La mayoría de consultas en atención primaria y comunitaria son por dolor, de las cuales 25 % son dolores de tipo neuropático. En los últimos años diversos estudios han sugerido el uso de la toxina botulínica tipo A en el tratamiento de dicho dolor.1 En el estudio de Park J y otros2 realizado en 2017 en Corea, se expone que el mecanismo por el cual la toxina botulínica actúa sobre el dolor neuropático implica inhibir la liberación de mediadores inflamatorios y neurotransmisores periféricos de los nervios sensoriales. Al realizar este efecto ha demostrado ser eficaz para el dolor neuropático, como la neuralgia posherpética, la neuralgia del trigémino, la neuralgia periférica, la neuropatía diabética, el dolor neuropático intratable (como el dolor posterior al accidente cerebrovascular) y la lesión de la médula espinal.

Las grandes pandemias demuestran el verdadero carácter humanista de los pueblos, donde se comparten los recursos que se tienen y no lo que se sobra. Bajo este precepto una brigada del contingente cubano Henry Reeve partió hacia lo desconocido en tierras aztecas el 23 de abril de 2020 en virtud de la solidaridad que caracteriza al gran ejército de batas blancas en la mayor de las antillas. La nueva escalada internacional de agresiones y los repetidos intentos de desacreditar nuestra obra moral no permitieron despedidas ni aplausos, pero tampoco pudieron impedir el accionar de 586 colaboradores que por tercera vez en la historia de la cooperación médica cubana laboraron en suelo mexicano

Enseñanza de la medicina, informatización de la sociedad y libro electrónico. Carta al editor

Introduction: Residents should receive methodological knowledge for research. Objective: To evaluate the research activity of residents of Anesthesiology and Resuscitation. Method: We conducted a modified survey validated for specialists receiving training in Health Sciences from the Spanish Ministry of Health. This questionnaire was subjected to the criteria of five experts on the subject. Results: We conducted a survey with 91 residents who had an average age of 29 years ± 4 years; 68.1% were male. Second-year and fourth-year residents predominated, accounting for 34.1% and 30.8%, respectively. 91.2% responded that their training plan included research, 92.3% took courses on research methodology, 87.9% participated in research, and 86.8% valued the final work of the residence as useful. The mean score for the information received on research activities was 7.7 ± 2.4 points. The mean weekly hours dedicated to research was 4.4 ± 2.9 hours. The score given to support provided by the teacher was 7.5 ± 2.7 points and encouragement by the tutor to carry out research work was 6.2 ± 3.5 points. Conclusions: Generally speaking, the research activity is valued as good among residents. However, at this stage, in which the academic training of the specialty has the greatest weight, there is not enough growth or time to develop research.

Introduction: Perioperative mortality rate represents a global indicator for safe access to surgical and anesthesiological care. Objective: To characterize patients who deceased during the perioperative period in surgical interventions. Methods: A cross-sectional and descriptive study was carried out in the anesthesiology service of Arnaldo Milián Castro Clinical-Surgical Hospital, in Villa Clara Province, in the period from January 2015 to December 2018. The study population consisted of patients who received surgery within that hospital (N: 133 724). The sample consisted of patients who died during the intraoperative period and within the first 24 hours after surgery (n: 77). Results: The general perioperative mortality rate was 5.76/10 000. There was incidence of higher mortality among men (59.7%), elderlies (75.3%), patients with several associated comorbidities (51.9%), those classified as ASA-IV (41.5%), those belonging to group II for surgical risk (62.3%), cases of abdominal surgery (63.6%), emergency interventions (88.3%), patients under general anesthetic technique (84.4 %), and at 24 hours after the postoperative period (68.8%). Septic shock was the main cause of mortality (48.1%). Conclusions: There was a predominance of deaths among elderlies with associated comorbidities, high anesthetic, as well as surgical risk, who received emergency surgery under general anesthesia, being septic shock the main cause of death. The perioperative mortality rate was similar to that in nations of equivalent socioeconomic development.

Introduction: Postoperative nausea and vomiting are an unwanted sequel during the anesthetic recovery stage. Objective: To evaluate the usefulness of dexamethasone compared with ondansetron for the prevention of postoperative nausea and vomiting after major gynecological surgical procedures, under general orotracheal anesthesia. Method: A prospective, analytical and observational study was carried out with 84 patients older than 19 years of age, at Miguel Enríquez Hospital Clinical-Surgical Hospital, from October 2018 to September 2019, divided sequentially, in order of arrival at the surgical unit, into two groups. The group 1 was administered dexamethasone (4 mg intravenously), and the group 2 was administered ondansetron (4 mg), 30 min before the end of the surgery. Results: The average risk of postoperative nausea and vomiting prevailed significantly among patients aged 41-50 years. Excellent and good conditions predominated (p>0.05) in terms of effectiveness of prophylactic treatment. Headache prevailed significantly in the group 2. Most of the patients did not present adverse events. Conclusions: Ondansetron and dexamethasone are useful for postoperative nausea and vomiting prophylaxis among patients who received major gynecological surgery, under general orotracheal anesthesia, a reason why it is considered a safe treatment, with mild adverse events and easy control.

