Introduction: Awake craniotomy is useful to achieve wide brain resections of lesions in eloquent areas. Objective: To present the case of a patient who was operated on with the asleep-awake-asleep technique. Method: Anesthesia was induced with propofol-fentanyl-rocuronium and a laryngeal mask was placed. After scalp block, the propofol-fentanyl and lidocaine infusion was maintained until craniotomy was performed. The infusion rate was decreased and remained this way until the end of the intervention. Results: The patient was awakened thirteen minutes after the infusion was reduced. Good hemodynamic stability was maintained, without respiratory depression or other complications. The patient remained collaborative, answered questions, and mobilized his limbs. He had no postoperative complications. Discussion: Among the anesthetic techniques used in the world, asleep-awake-asleep is the most popular. However, it is an alternative not to put the patient back to sleep or re-instrument the airway. The most commonly used drugs are propofol-remifentanil, although the comparison with other opioids does not show significant differences, except for dexmedetomidine, which does represent an additional benefit. Conclusions: Awake craniotomy is possible to be performed in the hospital setting as long as there is a multidisciplinary team that agrees on the best medical actions for the patient.

Introduction: Coexistence with COVID-19 infection in Cuba is a current challenge of adaptation to all hospital and health settings, creation of protocols and new models of care. The airway approach in its different forms represents a risk of contamination of the health personnel. Objective: To describe the anesthetic considerations in laparoscopic and endoscopic procedures during the COVID-19 pandemic. Methods: A qualitative, action-research study was carried out, supported by the analysis of documents and participant observation of the actions taken in the National Center for Minimally-Invasive Surgery in the course of four months after the first case of COVID-19 was identified in Cuba. Results: Anesthetic recommendations were established for the action procedure during COVID-19 in the National Center for Minimally-Invasive Surgery, which dictate the actions for the treatment of patients and the protection of workers. This makes it possible to maintain the quality of surgical medical services in these risk settings. Conclusions: Assessment and standardized anesthetic treatment of patients in the face of the COVID-19 outbreak and in the post-COVID phase allows optimizing the safety of the patient and the healthcare personnel. It is important to comply with the protocols aimed at controlling strictly the surgical setting, proper use of personal protective equipment, reduction of aerosols with barrier methods, and disinfection of the room and equipment at the conclusion of the intervention.

Introduction: Degenerative disc disease is a frequent condition and one of the main reasons to attend the consultation. It generates high rates of disability, useful years lost, as well as high economic costs for medical assistance and large monetary losses. Its treatment is generally conservative, although novel biological therapies are currently included. Objective: To describe the main biological properties that make platelet-rich plasma an effective therapy against degenerative disc disease. Methods: A nonsystematic review of the bibliography was carried out based on articles published, during the last ten years, in databases indexed in Infomed, such as Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, and LILACS, in Spanish, English and Portuguese. Development: Clinical-epidemiological characteristics of degenerative disc disease were presented, as well as the biological properties that allow platelet-rich plasma to have an active function in the regeneration of the intervertebral disc or the delay of its degradation cascade. The main studies are highlighted, according to the route of administration of platelet-rich plasma and their results. Conclusions: According to what has been published by authors, platelet-rich plasma is an effective alternative in the treatment of degenerative disc disease, due to the production of factors derived from platelets, which intervene in the degeneration of the intervertebral disc, being the intradiscal pathway the most used.

Introduction: Pulmonary arterial hypertension is a disease with low incidence in the pregnant woman, although it brings about high mortality once presented. Timely diagnosis and adequate perioeprative management minimize the risk of fatal outcome for both mother and fetus. Objective: To describe pulmonary arterial hypertension and its anesthetic management in the term pregnant woman. Case presentation: 23-year-old female patient, with health history and gestational age of 35.2 weeks. After presenting back pain and chest burning associated with exertion, palpitations, dyspnea and right bundle branch block in the electrocardiogram, the patient was admitted to the intensive care unit with suspected pulmonary thromboembolism, which was ruled out due to the confirmatory diagnosis of pulmonary hypertension after performing computerized tomography angiography and echocardiography. Scheduled cesarean section was decided to be perform using the regional peridural technique, without complications for both the mother and the child. After two days under intensive surveillance, she was transferred to her primary hospital. Conclusions: The route of delivery, as well as an adequate choice of the anesthetic technique, can be the difference between success and fatality. Regional techniques are usually recommended over the general anesthesia technique, as long as there are no contraindications.

