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1.
Rev. cuba. anestesiol. reanim ; 19(3): e653, sept.-dic. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1138888

ABSTRACT

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 una 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 carotideo. Se observa 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(AU) .


Introduction: Takayasu arteritis is an inflammatory disease that affects the aorta and its branches, and shows a predilection for the Asian population. Objective: To describe anesthetic management in an obstetric patient with Takayasu arteritis. Case presentation: Female patient, 20 years old, 39 weeks of pregnancy, a history of Takayasu arteritis. At six months of gestation, the first symptoms of the disease appeared. Diagnosis is confirmed through CT angiography of the supra-aortic trunk and neck vessels, in addition to carotid Doppler. Occlusive vascular disorders, as well as concentric stenosis of both carotids and the main branches of the aortic arch are observed. Finally, the diagnosis of type I Takayasu arteritis was confirmed. At the end of her pregnancy, an elective cesarean section was decided to avoid labor. Conclusions: Obstetric anesthesia for patients with this disease is highly complicated due to its complex management, observation and interpretation of multiparametric and imaging monitoring. During anesthetic conduction, strict hemodynamic control is essential, avoiding low blood flow syndrome and maternal or fetal ischemic damage(AU)


Subject(s)
Humans , Female , Pregnancy , Young Adult , Takayasu Arteritis/complications , Anesthesia, Obstetrical/methods
2.
Rev. cuba. anestesiol. reanim ; 18(3): e505, sept.-dic. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1093115

ABSTRACT

Introducción: El paro cardiaco en gestantes y la cesárea perimorten son infrecuentes. Estas constituyen catástrofes médicas que precisan atención inmediata. Realizar este proceder según normas adecuadas brinda mejores opciones a la madre y el feto. Cuba presta especial atención al binomio materno fetal, para ello emplea grandes recursos humanos y tecnológicos. Objetivo: Actualizar la información acerca de cesárea perimorten. Métodos: Se realizó una revisión en bases de datos que permitiese encontrar descripciones epidemiológicas, informes de casos, series de casos, comunicaciones personales, y estudios en diferentes contextos sanitarios, los cuales sirvieran de evidencia científica del tema. Resultados: El paro cardiaco en embarazadas es un evento infrecuente, la realización de una cesárea perimorten con tiempo reducido (4-5 min) resultó una opción efectiva. El trabajo del equipo multidisciplinario basado en protocolos tiene una función que beneficia tanto a la madre como al feto. Actualmente se recomienda el concepto de histerotomía resucitadora que refleja la optimización de los esfuerzos realizados en la reanimación. La muerte materna por anestesia es una emergencia médica que requiere especial atención. Existen asociaciones médicas que preconizan las escalas de cuidados precoces en gestantes graves, con un entrenamiento actualizado y con estrategias novedosas para obtener mejores resultados. Conclusiones: El estudio del paro cardiaco en gestantes, la cesárea perimorten y la muerte materna relacionada con la anestesia son importantes. La creación de grupos multidisciplinarios y grupos bien entrenados son la mejor opción en estas circunstancias. Se recomienda incrementar el estudio y entrenamiento para ofrecer las mejores opciones al binomio materno-fetal(AU)


Introduction: Cardiac arrest in pregnant women and perimortem cesarean section are rare. These are medical catastrophes that require immediate attention. Performing this procedure according to adequate standards provides better options for both the mother and the fetus. Cuba pays special attention to the maternal-fetal binomial, for which large amounts of human and technological resources are used. Objective: To update the information about perimortem cesarean section. Methods: A database review was carried out to find epidemiological descriptions, case reports, case series, personal communications, and studies in different health contexts, which would serve as scientific evidence on the subject. Results: Cardiac arrest in pregnant women is a rare event; the performance of a perimortem cesarean section with reduced time (4-5 min) was an effective option. The work of the multidisciplinary team based on protocols has a function that benefits both the mother and the fetus. Currently, the concept of resuscitative hysterotomy is recommended, which reflects the optimization of the resuscitation efforts. Maternal death by anesthesia is a medical emergency that requires special attention. There are medical associations that advocate the scales of early care in pregnant women, with updated training and innovative strategies to obtain better outcomes. Conclusions: The study of cardiac arrest in pregnant women, perimortem caesarean section and anesthesia-related maternal death are important. The creation of multidisciplinary groups and well-trained groups are the best option in these circumstances. It is recommended to increase the study and training to offer the best options to the maternal-fetal binomial(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/prevention & control , Cesarean Section/mortality , Hysterotomy/methods , Heart Arrest/complications , Anesthesia, Obstetrical/mortality , Pregnancy Complications/mortality
4.
Rev. bras. anestesiol ; 69(6): 631-634, nov.-Dec. 2019.
Article in English | LILACS | ID: biblio-1057483

