Jeanina de Los Angeles Montero Galban

Perioperative patient safety remains a major challenge for healthcare systems worldwide, as preventable adverse events continue to contribute to postoperative morbidity, avoidable mortality, prolonged hospitalization, and increased healthcare costs. This narrative review aimed to analyze the epidemiological burden, clinical determinants, and organizational factors associated with preventable perioperative adverse events, emphasizing the contribution of epidemiological surveillance, safety culture, and continuous process improvement. Twenty scientific publications were examined, integrating international evidence with investigations conducted in Latin America. A descriptive and comparative analytical approach was employed, using the Define, Measure, Analyze, Improve, and Control (DMAIC) framework to organize the evaluation of patient safety challenges and preventive strategies. The reviewed evidence identified surgical adverse events affecting approximately 14.4% of patients, with potentially preventable events affecting 5.2%. International studies demonstrated reductions in postoperative complications and in-hospital mortality following the implementation of standardized surgical safety checklists and comprehensive perioperative safety systems. Latin American investigations documented a substantial burden of healthcare-associated adverse events, with nearly 60% of identified events considered potentially preventable in the Iberoamerican Study of Adverse Events. Additionally, institutional quality improvement initiatives demonstrated marked increases in anesthesia-related incident reporting, highlighting the importance of distinguishing improved surveillance capacity from changes in actual patient harm. The findings indicate that sustainable perioperative safety depends on coordinated clinical protocols, reliable epidemiological monitoring, multidisciplinary communication, institutional leadership, and continuous organizational learning. Strengthening these interconnected components may contribute to reducing avoidable harm and improving surgical care quality, particularly in healthcare environments characterized by heterogeneous resources and institutional capacities.

Pleuropulmonary complications remain a frequent cause of morbidity after upper abdominal surgery and are associated with prolonged hospitalization, greater need for respiratory support, and delayed postoperative recovery. This study analyzed current evidence regarding the prediction, prevention, and stepwise management of postoperative pulmonary complications in adult patients undergoing major upper abdominal procedures. A structured integrative review was conducted using the Scientific Method, incorporating randomized clinical trials, observational studies, systematic reviews, meta-analyses, and relevant multicenter investigations. The evidence was organized into three main domains: perioperative risk prediction, preventive respiratory strategies, and escalation of postoperative respiratory support. The results showed that variables such as low preoperative oxygen saturation, advanced age, recent respiratory infection, anemia, prolonged surgery, emergency procedures, and upper abdominal incisions contribute to increased pulmonary risk. Preoperative physiotherapy and inspiratory muscle training were associated with reductions in postoperative respiratory complications in selected populations. Intraoperatively, lung-protective ventilation based on lower tidal volumes and individualized assessment of PEEP, respiratory compliance, and driving pressure was associated with improved pulmonary outcomes, whereas routine use of high PEEP did not consistently reduce complications. Postoperatively, prophylactic CPAP did not demonstrate universal benefit, while noninvasive ventilation reduced re-intubation and healthcare-associated infections in patients with established hypoxemic respiratory failure. Overall, the findings support a multimodal, risk-adapted, and stepwise perioperative strategy integrating early risk identification, pulmonary protection, postoperative surveillance, and timely escalation of respiratory support.

Arrhythmias and sudden cardiac death represent major challenges in sports cardiology because they may occur in apparently healthy athletes and may be related to structural heart disease, inherited channelopathies, coronary abnormalities, myocarditis, or other arrhythmogenic substrates. This study analyzed the principal factors associated with sudden cardiac death in athletes, with emphasis on cardiovascular preparticipation evaluation, electrocardiographic interpretation, characterization of ventricular arrhythmias, and perioperative cardiovascular management. An integrative review and analytical synthesis of clinical guidelines, consensus statements, epidemiological studies, systematic reviews, and relevant observational investigations was performed using evidence from recognized scientific databases and international cardiovascular societies. The findings demonstrated that sudden cardiac death is uncommon overall but is heterogeneously distributed, with higher incidence reported in specific groups such as male athletes, Black athletes, and Division I male basketball players. Hypertrophic cardiomyopathy, congenital coronary artery anomalies, myocarditis, arrhythmogenic cardiomyopathy, and inherited electrical disorders were identified among the principal underlying conditions. Athlete-specific electrocardiographic criteria reduced abnormal classifications while preserving the detection of clinically significant cardiovascular disease. The analysis of ventricular ectopy showed that morphology, complexity, exercise response, symptoms, and the presence of structural abnormalities are more clinically informative than arrhythmic burden alone. In the perioperative setting, high functional capacity does not eliminate cardiovascular risk, particularly in athletes with known or suspected arrhythmogenic substrates. Electrolyte disturbances, autonomic fluctuations, anesthetic agents, hypoxemia, hemodynamic changes, and surgical stress may facilitate perioperative rhythm disturbances. The evidence supports an integrated and individualized strategy combining preparticipation screening, targeted diagnostic testing, arrhythmic risk stratification, shared decision-making, and perioperative planning. This approach may improve the identification of high-risk athletes while avoiding unnecessary restrictions and promoting safer participation in sport and surgical care.

