Reply to the Letter to the Editor
Reply to the Letter to the Editor: Evidence based clinical practice manual: Patient preparation for surgery and transfer to the operating room theater
Réplica a la Carta al Editor: Manual de práctica clínica basado en la evidencia: preparación del paciente para el acto quirúrgico y traslado al quirófano
David A. Rincón-Valenzuelaa,
, Bibiana Escobarb
Corresponding author
darinconv@unal.edu.co
Corresponding author at: Ciudad Universitaria, Universidad Nacional de Colombia, Facultad de Medicina, Calle 45 No. 30-03, Bogotá D.C., Colombia. Tel.: +57 1 3165000.
Corresponding author at: Ciudad Universitaria, Universidad Nacional de Colombia, Facultad de Medicina, Calle 45 No. 30-03, Bogotá D.C., Colombia. Tel.: +57 1 3165000.
a Anesthesiologist, Master of Clinical Epidemiology, Professor of Anesthesiology, Universidad Nacional de Colombia; Anesthesiologist, Clínica Universitaria Colombia – Colsanitas, Bogotá D.C., Colombia
b Anesthesiologist, PhD in Medical Sciences, Professor of Anesthesiology, Universidad Nacional de Colombia; Instituto Nacional de Cancerología, Bogotá D.C., Colombia
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Tel.: +57 1 3165000." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Réplica a la Carta al Editor: Manual de práctica clínica basado en la evidencia: preparación del paciente para el acto quirúrgico y traslado al quirófano" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">At the end of 2014 the Colombian Society of Anesthesiology and Reanimation (Sociedad Colombiana de Anestesiología y Reanimación – S.C.A.R.E.) undertook a project that culminated with the publication of four evidenced-based manuals, resulting from a systematic adaptation process.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">1–4</span></a> Mainly, these manuals aimed to provide a base for clinics and hospitals who did not have access to these documents or the operative capacity to developed them. This was done in order to comply with Colombian regulations.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> Our goal was never to replace documents previously developed by other health institutions.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Ibarra and collaborators disagree with two recommendations published on the manual on preparing the patient for surgical procedures.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> Those disagreements are related to preoperative evaluation and correspond to only one of the eight sections of the manual.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The development and writing to the manual was carried out through a process of systematic adaptation that follows Colombian<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> and international guidelines,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> as adequately specified in the method section of the manual.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We found no justification to disqualify the protocol used for the adaptation<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> based on the (lack of) recognition of the institution that endorsed it, the authors’ work experience or publishing background or the lack of support from a scientific society of any particular country. In fact, tools used for the methodological evaluation in terms of validity and risk of bias in primary<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">10,11</span></a> and secondary<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">12,13</span></a> do not take these aspects into account as a source of methodological shortcomings.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To our knowledge, there is no published classification that shows that the American College of Cardiology/American Heart Association (ACC/AHA) 2014 guides<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> are the most relevant academically. This arbitrarily ignores the scientific value of other publications,<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">15,16</span></a> even more so when some authors have criticized the ACC/AHA guides base done empirical evidence.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">17,18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It is very important that the recommendations of the manual be interpreted and applied in the context of the level of evidence and the strength of recommendation following the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) classification.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the case of preoperative request of electrolytes the manual recommends it while warning that the level of evidence is very low and the strength of recommendation is weak. Nevertheless, other publications make similar recommendations.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">16,20</span></a> Furthermore, there is evidence of the independent association of electrolyte disorders (hypernatremia and hyponatremia) and mortality after 30 days in patients undergoing elective surgery.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The use of a 12-lead preoperative electrocardiogram (EKG) has been the object of intense debate.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> The manual recommends<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> adjusting the paraclinical request for cardiovascular assessment to one of the guides currently used internationally.