ABSTRACT

Abstract Loss of consciousness during spinal anesthesia is a rare but scary complication. This complication is generally related to severe hypotension and bradycardia, but in this case, the loss of consciousness occurred in a hemodynamically stable parturient patient. We present a 31 years-old patient who underwent an emergency cesarean section. She lost consciousness and had apnea that started 10 minutes after successful spinal anesthesia and repeated three times for a total of 25 minutes, despite the stable hemodynamics of the patient. The case was considered a subdural block, and the patient was provided with respiratory support. The subdural block is expected to start slowly (approximately 15-20 minutes), but in this case, after about 10 minutes of receiving anesthesia, the patient suddenly had a loss of consciousness. After the recovery of consciousness and return of spontaneous respiration, the level of a sensory block of the patient, who was cooperative and oriented, was T4. There were motor blocks in both lower extremities. Four hours after intrathecal injection, both the sensory and motor blocks ended, and she was discharged two days later with no complications. Hence, patients who receive spinal anesthesia should be closely observed for any such undesirable complications.


Resumo A perda de consciência durante a raquianestesia é uma complicação rara, mas assustadora. Essa complicação geralmente está relacionada à grave hipotensão e bradicardia, mas, neste caso, a perda de consciência ocorreu em uma paciente parturiente hemodinamicamente estável. Apresentamos o caso de uma paciente de 31 anos, submetida a uma cesariana de emergência. A paciente perdeu a consciência e apresentou apneia que teve início 10 minutos após a raquianestesia bem-sucedida e repetiu o episódio três vezes por 25 minutos, a despeito de sua hemodinâmica estável. O caso foi considerado como um bloqueio subdural e a paciente recebeu suporte respiratório. Espera-se que o bloqueio subdural inicie lentamente (aproximadamente 15-20 minutos), mas, neste caso, cerca de 10 minutos após a anestesia, a paciente repentinamente perdeu a consciência. Após a recuperação da consciência e o retorno da respiração espontânea, a paciente que estava orientada e cooperativa apresentou nível de bloqueio sensorial em T4. Havia bloqueio motor em ambas as extremidades inferiores. O bloqueio sensório-motor terminou quatro horas após a injeção intratecal e a paciente recebeu alta hospitalar dois dias depois, sem complicações. Considerando o exposto, os pacientes que recebem raquianestesia devem ser atentamente observados para quaisquer complicações indesejáveis.


Subject(s)
Humans , Female , Pregnancy , Adult , Unconsciousness/etiology , Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal/adverse effects , Cesarean Section/methods , Hemodynamics/physiology , Anesthesia, Obstetrical/methods , Anesthesia, Spinal/methods
5.
Rev. bras. anestesiol ; 69(3): 311-314, May-June 2019. graf
Article in English | LILACS | ID: biblio-1013425

ABSTRACT

Abstract Reversible cerebral vasoconstriction syndrome is a cerebrovascular disorder leading to multifocal arterial constriction and dilation. Reversible cerebral vasoconstriction syndrome is possibly caused by transient deregulation of cerebral vascular tone. We report a rare case of a patient with chief complain of postpartum headache, was later diagnosed as a case of reversible cerebral vasoconstriction syndrome. A young full term primigravida with good uterine contraction admitted to labour room. Later she complained of leaking per vagina and on examination meconium stained liquor was noted. Caesarean delivery under spinal anesthesia was done and intra-operative period was uneventful. Both mother and baby were normal and shifted to postoperative ward and nursery respectively. In postoperative ward, mother complained of severe headache after 1 h and later developed seizure. Midazolam was given intravenously and was intubated and transferred to critical care unit for further investigation and management. Non contrast computerised tomography scan of brain showed right occipital intracerebral as well as subarachnoid bleed. CT angiography showed right vertebral artery narrowing without any other vascular malformation. Patient was managed in critical care unit for 2 days and then extubated and shifted to high dependency ward after a day observation and discharged 3 days later after a full uneventful recovery.


