Letter to the Director
Ocean, wind and loneliness. Anaesthesia and reanimation on board the Spanish Navy Training Ship Juan Sebastián de Elcano, our experience
Océano, viento y soledad. Anestesia y reanimación a bordo del Buque Escuela de la Armada Española Juan Sebastián de Elcano, nuestra experiencia
a Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Central de la Defensa Gómez Ulla, Madrid, Spain
b Escuela Militar de Sanidad (Madrid)/Hospital Universitario Central de la Defensa Gómez Ulla, Madrid, Spain
c Servicio de Cardiología, Hospital Universitario Central de la Defensa Gómez Ulla, Madrid, Spain
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Anestesia y reanimación a bordo del Buque Escuela de la Armada Española <span class="elsevierStyleItalic">Juan Sebastián de Elcano</span>, nuestra experiencia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1563 "Ancho" => 2167 "Tamanyo" => 382590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) The Spanish Navy training ship <span class="elsevierStyleItalic">Juan Sebastián de Elcano</span>. (B) Onboard operating room and infirmary. (C) Surgical intervention under general anaesthesia while sailing in the Atlantic Ocean. (D) Telemedicine connection with the Gómez Ulla Military Hospital in Madrid (Spain) on 20 November 2019.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The training ship <span class="elsevierStyleItalic">Juan Sebastián de Elcano</span> of the Spanish Navy is a four-masted schooner launched in Cádiz in 1927.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> She takes her name from the famous Spanish sailor who accomplished one of the most important feats in world maritime history by circumnavigating the globe for the first time. I write this letter to the Editor on the 500th anniversary of that voyage. Two training events will take place to commemorate this nautical feat (2019–2020 and 2020–2021), during which the 230 members of the crew will repeat the original trip to South America, the Far East, the Indian Ocean before finally returning to Spain.</p><p id="par0010" class="elsevierStylePara elsevierViewall">From a medical point of view, this voyage can be considered a professional challenge, mainly due to the special characteristics of the ship: the speed is usually low (approximately 5 knots [9<span class="elsevierStyleHsp" style=""></span>km/h]); manoeuvring is cumbersome due to the rig; crew working on the rigging are in danger due to the height of the masts and the motion of the ship; air evacuation is complicated because the ship sails out of the range of land-based helicopters during long transoceanic crossings and the masts and sails make it difficult to approach the aircraft; the weather can be a decisive factor; and the ship sometimes docks at ports where hygiene leaves something to be desired.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A surgical team consisting of a navy surgeon and anaesthesiologist provide temporary support to the ship's doctor, nurse and assistant. The ship is equipped with an infirmary located under the bridge that has a consultation room, an operating room, four beds, and a medicine chest. The infirmary is connected to oxygen, protoxide and air bottles located on the main deck. There is a Dräger® Fabius Tiro anaesthesia workstation with a sevoflurane vaporiser, various portable respirators (Dräger Oxilog 1000® and Monnal 160®), a capnograph, two vital signs monitors (Propaq® and Mindray Beneview T1), and two infusion pumps (Alaris®). There are also diagnostic tools, such as an electrocardiograph, portable radiology equipment, a Sonosite ultrasound scanner® (with convex and linear transducers), a portable laboratory with reagents for basic analysis (iSTAT®) and a telemedicine connection to the Gómez Ulla Military Hospital in Madrid. The standard drugs needed for general and regional anaesthesia are also on hand, together with haemotherapy agents (topical haemostatic material, tourniquets, packed red blood cells, prothrombin complex – Octaplex®, calcium chloride, fibrinogen – Riastap®, and tranexamic acid – Amchafibrin®). Before setting off, Intralipid® and dantrolene were added to the medicine chest (the latter mainly for treating possible cases of heat stroke due to the weather conditions and latitudes).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> This equipment allow us to perform anaesthesia following the Helsinki safety recommendations under medical standards similar to those found in mainland hospitals.