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Antibiotic allergy labels (AAL) are related to worse therapeutic results. Strategies to improve the management of these patients, such as the implementation of antibiotic desensitization, are essential for Antimicrobial Stewardship Programs (ASP). The aim of our study is to evaluate the efficacy and safety of antibiotic desensitization procedures for the management of patients with AAL. A retrospective study from 2015 to 2022 was performed to describe all antibiotic desensitization conducted in our institution, within the framework of ASP. A systematic literature review using electronic databases, such as PubMed, was also done to identify studies describing antibiotic desensitization between 2000 and 2022. Sixteen antibiotic desensitization protocols were carried out in our institution. In fourteen cases, the desensitization was successfully completed, and the antibiotic could be used to treat the infection. In the systematic review, twenty-two studies were included, with a total of 202 desensitization episodes . In 97% of them, the desensitization was completed successfully. No desensitization-related mortality was observed neither in our cohort nor in literature review. Antibiotic desensitization strategies should be considered a safe and effective tool that can be included in ASP for patients with a high risk of or confirmed allergy to penicillin.

Resumen Introduccion La pandemia producida por COVID-19 ocasiono la cancelacion de los procedimientos quirurgicos no esenciales en marzo de 2020. Con el reinicio de la actividad quirurgica, los pacientes que se sometian a una cirugia fueron uno de los primeros grupos poblacionales a los que se realizo test PCR de forma sistematica. El objetivo de este estudio fue determinar la prevalencia de portadores asintomaticos de SARS-CoV-2 tras el reinicio de la actividad quirurgica no esencial. Metodos Estudio observacional multicentrico retrospectivo de los pacientes programados para cirugia o que se sometieron a cirugia urgente en Cataluna entre el 20 de abril y el 31 de mayo de 2020. Se revisaron los resultados microbiologicos de los test PCR preoperatorios, las historias clinicas y se realizo una encuesta epidemiologica a los pacientes con PCR positiva para SARS-CoV-2. Resultados Un total de 10.838 pacientes programados para una intervencion quirurgica o a los que se realizo una cirugia urgente fueron sometidos a cribado para COVID-19. Ciento dieciocho pacientes (1,09%) fueron positivos para SARS-CoV-2 en las 72 h previas a la cirugia. La prevalencia de portadores asintomaticos fue del 0,7% (IC95%: 0,6-0,9%). La primera semana del estudio presento la prevalencia mas alta de portadores asintomaticos [1,9% (IC95%: 1,1-3,2%)]. Conclusiones Los bajos niveles de portadores asintomaticos de infeccion por COVID-19 obtenidos en la poblacion quirurgica de los hospitales de Cataluna tras el reinicio de la actividad quirurgica muestran que la mayoria de pacientes se pudieron someter a procedimientos quirurgicos sin los riesgos de las complicaciones asociadas al COVID-19 en el periodo perioperatorio.

Fundamento y objetivo Conocer y cuantificar el peso de la actividad anestesica no quirurgica en Cataluna (Espana) en el ano 2003. Pacientes y metodo Estudio prospectivo de las anestesias no quirurgicas realizadas en 131 hospitales catalanes en 14 dias del 2003. Se analizaron: caracteristicas de los pacientes, tecnicas anestesicas, procedimientos, duracion, tipo de actividad, tipos de centros y distribucion geografica. Resultados Las anestesias no quirurgicas representaron el 10,4% del total de anestesias. De estos procedimientos, la endoscopia digestive represento un 70,4%, el tratamiento electroconvulsivo el 11,7%, la radiologia un 11,5% y las cardioversiones un 1,5%. El 73,7% de estos procedimientos se realizaron fuera de quirofano. Hubo un predominio de actividad programada realizada ambulatoriamente bajo sedacion o anestesia general. Las endoscopias digestivas mas representativas fueron la colonoscopia y la gastroscopia, realizadas mayoritariamente en centros privados. Conclusiones La anestesia para procedimientos no quirurgicos, especialmente endoscopias digestivas, fue superior al 10% de todas las anestesias. Estas tecnicas tienden a aumentar y es necesario conocer su frecuencia para una correcta planificacion y para adelantar las estrategias formativas y organizativas.