Introduction: The process of improvement for professionals dedicated to surgical specialties and preoperative care of patients is vital and constitutes a way to manage the updating of knowledge and skills. These favor the increase in the quality of performance, a fact aimed at avoiding surgical suspensions, which often have overlapping limitations and inadequacies of medical personnel. Objective: To identify the theoretical foundations supporting professional improvement and performance of general surgeons in view of improving the quality of preoperative care. Methods: Analysis-synthesis, the historical-logical method, systematization, the hermeneutic-dialectic method, scientific observation and documentary analysis were used. Development: In the literature, there are dissimilar articles about the improvement of professional performance. These propose professional improvement strategies leading to the undeniable improvement in the quality of care provided to patients; the interrelation and interconnection between improvement and professional performance to manage the updating of knowledge and skills in preoperative care constitutes the fundamental link. Conclusion: The present work allowed identifying and commenting about the theoretical foundations necessary for the process of professional improvement and aimed at the improvement of professional performance of general surgeons in preoperative care, demonstrating a direct relationship between both categories.

Introduction: There are multiple articles published that address the subject of open science and its importance for society, especially for the research community. This constitutes, inevitably, the present and future of scientific journals as a method of expanding research with high quality and credibility. Open science, as a movement, has several components including the management of citations and references of data, codes and materials, which support the need for authors to have available the underlying content of the articles published and constituting the base for the results obtained in each investigation. Objective: Assessment of the efficacy of improved recovery protocols in cardiac surgery. Methods: The proposed protocol was prepared by the main researcher Cuban public registry of clinical trials, and is described according to the recommendations of the international checklist for clinical trials, SPIRIT. Conclusions: They would be related to whether it can be demonstrated, after the end of the investigation, if the protocol reason for the intervention is better, equal to, or worse than the control protocol.

Introduction: Ischemic heart disease is frequent, has different manifestation forms, and predominates among diseases leading to patient admission into emergency units and hospital admissions in general. Objective: To deepen the knowledge of patients with ischemic heart disease in a municipal intensive care unit. Method: A descriptive and cross-sectional study was carried out of 528 patients who were admitted into the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital in Contramaestre Municipality, Santiago de Cuba, with a diagnosis of ischemic heart disease, from January 2016 to June of 2019. The variables used were age group, sex, diagnosis at admission, personal pathological history, hospital stay, and status at discharge. We used percentage to summarize the information, as well as the chi-square test to identify statistical association. Results: There was a predominance of males and ages between 60-70 and 36-59 years. Acute myocardial infarction and the combination of three or more risk factors were more frequent. The highest number of deaths occurred in the first three days after admission and among patients with invasive mechanical ventilation. Conclusions: The characteristics of cardiovascular diseases continues to be a major health concern, as long as they are appearing at increasingly earlier ages. In severe cases, mortality can occur in the first seventy-two hours.

