1. Regarding Enhanced Recovery After Surgery programs, the first intervention performed with this program was¹:

• Colon and rectum surgery.

• Bariatric surgery.

• Gastro-esophageal surgery.

• Hepato-biliary surgery.

2. In the area of patient safety, which of the contributing factors related to so-called reportable events with unwanted effects (REUE) has the highest incidence rate?²

• Work environment factors (workload).

• Communication problems between work teams and team structure.

• Complexity of the pathologies treated number of comorbidities and advanced age.

• Individual factors, such as lack of or inadequate training.

3. The occurrence of preventable reportable events is associated with unfavorable legal or ethical decisions in civil, ethical, and administrative medical liability processes in Colombia. Which of the following specialties has the least risk of being the object of medical-legal lawsuits?³

• Emergency medicine.

• Anesthesiology.

• Obstetrics.

• Pediatrics.

4. Pediatric patients intubated in mechanical ventilation are considered to be responsive to a volume load when the increase in the inferior vena cava distensibility index is above⁴:

• 8%.

• 18%.

• 28%.

• 38%.

5. In the placement of an interscalene block, which of the following conditions is an intraneural puncture signal very close to or within the fascicule?⁵

• Stimulation at intensities of <0.3 mA (with a frequency of 2 Hz and a pulse duration of 100 ms) and an injection pressure of >15 psi (measured with a manometer in the line, placed before the syringe).

• Stimulation at intensities of <0.5 mA (with a frequency of 1 Hz and a pulse duration of 200 ms) and an injection pressure of >20 psi (measured with a manometer in the line, placed before the syringe).

• Stimulation at intensities of <0.2 mA (with a frequency of 2 Hz and a pulse duration of 10 ms) and an injection pressure of >10 psi (measured with a manometer in the line, placed before the syringe).

• Stimulation at intensities of <0.3 mA (with a frequency of 1 Hz and a pulse duration of 200 ms) and an injection pressure of 25 psi (measured with a manometer in the line, placed before the syringe).

6. In the algorithm proposed by X. Sala-Blanch, A. López, and C. Vandepitte,⁵ performing a peripheral nerve block includes all the following except:

• Evaluation of the patient.

• Nerve stimulation.

• Injection pressure monitoring no greater than >25psi.

• Visualization of local anesthetic propagation.

7. A 63-year-old non-insulin-required diabetic patient has a right shoulder reverse prosthesis implanted under general anesthesia, after interscalene blockage under sedation. Two weeks later, during control visit, he describes a loss of strength in all his upper right extremity, inability to bend his fingers except the thumb, index, and heart, with predominant numbness of the ring and pinky finger and dynamic allodynia in the distal ulnar region, with change of color and temperature in the right hand, in contrast with the left hand. Intraneural root lesion is suspected for⁵:

• C4, C5, C6, C7.

• C5, C6, C7.

• C3, C4, C5, C6.

• C4, C5, C6, C7, C8.

8. According to the systematic literature review by F. Calderón-Ochoa, A. Mesa Oliveros, G. Rincón Plata, and I. Pinto Quiñones, when comparing the effectiveness and safety of exclusive spinal anesthesia with bupivacaine vs. sciatic-femoral block in the postoperative period of patients of knee arthroscopy, the incidence of urinary retention with spinal anesthesia is close to⁶:

• 5%.

• 10%.

• 20%.

• 30%.

9. In the study by K. Estrada-Orozco, H. Gaitán-Duarte, S. Moreno, and J. Moreno-Chaparro on unwanted reportable events in the surgical population, it was their most frequent place of occurrence is in²:

• Hospitalization.

• Surgery rooms.

• Intensive postsurgical care.

• Recovery rooms.

10. The gold standard for the measurement of right ventricular function, due to its complex geometry, is⁴:

• Nuclear magnetic resonance.

• Echocardiogram.

• Swan Ganz catheter.

• Ventriculography.

Answers

1. 1. a
2. 2. c
3. 3. d
4. 4. b
5. 5. a
6. 6. c
7. 7. b
8. 8. b
9. 9. a
10. 10. a

References

1. Street AD. Two unique studies highlighting the positive effects of enhanced recovery after surgery (ERAS) pathways on patient care and satisfaction. Colombian Journal of Anesthesiology 2019;47:1-4.

2. Estrada-Orozco K, Gaitán-Duarte H, Moreno S, et al. Reportable hospital events: incidence and contributing factors in the surgery service of a high complexity hospital in Bogotá, Colombia, 2017. Colombian Journal of Anesthesiology 2019;47:5-13.

3. Gaitan-Duarte H, Eslava-Schmalbach J, Montoya L, et al. Association between reportable preventable adverse events and unfavorable decisions in medical malpractice claims involving obstetricians covered by FEPASDE Colombia 1999 to 2014. Case-control study. Colombian Journal of Anesthesiology 2019;47:14-22.

4. Puente-Reyes C, Plazas-Castro H, Guzmán MC, et al. Focused critical care echocardiography: training for pediatricians and pediatric intensivists in an intensive care unit. Colombian Journal of Anesthesiology 2019;47:23-31.

5. Villar T, Pacreu S, Chavero E, et al. Prolonged brachial plexopathy following interscalene block for shoulder arthroplasty. Colombian Journal of Anesthesiology 2019;47:71-75.

6. Calderón-Ochoa F, Mesa Oliveros A, Rincón Plata G, et al. Effectiveness and safety of exclusive spinal anesthesia with bupivacaine vs femoral sciatic block during the postoperative period of patients having undergone knee arthroscopy: systematic review. Colombian Journal of Anesthesiology 2019;47:57-68.

Notes