Fundamento y objetivo Analizar las caracteristicas de los pacientes en los extremos de la edad y conocer el tipo y frecuencia de procedimientos para los que se administra anestesia. Pacientes y metodo De los cuestionarios de la encuesta ANESCAT 2003 se analizaron los datos registrados en pacientes menores de 14 anos (grupo pediatria) y mayores de 65 (grupo geriatria). Resultados El porcentaje de anestesias en pacientes menores de 14 anos fue el 6,3% del total y en mayores de 65, el 32,9%. Se administro anestesia a 2 ninos por cada nina, mientras que el 55% de los mayores de 65 anos fueron mujeres. Los procedimientos con anesthesia mas frecuentes en menores de 14 anos fueron la amigdalectomia y/o la adenoidectomia (19,3%), los procedimientos no quirurgicos (11,5%), la circuncision (10,6%), la herniorrafia inguinal (8,3%) y la apendicectomia (4,2%); en la poblacion geriatrica fueron la cirugia de cataratas (31,9%), los procedimientos no quirurgicos (9,5%), la herniorrafia inguinal (4,4%), la sustitucion total de rodilla (3,6%), la cirugia transuretral de vejiga (3,2%) y la reparacion de la fractura del cuello de femur (2,6%). Debido a la alta incidencia de apendicectomia entre los 8 y 14 anos y de cirugia del cuello de femur por encima de los 85 anos, la proporcion de urgencias en estas edades fue aproximadamente del 30%. Conclusiones Los pacientes pediatricos y geriatricos y los procedimientos para los que se les administra anestesia presentan unas singularidades que deberan considerarse a corto plazo a fin de desarrollar nuevas estrategias terapeuticas e introducir cambios en la organizacion sanitaria.

This arm of the ANESCAT survey sought to characterize and quantify nonsurgical anesthesia practice in Catalonia, Spain.Information about anesthesia for nonsurgical procedures in 131 Catalan hospitals was gathered prospectively on 14 days in 2003. We analyzed patient characteristics, anesthetic techniques, procedures, duration, interventional context for the anesthetic procedure, type of hospital, and geographic distribution.Nonsurgical anesthesia accounted for 10.4% of all acts. Endoscopy of the digestive tract accounted for 70.4% of all nonsurgical procedures, electroconvulsive treatment for 11.7%, radiology for 11.5%, and electrical cardioversion for 1.5%. Anesthesia was provided outside an operating room in 73.7% of the cases. Most procedures were scheduled to be performed in outpatients under sedation or general anesthesia. The most commonly performed digestive tract endoscopic examinations were colonoscopy and gastroscopy, and most took place in private hospitals.Over 10% of anesthesia practice is for nonsurgical procedures and digestive tract endoscopy accounts for the largest proportion of such practice. As the trend is for such procedures to increase in number, their frequency should be studied so that organization and training can be planned.

The objective of this arm of the ANESCAT 2003 study was to analyze the characteristics of the youngest and oldest patients receiving anesthesia in Catalonia, Spain, and the procedures for which they require it.We analyzed data from questionnaires pertaining to pediatric (under age 14 years) and geriatric patients (older than age 65 years).Pediatric patients underwent 6.3% of all anesthetic procedures and patients over 65 years old accounted for 32.9% of the sample population. Two of every 3 pediatric patients were males, whereas 55% of patients over age 65 years were females. The most frequently performed interventions requiring anesthesia in patients under 14 years of age were tonsillectomy and/or adenoidectomy (19.3%), nonsurgical procedures (11.5%), circumcision (10.6%), inguinal herniorrhaphy (8.3%), and appendectomy (4.2%). The most common procedures in elderly patients were cataract extraction (31.9%), nonsurgical procedures (9.5%), inguinal herniorrhaphy (4.4%), total knee replacement (3.6%), transurethral bladder surgery (3.2%), and repair of femoral neck fractures (2.6%). Because of the high incidence of appendectomy in patients between 8 and 14 years old and of femoral neck fractures in patients over 85 years old, the rate of emergency anesthesias in patients in those age brackets was around 30%.Pediatric and geriatric patients and the interventions for which they are administered anesthesia have particular features. Taking them into consideration in the short term would facilitate the development of new therapeutic strategies and the introduction of changes in health care organization.

A patient with severe coronary disease, who underwent inguinal hernia repair, suffered a cardiovascular collapse after anaesthetic induction and died. He had Kounis syndrome, which is the concurrence of acute coronary syndrome (ACS) with conditions associated with mast cell activation. We measured the serum tryptase level in this patient and in a group of ten other patients admitted to hospital with the diagnosis of ACS with ST elevation in order to determine the origin of these events.