Introduction: Written documents of informed consent possess deficient quality, a reason why the need appears for a written format reflecting the patient’s autonomy, obtained through an educational information process. Objective: To design a unique, useful and complete document covering all ethical-legal aspects, based on the education of patients who access secondary health care services. Methods: Exploratory development study carried out in the period from October 1 to November 2, 2019. After systematization and consultation with experts, we designed a model assessed, through a survey and interview, by 30 teaching specialist physicians from the department of surgical sciences. The group satisfaction index (Iadov test) and the Delphy method were applied for consulting experts. In addition, absolute and relative frequencies were used. Results: The document was made up of three sections covering general and specific aspects about disease, others related to autonomy, in accordance with the principles of medical ethics. The group satisfaction index (0.86) was very satisfactory. Conclusions: The proposed document improves the process of informed consent and, consequently, the care of the patient admitted to secondary health care, according to the criteria of the surveyed professionals.

Introduction: The increase in life expectancy determines an increase in the incidence of diseases with surgical indication. Advances in surgical techniques, intensive care and deeper understanding of the aging process tend to favor the reduction of perioperative morbidity and mortality among geriatric patients. Objective: To determine the incidence of intraoperative and postoperative complications among geriatric patients during elective major abdominal surgery. Methods: A descriptive, cross-sectional and observational study was carried out with 373 geriatric patients scheduled for major abdominal surgery from January 2017 to December 2019 at Dr. Miguel Enríquez Clinical-Surgical Hospital. The incidence of perioperative complications was recorded, relating them to the study variables. Results: The most frequent complications were the cardiovascular ones. Mortality was low. Conclusions: The perioperative complications identified among the geriatric patients studied are related with previous diseases, with the type and extent of surgery, and with the surgical time.

Introduction: Written documents of informed consent possess deficient quality, a reason why the need appears for a written format reflecting the patient’s autonomy, obtained through an educational information process. Objective: To design a unique, useful and complete document covering all ethical-legal aspects, based on the education of patients who access secondary health care services. Methods: Exploratory development study carried out in the period from October 1 to November 2, 2019. After systematization and consultation with experts, we designed a model assessed, through a survey and interview, by 30 teaching specialist physicians from the department of surgical sciences. The group satisfaction index (Iadov test) and the Delphy method were applied for consulting experts. In addition, absolute and relative frequencies were used. Results: The document was made up of three sections covering general and specific aspects about disease, others related to autonomy, in accordance with the principles of medical ethics. The group satisfaction index (0.86) was very satisfactory. Conclusions: The proposed document improves the process of informed consent and, consequently, the care of the patient admitted to secondary health care, according to the criteria of the surveyed professionals.

Introduction: Suspension of the surgical intervention is a situation that causes inconveniences, goes against optimizing activities, reducing costs, avoiding loss of materials and developing the work with the highest quality. Objective: To describe the main causes for the suspension of elective surgery for eligible patients. Methods: A cross-sectional and descriptive study was carried out at Dr. Juan Bruno Zayas Alfonso General Teaching Hospital in Santiago de Cuba, in the period from September 2017 to September 2018. From a population of 4511 announced surgeries, a sample of 1289 patients was taken, who were interrupted for surgery during the anesthesia consultation and in the immediate preoperative period. Results: The specialty of general surgery presents the highest indicator (26.9%) of the total number of suspensions during consultation; thus, of the 798 suspensions during consultation, 476 (59.6%) were due to patients, and 341 were due to medical causes (42.7%), that is, more than half of the suspensions owed to clinical alterations. The hospital was attributed 386 suspensions, accounting for 29.9% of the total. Conclusions: The incidence of anesthetic-surgical suspensions is high both during anesthesiology consultation and in the immediate preoperative period. These, together with the causes related to the patient, constitute the most relevant medical-assistance practical experience and must be taken into consideration by the acting anesthesiologist, mainly in the presence of patients suffering from cardiovascular comorbidities.

Introduction: Cranioencephalic trauma corresponds to changes and alterations suffered by the brain, its meningeal envelopes, the cranial vault, or the epicranial soft tissues due to the action of damaging physical agents. Objective: To identify modifiable and non-modifiable risk factors that determine mortality in the immediate postoperative period among patients with acute head trauma. Methods: A prospective and longitudinal descriptive study was carried out with a sample of 38 patients who received surgery for head trauma, treated at Manuel Ascunce Domenech University Hospital, from 2016 to 2019. We worked with the following variables: age, sex, physical state, classification of cranioencephalic trauma, immediate complications, and mortality in the immediate postoperative period. Results: Surgical head trauma was frequent among young male patients who were evaluated as ASA-III. Patients with mild trauma, according to the Glasgow scale, predominated. Despite not having a significant association with mortality, cerebral edema, hyperglycemia and hypothermia were the most frequently found complications. Conclusions: Surgical head trauma was more frequent among young patients. Despite the complications presented, most of them left the emergency service alive.