Resumo A síndrome de vasoconstrição cerebral reversível é uma doença cerebrovascular que leva à constrição e dilatação arterial multifocal. A síndrome de vasoconstrição cerebral reversível é possivelmente causada pela desregulação transitória do tônus vascular cerebral. Relatamos um caso raro de uma paciente com queixa principal de cefaleia pós-parto, posteriormente diagnosticada como um caso de síndrome de vasoconstrição cerebral reversível. A jovem primigesta a termo apresentando boa contração uterina foi internada em sala de parto. Mais tarde, a parturiente queixou-se de perda de líquido pela vagina e, ao exame, líquido amniótico manchado foi observado. O parto cesariano sob raquianestesia foi realizado, e não houve intercorrência no período intraoperatório. Tanto a mãe quanto o bebê estavam normais e foram transferidos para a sala de recuperação pós-operatória e berçário, respectivamente. Na sala de recuperação, a mãe queixou-se de forte dor de cabeça após uma hora e depois desenvolveu convulsão. Midazolam foi administrado por via intravenosa, e a paciente foi intubada e transferida para uma unidade de terapia intensiva para posterior investigação e tratamento. A tomografia computadorizada sem contraste do cérebro mostrou hemorragia intracerebral occipital direita e subaracnoide. A angiotomografia mostrou estreitamento da artéria vertebral direita, sem qualquer outra malformação vascular. A paciente foi tratada em unidade de terapia intensiva por dois dias e, em seguida, foi extubada e transferida para a ala de alta dependência onde permaneceu um dia em observação, recebendo alta hospitalar três dias depois, após uma recuperação completa e sem intercorrências.


Subject(s)
Humans , Female , Pregnancy , Adult , Vasoconstriction , Cerebrovascular Disorders/diagnostic imaging , Postpartum Period , Headache/etiology , Syndrome , Computed Tomography Angiography/methods , Headache/diagnostic imaging , Anesthesia, Obstetrical/methods , Anesthesia, Spinal/methods
6.
Rev. bras. anestesiol ; 69(1): 13-19, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-977430

ABSTRACT

Abstract Background and objectives: Hypothermia occurs in about 60% of patients under anesthesia and is generally not managed properly during short lasting surgical procedures. Hypothermia is associated with adverse clinical outcomes. The current study is designed to assess the effects of crystalloid warming on maternal and fetal outcomes in patients undergoing elective cesarean section with spinal anesthesia. Methods: In this prospective randomized controlled trial, sixty parturients scheduled for elective cesarean section with spinal anesthesia were randomly allocated to receive crystalloid at room temperature or warmed at 37 °C. Spinal anesthesia was performed at L3-L4 interspace with 10 mg of hyperbaric bupivacaine without adding opioids. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and 5-min intervals until the end of operation. The primary outcome was maternal core temperature at the end of cesarean section. Results: There was no difference for baseline tympanic temperature measurements but the difference was significant at the end of the operation (p = 0.004). Core temperature was 36.8 ± 0.5 °C at baseline and decreased to 36.3 ± 0.5 °C for isothermic warmed crystalloid group and baseline tympanic core temperature was 36.9 ± 0.4 °C and decreased to 35.8 ± 0.7 °C for room temperature group at the end of the operation. Shivering was observed in 43.3% in the control group. Hemodynamic parameter changes and demographic data were not significant between groups. Conclusions: Isothermic warming crystalloid prevents the decrease in core temperature during cesarean section with spinal anesthesia in full-term parturients. Fetal Apgar scores at first and fifth minute are higher with isothermic warming.