</p><p id="par0020" class="elsevierStylePara elsevierViewall">From November to December 2019, the most common pathology on board was otorhinolaryngological, followed by injuries and digestive symptoms. Local anaesthesia was used in 3 cases of minor injury. After 9 days sailing from the port of Las Palmas in the Canary Islands, and 19 days after arriving in Rio de Janeiro (Brazil), a patient diagnosed with a perianal abscess underwent general anaesthesia. After being considered fit for surgery in the pre-anaesthesia evaluation, the patient signed the corresponding informed consent forms and the pre-surgical checklist was completed. Surgery lasted 4 hours, and was uneventful. Despite being a minor procedure, several determining variables unique to the maritime setting had to be taken into consideration.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> First, although surgery was not urgent, it could not be delayed long enough to reach the nearest port, and helicopter evacuation was not an option as the ship was at that moment in the middle of the Atlantic Ocean. We decided to go ahead with the surgery, taking advantage of the calm seas normally encountered in the tropics before an upcoming storm which, when it struck, lasted several hours with high seas that would have greatly complicated the procedure. We ruled out regional anaesthesia due to the non-sterile conditions of the operating room and the unavoidable movement of the ship, which could have affected the precision of the injection in the intradural space.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> General anaesthesia is always an option in any surgery, despite the need for airway management (in our case with a laryngeal mask), and the limited supply of oxygen on board. Finally, anaesthesia was satisfactorily maintained with total intravenous anaesthesia (propofol and fentanyl), monitoring hypnotic depth and analgesia using the Conox monitor® (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In 1985, the Juan Sebastian Elcano, following a similar route, was also the setting for the first experiment in telemedicine which involved the radio transmission of an electrocardiogram from the ship to a hospital in Madrid. This event was commemorated 34 years later during the 92nd voyage when ECG, NIBP, HR, temperature, SaO<span class="elsevierStyleInf">2</span>, echocardiographic images of central veins and different peripheral nerve plexuses obtained from a healthy volunteer by the on-board anaesthesiologist were transmitted via satellite to the Telemedicine Service of the Gómez Ulla Military Hospital in Madrid.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Spain should not miss this opportunity to showcase the achievements of our predecessors whose admirable boldness, courage, and discoveries 500 years ago changed the course of humanity and paved the way to globalisation. We thank the JOURNAL OF THE SPANISH SOCIETY OF ANAESTHESIOLOGY for allowing us to report our onboard experience and pay a small “anaesthesiological” tribute to these heroes and their achievements in a setting where our lives are governed by the ocean, the wind, and solitude.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">There has been no source of funding.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => 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: Navarro Suay R, Castillejo Pérez S, Díaz Viudes A, López Soberón E. Océano, viento y soledad. Anestesia y reanimación a bordo del Buque Escuela de la Armada Española <span class="elsevierStyleItalic">Juan Sebastián de Elcano</span>, nuestra experiencia. Rev Esp Anestesiol Reanim. 2020;67:358–360.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1563 "Ancho" => 2167 "Tamanyo" => 382590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) The Spanish Navy training ship <span class="elsevierStyleItalic">Juan Sebastián de Elcano</span>. (B) Onboard operating room and infirmary. (C) Surgical intervention under general anaesthesia while sailing in the Atlantic Ocean. (D) Telemedicine connection with the Gómez Ulla Military Hospital in Madrid (Spain) on 20 November 2019.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La Sanidad Naval Española. Historia y Evolución" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Gracia Rivas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1995" "editorial" => "Bazán" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aquella cirugía naval" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. 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Díaz Ponce-Medrano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Mex Anestesiol" "fecha" => "2014" "volumen" => "37" "paginaInicial" => "120" "paginaFinal" => "122" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006700000006/v1_202008190659/S2341192920300822/v1_202008190659/en/main.assets" "Apartado" => array:4 [ "identificador" => "66474" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006700000006/v1_202008190659/S2341192920300822/v1_202008190659/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300822?idApp=UINPBA00004N" ]