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">14,15</span></a> Though the 2014 ACC/AHA guides<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> and the 2012 American Society of Anesthesiologists (ASA) guide<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> do not take preoperative EKGs based on age into account, the 2014 European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA) guidelines recommend it in patients over the age of 65, even when risk factors are not present, in patients scheduled for surgeries of intermediate risk.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> This is based on observational evidence<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> and on the idea that the usefulness of preoperative EKGs goes beyond preoperative risk-determination, as it can be useful to have a base pattern to correctly interpret abnormalities detected during or after surgery that could be interpreted incorrectly as new findings.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> Furthermore, apart from age, an abnormal preoperative EKG is associated independently with perioperative complications (OR 2.8; CI 95% 1.4–5.8).<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> In patients with coronary disease, the prognostic utility of the EKG is independent from findings in the health record.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">As such, this manual continues to be available, and surgical services of health institutions that require it are invited to take it into account as an option to be adopted or adapted.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financing</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors did not receive any sponsorship to produce this article.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare having no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financing" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rincón-Valenzuela DA, Escobar B. Réplica a la Carta al Editor: Manual de práctica clínica basado en la evidencia: preparación del paciente para el acto quirúrgico y traslado al quirófano. Rev Colomb Anestesiol. 2016;44:71–73.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manual de práctica clínica basado en la evidencia: preparación del paciente para el acto quirúrgico y traslado al quirófano" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.A. Rincón-Valenzuela" 1 => "B. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 9 | 1 | 10 |
| 2024 September | 6 | 5 | 11 |
| 2024 August | 11 | 6 | 17 |
| 2024 July | 16 | 8 | 24 |
| 2024 June | 11 | 15 | 26 |
| 2024 May | 22 | 40 | 62 |
| 2024 April | 25 | 10 | 35 |
| 2024 March | 12 | 10 | 22 |
| 2024 February | 11 | 3 | 14 |
| 2024 January | 7 | 2 | 9 |
| 2023 December | 11 | 3 | 14 |
| 2023 November | 6 | 8 | 14 |
| 2023 October | 6 | 7 | 13 |
| 2023 September | 5 | 3 | 8 |
| 2023 August | 11 | 2 | 13 |
| 2023 July | 10 | 3 | 13 |
| 2023 June | 10 | 4 | 14 |
| 2023 May | 38 | 3 | 41 |
| 2023 April | 35 | 4 | 39 |
| 2023 March | 16 | 2 | 18 |
| 2023 February | 25 | 3 | 28 |
| 2023 January | 27 | 8 | 35 |
| 2022 December | 36 | 4 | 40 |
| 2022 November | 34 | 11 | 45 |
| 2022 October | 12 | 5 | 17 |
| 2022 September | 8 | 7 | 15 |
| 2022 August | 6 | 6 | 12 |
| 2022 July | 7 | 9 | 16 |
| 2022 June | 11 | 11 | 22 |
| 2022 May | 8 | 18 | 26 |
| 2022 April | 10 | 8 | 18 |
| 2022 March | 7 | 13 | 20 |
| 2022 February | 7 | 19 | 26 |
| 2022 January | 10 | 8 | 18 |
| 2021 December | 10 | 7 | 17 |
| 2021 November | 10 | 13 | 23 |
| 2021 October | 12 | 14 | 26 |
| 2021 September | 4 | 19 | 23 |
| 2021 August | 3 | 9 | 12 |
| 2021 July | 5 | 11 | 16 |
| 2021 June | 6 | 11 | 17 |
| 2021 May | 5 | 10 | 15 |
| 2021 April | 11 | 14 | 25 |
| 2021 March | 5 | 4 | 9 |
| 2021 February | 3 | 8 | 11 |
| 2021 January | 3 | 8 | 11 |
| 2020 December | 2 | 7 | 9 |
| 2020 November | 1 | 2 | 3 |
| 2020 October | 0 | 2 | 2 |
| 2020 September | 6 | 13 | 19 |
| 2020 August | 6 | 12 | 18 |
| 2020 July | 6 | 7 | 13 |
| 2020 June | 5 | 4 | 9 |
| 2020 May | 1 | 5 | 6 |
| 2020 April | 3 | 2 | 5 |
| 2020 March | 3 | 4 | 7 |
| 2020 February | 2 | 6 | 8 |
| 2020 January | 1 | 7 | 8 |
| 2019 December | 6 | 3 | 9 |
| 2019 November | 2 | 1 | 3 |
| 2019 October | 0 | 3 | 3 |
| 2019 September | 2 | 2 | 4 |
| 2019 August | 0 | 1 | 1 |
| 2019 July | 5 | 6 | 11 |
| 2019 June | 0 | 3 | 3 |
| 2019 May | 0 | 10 | 10 |
| 2019 April | 1 | 0 | 1 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 2 | 4 | 6 |
| 2018 May | 17 | 6 | 23 |
| 2018 April | 32 | 6 | 38 |
| 2018 March | 17 | 9 | 26 |
| 2018 February | 8 | 5 | 13 |
| 2018 January | 21 | 7 | 28 |
| 2017 December | 14 | 4 | 18 |
| 2017 November | 9 | 5 | 14 |
| 2017 October | 14 | 10 | 24 |
| 2017 September | 12 | 10 | 22 |
| 2017 August | 10 | 8 | 18 |
| 2017 July | 14 | 3 | 17 |
| 2017 June | 17 | 5 | 22 |
| 2017 May | 20 | 9 | 29 |
| 2017 April | 36 | 11 | 47 |
| 2017 March | 11 | 4 | 15 |
| 2017 February | 4 | 1 | 5 |
| 2017 January | 9 | 6 | 15 |
| 2016 December | 30 | 9 | 39 |
| 2016 November | 22 | 4 | 26 |
| 2016 October | 24 | 5 | 29 |
| 2016 September | 21 | 4 | 25 |
| 2016 August | 18 | 7 | 25 |
| 2016 July | 18 | 7 | 25 |
| 2016 May | 3 | 0 | 3 |
| 2016 April | 0 | 23 | 23 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 3 | 19 | 22 |
Show all