Resumo Justificativa e objetivos: A hipotermia ocorre em cerca de 60% dos pacientes sob anestesia e geralmente não é tratada adequadamente durante procedimentos cirúrgicos de curta duração. A hipotermia está associada a desfechos clínicos adversos. O presente estudo teve como objetivo avaliar os efeitos do aquecimento de cristaloides nas condições maternas e fetais em pacientes submetidas à cesariana eletiva com raquianestesia. Métodos: Neste estudo prospectivo, randômico e controlado, 60 parturientes agendadas para cesárea eletiva com raquianestesia foram distribuídas aleatoriamente para receber cristaloides à temperatura ambiente ou aquecidos a 37 °C. A raquianestesia foi realizada no interespaço L3-L4 com 10 mg de bupivacaína hiperbárica sem adição de opioides. Temperatura central, tremores e parâmetros hemodinâmicos foram medidos a cada minuto até o décimo minuto e em intervalos de 5 min até o fim da operação. O desfecho primário foi a temperatura central materna ao final da cesárea. Resultados: Não houve diferença nas mensurações basais da temperatura timpânica, mas a diferença foi significativa no fim da operação (p = 0,004). A temperatura central foi de 36,8 ± 0,5 °C na fase basal e diminuiu para 36,3 ± 0,5 °C no grupo com aquecimento isotérmico de cristaloides e a temperatura basal timpânica foi de 36,9 ± 0,4 °C e diminuiu para 35,8 ± 0,7 °C no grupo sem aquecimento das soluções no fim da operação. Tremores foram observados em 43,3% no grupo controle. Alterações nos parâmetros hemodinâmicos e dados demográficos não foram significantes entre os grupos. Conclusões: O aquecimento isotérmico de cristaloides previne a redução da temperatura central durante a cesariana com raquianestesia em parturientes a termo. Os escores de Apgar para os fetos no primeiro e quinto minutos são maiores com o aquecimento isotérmico.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Body Temperature/drug effects , Cesarean Section , Double-Blind Method , Fetus/drug effects , Crystalloid Solutions/therapeutic use , Hypothermia/therapy , Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal/adverse effects , Prospective Studies , Crystalloid Solutions/pharmacology , Hyperthermia, Induced/methods , Middle Aged
7.
Article in English | WPRIM | ID: wpr-759545

ABSTRACT

BACKGROUND: The trans-tracheal rapid insufflation of oxygen (TRIO) device is less commonly used and is an alternative to trans-tracheal jet ventilation for maintaining oxygenation in a “cannot intubate, cannot oxygenate” (CICO) scenario. CASE: We report the successful use of this device to maintain oxygenation after jet ventilator failure in a parturient who presented with the CICO scenario during the procedure for excision of laryngeal papilloma. CONCLUSIONS: A stepwise approach to the airway plan and preparation for an event of failure is essential for good materno-fetal outcomes. The TRIO device may result in inadequate ventilation that can lead to hypercarbia and respiratory acidosis. Hence, it should only be used as a temporizing measure before a definitive airway can be secured.


Subject(s)
Acidosis, Respiratory , Airway Management , Airway Obstruction , Anesthesia, Obstetrical , High-Frequency Jet Ventilation , Insufflation , Oxygen , Papilloma , Ventilation , Ventilators, Mechanical
8.
Article in English | WPRIM | ID: wpr-785850

ABSTRACT

PURPOSE: Pudendal neuralgia (PN) is a painful and disabling condition, which reduces the quality of life as well. Pudendal nerve infiltrations are essential for the diagnosis and the management of PN. The purpose of this study was to compare the effectiveness of finger-guided transvaginal pudendal nerve infiltration (TV-PNI) technique and the ultrasound-guided transgluteal pudendal nerve infiltration (TG-PNI) technique.METHODS: Forty patients who underwent PNI for the diagnosis of PN were evaluated. Thirty-five of these 40 patients, who were diagnosed as PN, underwent a total of 70 further unilateral PNI. All the patients underwent PNI for twice after the first diagnostic PNI, 1 week apart.RESULTS: In the ultrasound (US)-guided TG-PNI group, the success rate was 68.8% (11 of 16) in both “pain in the sitting position” and “pain in the region from the anus to the clitoris.” The success rate of blocks in the US-guided TG-PNI group was 75% (12 of 16) in terms of pain during/after intercourse. In the finger-guided TV-PNI group, the success rate was 84.2% in both “pain in the sitting position” and “pain in the region from the anus to the clitoris.” The success rate of blocks in the fingerguided TV-PNI group was 89.5% (17 of 19) in terms of pain during/after intercourse. There was no statistically significant difference in the success rate of the 3 assessed conditions between the 2 groups (P>0.05).CONCLUSIONS: The TV-PNI may be an alternative to US-guidance technique as a safe, simple, effective approach in pudendal nerve blocks.


