CI)] time spent in the isoelectric state per patient: 12.4 (3.3 to 21.5)% versus 28.6 (14.4 to 42.8)%, P < 0.002. A reduced spectral power was observed across all frequency bands during low-voltage states (all P < 0.026). Gestational age was negatively correlated with time in the isoelectric state; rho, 95% CI, −0.539 (−0.11 to −0.87), P = 0.031. CONCLUSION Our results show that isoelectric periods are common before anaesthesia in our studied population and more frequent in patients born at earlier gestational ages. The data suggest that propofol anaesthesia increases isoelectric EEG states while also reducing the spectral power, specifically during low-voltage EEG states. Potentially, both of these EEG changes could be biomarkers of neonatal hypnosis depth in this particular critically ill subpopulation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04904965.
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    Interactive Process Mining for Medical Training
    (2020) Muñoz, Gama Jorge; Victor, Galvez; Rene de la Fuente; Sepúlveda, Marcos; Fuentes, Ricardo
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    Performance of the cerebral state index during increasing levels of propofol anesthesia: A comparison with the bispectral index
    (LIPPINCOTT WILLIAMS & WILKINS, 2007) Cortinez, Luis I.; Delfino, Alejandro E.; Fuentes, Ricardo; Munoz, Hernan R.
    BACKGROUND: The cerebral state monitor is a new device to measure depth of anesthesia. In this study we compared the cerebral state monitor with the bispectral index (BIS) monitor during propofol anesthesia.
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    Pharmacokinetics of levobupivacaine (2.5 mg/kg) after caudal administration in children younger than 3 years
    (LIPPINCOTT WILLIAMS & WILKINS, 2008) Cortinez, Luis I.; Fuentes, Ricardo; Solari, Sandra; Ostermann, Paola; Vega, Miguel; Munoz, Hernan R.
    BACKGROUND: Caudal administration of levobupivacaine (2.5 mg/kg) in children is used frequently in some hospitals. However, no reports of levobupivacaine concentrations have been published with this dosing scheme. We report the results of a study on the pharmacokinetics of levobupivacaine (2.5 mg/kg) after caudal administration in children younger than 3 yr.
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    Process-oriented instrument and taxonomy for teaching surgical procedures in medical training: The ultrasound-guided insertion of central venous catheter
    (2024) Gálvez, Víctor; De La Fuente Sanhueza, René Francisco; Meneses, César; Leiva, Luis; Fagalde, Gonzalo; Herskovic, Valeria; Fuentes, Ricardo; Muñoz Gama, Jorge; Sepúlveda, Marcos
    Procedural training is relevant for physicians who perform surgical procedures. In the medical education field, instructors who teach surgical procedures need to understand how their students are learning to give them feedback and assess them objectively. The sequence of steps of surgical procedures is an aspect rarely considered in medical education, and state-of-the-art tools for giving feedback and assessing students do not focus on this perspective. Process Mining can help to include this perspective in this field since it has recently been used successfully in some applications. However, these previous developments are more centred on students than on instructors. This paper presents the use of Process Mining to fill this gap, generating a taxonomy of activities and a process-oriented instrument. We evaluated both tools with instructors who teach central venous catheter insertion. The results show that the instructors found both tools useful to provide objective feedback and objective assessment. We concluded that the instructors understood the information provided by the instrument since it provides helpful information to understand students' performance regarding the sequence of steps followed.
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    Propofol induce modulaciones espectrales diferenciales en los estados isoeléctricos en el EEG de neonatos
    (2023) Ibacache Figueroa, Mauricio Enrique; Boncompte Lezaeta, Gonzalo Nicolás; Cortinez Fernández, Luis Ignacio; Toso Milos, Alberto Antonio; Fuentes, Ricardo; Contreras Ibacache, Victor Eliseo; Biggs Muñoz, Daniela Paola; Chiu, Esteban
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    The Dynamic Relationship Between End-Tidal Sevoflurane Concentrations, Bispectral Index, and Cerebral State Index in Children
    (LIPPINCOTT WILLIAMS & WILKINS, 2008) Fuentes, Ricardo; Cortinez, Luis I.; Struys, Michel M. R. F.; Delfino, Alejandro; Munoz, Hernan
    BACKGROUND: To guide anesthetic administration with electroencephalogram monitors in children, an adequate characterization of the anesthetic effect measured by these monitors in this population is needed. We sought to quantify and compare the dynamic profile of sevoflurane's effect measured with the cerebral state index (CST) and the bispectral index (BIS) in children.
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    The Influence of Age on the Dynamic Relationship Between End-Tidal Sevoflurane Concentrations and Bispectral Index
    (LIPPINCOTT WILLIAMS & WILKINS, 2008) Cortinez, Luis I.; Troconiz, Inaki F.; Fuentes, Ricardo; Gambus, Pedro; Hsu, Yung Wei; Altermatt Couratier, Fernando René; Munoz, Hernan R.
    BACKGROUND: Age is an important determinant of the pharmacokinetic profile of inhaled anesthetics. The influence of age on the dynamic profile of sevoflurane's effect has not been well described. We performed this study to characterize the influence of age and other covariates on the dynamic relationship between sevoflurane end-tidal concentration (C-ET) and its effect measured by bispectral index (BIS).
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    Understanding Undesired Procedural Behavior in Surgical Training: The Instructor Perspective
    (SPRINGER INTERNATIONAL PUBLISHING AG, 2019) Galvez, Victor; Meneses, Cesar; Fagalde, Gonzalo; Munoz Gama, Jorge; Sepulveda, Marcos; Fuentes, Ricardo; de la Fuente, Rene; DiFrancescomarino, C; Dijkman, R; Zdun, U
    In recent years, a new approach to incorporate the process perspective in the surgical procedural training through Process Mining has been proposed. In this approach, training executions are recorded, to later generate end-to-end process models for the students, describing their execution. Although those end-to-end models are useful for the students, they do not fully capture the needs of the instructors of the training programs. This article proposes a taxonomy of activities for surgical process models, analyzes the specific questions instructors have about the student execution and their undesired procedural behavior, and proposes the Procedural Behavior Instrument, an instrument to answer them in an easy-to-interpret way. A real case was used to test the approach, and a preliminary validity was developed by a medical expert.