Introduction: The quality criteria in radical oncological surgery are based on complete tumor removal, with free margins, without residual macroscopic disease, with adequate lymphadenectomy and minimal possible tumor manipulation. Despite achieving these objectives, non-visible residual disease or micrometastasis may remain, likely to grow and spread depending on tumor capacity and the host defenses. Objectives: To evaluate the influence of perioperative factors on the immunity of cancer patients operated on and the potential effect of anesthetic drugs on recurrence, as well as other perioperative factors that may affect long-term tumor spread. Methods: An electronic bibliographic search was carried out of the articles published in the last ten years and that fulfilled the established objective. Development: During the perioperative period, activation of the response to surgical stress triggers a series of complex neuroendocrine, humoral and immune reactions. Surgery, with unquestionable curative potential, is related to a state of immunosuppression due to activation of the hypothalamic-pituitary-adrenal axis and inflammation. On the other hand, anesthesia produces biomolecular changes that affect cellular immunity and the number of natural killers, which can influence cancer recurrence in the long term. Conclusions: To reduce surgical and psychological stress, to control surgical pain, to maintain normothermia, and a judicious blood transfusion, in addition to an anesthetic technique with reduced opiates usage, can be beneficial to protect the body antimetastatic immune response and can have a beneficial effect on oncological disease

Introducción: La arteritis de Takayasu es una enfermedad inflamatoria, que afecta la aorta y sus ramas y muestra predilección por la población asiática. Objetivo: Describir la conducción anestésica en paciente obstétrica con Arteritis de Takayasu. Presentación del caso: Paciente femenina, de 20 años de edad, con embarazo de 39 semanas, antecedentes de Arteritis de Takayasu. A los seis meses de gestación aparecieron los primeros síntomas de la enfermedad. Se confirma diagnostico a través de AngioTAC de tronco supraaórtico y vasos del cuello, además de Doppler carotídeo, observándose trastornos vasculares oclusivos, estenosis concéntrica de ambas carótidas y de principales ramas del cayado aórtico. Finalmente, se confirmó el diagnóstico de arteritis de Takayasu tipo I. Al término de su embarazo, se decide cesárea electiva para evitar el trabajo de parto. Conclusiones: La anestesia obstétrica para pacientes con esta enfermedad, es altamente complicada por su compleja conducción, observación e interpretación de la monitorización multiparamétrica e imagenológica. Durante la conducción anestésica, es imprescindible el control estricto hemodinámico, evitando síndrome de bajo flujo sanguíneo y daño isquémico materno o fetal.

Introduction: Laryngospasm is a complication feared by anesthesiologists. It is associated with bronchospasm, hypoxia, arrhythmias, aspiration of gastric contents, and cardiac arrest. It is more common among neonates and infants. It is closely related to the type of surgery and consists in an intense and prolonged closure of the glottis in response to direct or reflex glottic stimulation. Objective: To describe the management of reflex partial laryngospasm in a pediatric patient during a urological intervention. Case presentation: 18-month-old patient who received meatotomy. During surgery, he presented reflex partial laryngospasm managed with physical maneuvers, without the need to use medication or the mechanic airways ventilation. Conclusions: The maneuvers used are safe and effective for the management of reflex laryngospasm without the need to address the airway or using of medications. Satisfactory outcomes were achieved with a risk-benefit ratio in favor of the patient.

Introduction: Since the introduction of anesthesia in Cuba, the Spanish colony back then experienced progressive advances. Cuban doctors began to associate themselves by specialties, and the first doctors dedicated to the anesthesiological practice were integrated. Objective: To investigate the scientific association of anesthesiologists in Cuba and describe the activities carried out by them in their first decade of work. Method: A documentary and bibliographic study was carried out about the date and circumstances in which the scientific association of Cuban anesthesiologists began. The documentation of the Cuban Society of Anesthesiology was reviewed, as well as the authors private files. The historical-logical and chronological method was used. Development: It was found that, after several months of activity of a Management Committee, the National Society of Anesthesiology was founded. In its first decade, the new Society engaged in union struggles to improve the specialty and working conditions of its members. Outstanding physicians in that period gave their contribution to the progress of anesthesiology in republican Cuba, in addition to ensuring that their Society be integrated into the organizations and events of the specialty, among which being the founder of the World Federation of Anesthesiology Societies is an outstanding fact. Conclusions: The National Society of Anesthesiology was founded on September 12, 1950. In its first decade, it developed constant work for the development of the specialty and was integrated into regional and world anesthesiology organizations.

La comunicación científica es el proceso de compartir, diseminar y publicar resultados por parte de académicos e investigadores, y de esta forma generar nuevos contenidos disponibles para la comunidad científica global La Revista Cubana de Anestesiología y Reanimación desde sus inicios ha estado apegada a estos principios. Actualmente se encuentra indexada en Cumed, BVS, SciELO, SeCiMed, medigraphic, Latindex (catálogo 2.0), Google académico, Redib, DRJI, Lilacs y DOAJ, de acuerdo con las exigencias en materia de visibilidad para las publicaciones científicas El trabajo de todos estos años ha sido posible gracias a la estrecha relación entre los directivos y miembros del comité editorial con los investigadores, médicos, enfermeras, residentes y todos aquellos que han confiado los resultados de sus investigaciones para que sean conocidos a través de esta revista