Subject(s)
Anal Canal , Anesthesia, Obstetrical , Diagnosis , Humans , Nerve Block , Neuralgia , Pelvic Pain , Pudendal Nerve , Pudendal Neuralgia , Quality of Life , Ultrasonography , Ultrasonography, Interventional
9.
Rev. cuba. anestesiol. reanim ; 17(3): 1-7, set.-dic. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-991037

ABSTRACT

Introducción: La anestesia regional es la más empleada en la cesárea obstétrica. En particular, el uso de la anestesia intratecal tiene sus ventajas. Aunque la tasa de falla es baja, la aparición de este evento genera dificultades que merecen atención. Objetivo: Describir la conducta anestésica en una paciente obstétrica en la que falla la anestesia regional intratecal. Caso clínico: Paciente femenina, de 20 años a la que se le administró anestesia intratecal por el especialista. No hubo errores en la punción lumbar, esta se realizó con trócar 25 punta Whitacre. No se constató bloqueo sensitivo, motor ni simpático, por lo que se realizó anestesia general endotraqueal, la cual transcurrió sin dificultades. En el posoperatorio inmediato se observa hiperlaxitud articular lo que llevó a sospechar el diagnóstico. Este fue positivo conjuntamente con el servicio de Neurología, se determinó Síndrome de Ehlers danlos tipo III. Conclusiones: El índice de falla es muy bajo en anestesia suaracnoidea pero si se presenta un paciente de este tipo, debe descartarse por completo. Existen pocos casos documentados de resistencia a la anestesia local; pero si así fuera, debe estudiarse exhaustivamente para buscar estrategias que permitan un acto anestésico óptimo(AU)


Introduction: Regional anesthesia is the most used in obstetric caesarean section. In particular, the use of intrathecal anesthesia has its advantages. Although the failure rate is low, the onset of this event generates difficulties that deserve attention. Objective: To describe the anesthetic management in an obstetric patient with failure of regional intrathecal anesthesia. Clinical case: Female patient, aged 20 years, who was administered intrathecal anesthesia by the specialist. There were no errors in the lumbar puncture, this was done with a trocar 25 of Whitacre tip. No sensory, motor or sympathetic block was observed, so general endotracheal anesthesia was performed, which went on smoothly. In the immediate postoperative period, joint hypermobility was observed, leading to suspicion of the diagnosis. This was positive in conjunction with the Neurology service, Ehlers-Danlos syndrome type 3 was determined. Conclusions: The failure rate is very low for subarachnoid anesthesia. However, for a patient of this type, it should be completely ruled out. There are few documented cases of resistance to local anesthesia. If it were the case, it should be studied exhaustively to look for strategies that allow an optimal anesthetic management(AU)


Subject(s)
Humans , Female , Young Adult , Drug Resistance/genetics , Cesarean Section/methods , Anesthesia, Spinal/methods , Ehlers-Danlos Syndrome/complications , Anesthesia, Obstetrical/methods
10.
Rev. bras. anestesiol ; 68(6): 641-644, Nov.-Dec. 2018.
Article in English | LILACS | ID: biblio-977394

ABSTRACT

Abstract Introduction: Klippel-Trenaunay syndrome is a rare congenital vascular disease characterized by cutaneous hemangiomas, varicosities, and limb asymmetry, which may evolve with coagulation disorders and hemorrhage as those more frequent complications in pregnant patients. Pregnancy is not advised in women with this syndrome due to increased obstetrical risk. Case report: Female patient, 29 years old, 99 kg, 167 cm, BMI 35.4 kg.m−2, physical status ASA III, with 27 weeks of gestational age and diagnosis of Klippel-Trenaunay syndrome. She was admitted to attempt inhibition of preterm labor. As manifestations of Klippel-Trenaunay syndrome, the patient presented with cerebral and cutaneous hemangioma mainly in the trunk and lumbar region, paresis in the left upper and lower limbs, and limb asymmetry requiring the use of a walking stick. Physical examination revealed absence of airway vascular malformations and Mallampati class 3. Laboratory tests were normal and abdominal angiotomography showed irregular uterus, with multiple varices and vessels of arterial origin and bilateral periadnexal varices. She evolved with failure in preterm labor inhibition, and cesarean section under total intravenous anesthesia was indicated. Monitoring, central and peripheral venous access, radial artery catheterization, and diuresis were secured. Cesarean section was performed with median incision and longitudinal uterine body section for fetal extraction. Two episodes of arterial hypotension were seen intraoperatively. The postoperative evolution was uneventful. The choice of anesthesia was dependent on the clinical manifestations and the lack of imaging tests proving the absence of neuraxial hemangiomas.