Carbon dioxide pneumoperitoneum is an essential component of advanced laparoscopic surgery, but the increase in intra-abdominal pressure required to create the surgical workspace produces important hemodynamic and respiratory alterations. This study analyzed the principal physiological effects of pneumoperitoneum on cardiovascular performance and respiratory mechanics, considering the influence of insufflation pressure, patient positioning, obesity, duration of surgery, mechanical ventilation, and cardiopulmonary reserve. An analytical review of relevant physiological, anesthesiological, and surgical evidence was performed, integrating studies focused on venous return, preload, afterload, systemic and pulmonary vascular resistance, arterial pressure, stroke volume, cardiac output, respiratory compliance, airway pressures, diaphragmatic displacement, gas exchange, and carbon dioxide elimination. The findings showed that pneumoperitoneum can decrease cardiac output while simultaneously increasing mean arterial pressure and systemic vascular resistance, particularly when higher insufflation pressures are used. Respiratory effects were characterized by cephalad diaphragmatic displacement, reduced respiratory system compliance, increased peak and plateau airway pressures, and impaired regional ventilation. These changes were intensified by steep Trendelenburg positioning, prolonged procedures, and obesity. The evidence also demonstrated that arterial pressure alone may not accurately reflect circulatory performance and that elevated airway pressures should be interpreted in conjunction with compliance and thoracoabdominal mechanics. Overall, pneumoperitoneum represents a dynamic cardiopulmonary condition rather than an isolated surgical maneuver. Its physiological impact depends on the interaction between intra-abdominal pressure, ventilation, positioning, body habitus, and baseline cardiopulmonary function. Individualized insufflation pressures, respiratory settings, PEEP, hemodynamic monitoring, and perioperative management may reduce physiological stress and improve safety during complex laparoscopic and robotic-assisted procedures.

Precision medicine has progressively transformed anesthesiology by promoting individualized perioperative management based on biological, physiological, and technological information. Within this context, biomarker-guided anesthesia and real-time metabolic monitoring have emerged as promising approaches for improving patient safety, optimizing anesthetic interventions, and enhancing clinical outcomes in surgical and critically ill populations. This review analyzed current scientific evidence regarding the role of biomarkers, advanced physiological monitoring technologies, pharmacogenomics, artificial intelligence, and metabolic surveillance systems in precision anesthesia. A comprehensive review of the literature published between 2009 and 2025 was conducted using major biomedical databases, including PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, SpringerLink, Wiley Online Library, and the Cochrane Library. The findings demonstrated increasing utilization of cardiovascular and metabolic biomarkers, electroencephalographic monitoring, near-infrared spectroscopy, continuous glucose monitoring, lactate surveillance, advanced hemodynamic assessment, and artificial intelligence-supported decision systems. Collectively, these technologies contributed to improved risk stratification, earlier detection of physiological deterioration, optimization of anesthetic drug administration, enhanced postoperative recovery, and reduction of perioperative complications. The evidence also indicated that multimodal monitoring strategies consistently outperform isolated monitoring approaches by providing a more comprehensive representation of patient physiology. Furthermore, artificial intelligence and automated monitoring platforms showed significant potential for improving predictive accuracy and individualized clinical decision-making. Overall, biomarker-guided precision anesthesia and real-time metabolic monitoring represent transformative developments in perioperative and critical care medicine. The integration of biological indicators, advanced monitoring technologies, and data-driven clinical strategies supports a more personalized approach to anesthetic management and may contribute to safer, more effective, and outcome-oriented patient care. Continued research and technological standardization will be essential to facilitate broader implementation of precision anesthesia within future healthcare systems.