Introduction: Study and treatment of pain has been one of the most important concerns in the last thirty years in the worldwide medical field. For several decades, international studies have been carried out on the effect of tramadol and lidocaine as intraoperative analgesics, in order to achieve adequate analgesia during surgical procedures and the immediate postoperative period. Objective: To compare the analgesic effect of tramadol and lidocaine during the intraoperative period in canines scheduled for surgical intervention. Method: A prospective, comparative study was carried out with animals scheduled for surgical treatment due to peripheral tumors. Ten animals were included, divided into two groups: the control group, which received lidocaine without preservation in continuous infusion during the surgical procedure, and group 1, which was administered intravenous tramadol prior to the surgical act. Hemodynamic and oxygenation variables were assessed as indirect indicators of intraoperative pain. Results: The sample was homogeneous for age and sex. The behavior of the hemodynamic variables was more stable during the lidocaine infusion. Peripheral oxygen saturation was similar in both drugs, as well as temperature. Conclusions: Intravenous infusion of lidocaine without preservation during the intraoperative period in oncological canines showed better analgesic effectiveness compared to tramadol applied preoperatively, according to the parameters assessed.

Introduction: The selection of preoperative laboratory tests (specific tests or imaging tests) should be done, as a complementary measure, in the case of clinical suspicion. Indiscriminate and routine request is unnecessary and implies additional costs for the institution, in addition to the possibility of false positive results, with more or less serious repercussions for patients. Objective: To highlight the results and the clinical-anesthetic repercussion of complementary preoperative examinations in ASA-I patients who arrive for ambulatory surgery at Comandante Pinares General Teaching Hospital in San Cristóbal Municipality, Artemisa Province, during the year 2017. Method: An observational, descriptive, cross-sectional study was carried out at Comandante Pinares General Teaching Hospital in San Cristóbal Municipality, Artemisa Province, during the year 2017. The universe was represented by 823 patients who underwent ambulatory surgery. The sample consisted of 394 patients, following nonprobabilistic, intentional selection criteria. Results: The sex with the highest prevalence of surgeries was the female sex (65.98%). The most frequent ages were between 18 and 30 years. The most performed elective surgery was cholecystectomy (43.18%). Regarding the paraclinical examinations performed, a low incidence of alterations was detected; the perioperative complication detected was hypertensive crisis (0.50%). Conclusion: The results of the complementary examinations were normal in most of the patients, without repercussions or changes in the clinical anesthetic behavior. In addition, they generated high expenses for the health institution.

Introduction: The prognosis of dying from digestive bleeding allows individualizing treatment and reducing mortality. Objectives: To identify the prognostic factors of mortality due to nonvariceal gastrointestinal bleeding in seriously-ill patients. Methods: Cases and controls were studied in patients admitted to the intensive care unit of Joaquín Albarrán Domínguez Clinical-Surgical Teaching Hospital, between January 1, 2018 and December 31, 2019. The universe consisted of 1060 patients, 154 of which were selected to make up the sample (137 controls and 17 cases). Chi-square and odds ratio (CI: 95%) were applied. Results: Of the total of patients studied, 11.3% died, the average age was 69±11.58 (control group) and 75±11.42 (case group). Alterations in acid-base balance accounted for 7.4 as risk of dying (CI: 95%; 2.5-21.9), hypoxia accounted for 1.1 (CI: 95%; 0.41-3.2), variations in potassium accounted for 4.9 (CI: 95%; 1.54-16.1), hyperlacthemia accounted for 16.9 (CI: 95%; 5.3-52.0), and sodium deviations accounted for 6.5 (CI: 95%; 0.8-51, 4), mechanical ventilation accounted for 2.17 (CI: 95%; 0.6-7.0), vasoactive amines support accounted for 16.9 (CI: 95%; 5.30-52.0), red blood cell transfusion accounted for 11.7 (CI: 95%; 3.1-4.3), dialysis treatment accounted for 47.5 (CI: 95%; 8.6-258.0), and complications accounted for 3.4 (CI: 95%; 1.15-10.4). Endoscopic treatment was 93.5% in the control group and 41.3% in the case group, with odds ratio at 0.04 (CI: 95%; 0.01-0.15). Conclusions: The prognostic factors identified were alterations in pH, sodium, potassium, elevated lactate, mechanical ventilation, transfusions of more than 250 mL of red blood cells, vasoactive amine support, dialysis treatment, and complications related to bleeding. Endoscopic treatment was a protective factor.