Resumo Introdução: A síndrome de Klippel-Trenaunay é uma doença vascular congênita rara caracterizada por hemangiomas cutâneos, varicosidades e assimetria de membros, que pode evoluir com distúrbios de coagulação e hemorragia como complicações mais frequentes na paciente grávida. A gestação é desaconselhada nas mulheres portadoras dessa síndrome devido ao aumentado risco obstétrico. Relato de caso: Paciente com 29 anos, 99 kg e 167 cm, IMC 35,4 kg.m-2, estado físico ASA III, com 27 semanas de idade gestacional, com diagnóstico de síndrome de Klippel-Trenaunay, foi internada para tentativa de inibição de trabalho de parto prematuro. Como manifestações da síndrome de Klippel-Trenaunay apresentava hemangiomas cerebral e cutâneos, principalmente em tronco e região lombar, paresia em membros superior e inferior esquerdos e assimetria de membros, necessitando de bengala para locomoção. Ao exame físico: ausência de malformações vasculares em vias aéreas, escore 3 pela classificação de Mallampati; exames laboratoriais normais; angiotomografia computadorizada de abdômen mostrava útero irregular, com múltiplas varizes e vasos de permeio de origem arterial e varizes perianexiais bilaterais. Evoluiu com falha de inibição do trabalho de parto prematuro e foi indicada a cesariana sob anestesia geral venosa total. Monitoração, acesso venoso central e periférico, cateterização de artéria radial, diurese. Operação cesariana com incisão mediana e secção corporal longitudinal uterina para extração fetal. No intraoperatório, observaram-se dois episódios de hipotensão arterial. A evolução pós-operatória seguiu sem complicações ou intercorrências. A escolha da anestesia dependeu das manifestações clínicas e da falta de exames de imagem que comprovassem a ausência de hemangiomas no neuroeixo.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Pregnancy Complications, Cardiovascular , Cesarean Section , Klippel-Trenaunay-Weber Syndrome , Anesthesia, Obstetrical
11.
Gac. méd. boliv ; 41(1): 41-46, jun. 2018. ilus, graf, map, tab
Article in Spanish | LILACS | ID: biblio-953636

ABSTRACT

La hipotensión materna es una complicación común de la anestesia raquídea durante la cesárea. El bloqueo de receptores de serotonina 5-HT podría reducir la incidencia de hipotensión y el uso de vasopresores. Objetivo: eficacia del ondansetron como prevención de hipotensión materna posterior a anestesia raquídea. Métodos: un total de 72 pacientes de forma aleatorizada, ensayo clínico y simple ciego. Se administró ondansetron 5 minutos antes del bloqueo anestésico. Grupo O4 (4 mg), grupo O8 (8 mg) y grupo P (placebo) en jeringa de 10 ml, se midió frecuencia cardiaca, presión arterial media, nivel de dermatoma alcanzado, las puntuaciones de Apgar y complicaciones maternas. Resultados: existe diferencia significativa entre los grupos en cuanto a la incidencia de hipotensión y se observó que el requerimiento de vasopresor fue menor en el grupo O8 (p= 0,000), los eventos adversos maternos (p= 0, 087), fueron menores cuando se aplica ondansetron. Las puntuaciones del APGAR fueron similares en los grupos (p= 0,373). Conclusiones: se determina; que el uso de ondansetron atenúa la incidencia de hipotensión aunque no está claro la dosis exacta en las pacientes obstetras, además queda claro es que también disminuye el requerimiento de vasopresor, los efectos adversos como ser prurito, náuseas y vómitos. Limitaciones cantidad de pacientes de estudio y análisis gasométrico por falta de insumo en el hospital.


Maternal hypotension is a common complication of spinal anesthesia during cesarean section. Blocking serotonin 5-HT receptors could reduce the incidence of hypotension and the use of vasopressors. Objetive: efficacy of ondansetron as prevention of maternal hypotension after spinal anesthesia. Methods: a total of 72 patients randomized, clinic ensay and single-blind. Ondansetron was administered 5 minutes before the spinal anesthetic. Group O4 (4 mg), group O8 (8 mg) and group P (placeb) in a 10 ml syringe were measured heart rate, blood pressure mean, dermatome level reached, Apgar scores and maternal complications. Results: there was significant difference between the groups in terms of the incidence of hypotension and it was observed that the vasopressor requirement was lower in group O8 (p = 0,000), maternal adverse events (p = 0.087) were lower when ondansetron is applied. APGAR scores were similar in the groups (p = 0, 373). Conclusion: use of ondansetron is determined to attenuate the incidence of hypotension although the exact dose in obstetric patients is not clear, it is also clear that it also decreases the vasopressor requirement, adverse effects such as pruritus, nausea and vomiting. Limitations number of study patients and gasometric analysis due to lack of input in the hospital.


Subject(s)
Anesthesia, Obstetrical , Anesthesia, Spinal/methods , Pregnancy
13.
Rev. bras. anestesiol ; 68(1): 57-61, Jan.-Feb. 2018. tab
Article in English | LILACS | ID: biblio-897800

ABSTRACT

Abstract Background Post-extubation laryngospasm is a dangerous complication that should be managed promptly. Standard measures were described for its management. We aimed to compare the efficacy of propofol (0.5 mg.kg-1) vs. lidocaine (1.5 mg.kg-1) for treatment of resistant post-extubation laryngospasm in the obstetric patients, after failure of the standard measures. Method This study was conducted over 2 years on all obstetric patients scheduled for cesarean delivery. Post-extubation laryngospasm was initially managed with a standard protocol (removal of offending stimulus, jaw thrust, positive pressure ventilation with 100% oxygen). When this protocol failed, the tested drug was the second line (lidocaine in the first year and propofol in the second year). Lastly, succinylcholine was used when the tested drug failed. Results In lidocaine group, 5% of parturients developed post-extubation laryngospasm, 31.9% of them were successfully treated via standard protocol, and 68.1% required lidocaine treatment. Among these, 65.6% of patients treated with lidocaine responded successfully and 34.4% required succinylcholine to relieve laryngospasm. In propofol group, 4.7% of parturients developed post-extubation laryngospasm, 30.1% of them were successfully treated via standard protocol, and 69.9% required propofol treatment. Among these, 82.8% of patients treated with propofol responded successfully and 17.2% required succinylcholine to relieve laryngospasm. Conclusion Small dose of propofol (0.5 mg.kg-1) is marginally more effective than lidocaine (1.5 mg.kg-1) for the treatment of resistant post-extubation laryngospasm in obstetric patients, after failure of standard measures and before the use of muscle relaxants.


Resumo Justificativa O laringoespasmo pós-extubação é uma complicação perigosa que deve ser prontamente tratada. Medidas padrão para o seu manejo foram descritas. O nosso objetivo foi comparar a eficácia de propofol (0,5 mg.kg-1) versus lidocaína (1,5 mg.kg-1) no tratamento de laringoespasmo resistente pós-extubação em pacientes obstétricas após falha das medidas padrão. Método Este estudo foi conduzido ao longo de dois anos em todas as pacientes obstétricas programadas para cesariana. O laringoespasmo pós-extubação foi inicialmente tratado com um protocolo padrão (remoção do estímulo ofensivo, protrusão mandibular, ventilação com pressão positiva com oxigênio a 100%). Ao constatar a falha desse protocolo, o fármaco testado foi a segunda opção (lidocaína no primeiro ano e propofol no segundo ano). Por fim, succinilcolina foi usada quando houve falha do fármaco testado. Resultados No grupo lidocaína, 5% das parturientes desenvolveram laringoespasmo pós-extubação, 31,9% delas foram tratadas com sucesso via protocolo padrão e 68,1% precisaram de tratamento com lidocaína, das quais, 65,6% responderam com sucesso ao tratamento com lidocaína e 34,4% precisaram de succinilcolina para alívio do laringoespasmo. No grupo propofol, 4,7% das parturientes desenvolveram laringoespasmo pós-extubação, 30,1% delas foram tratadas com sucesso via protocolo padrão e 69,9% precisaram de tratamento com propofol, das quais, 82,8% responderam com sucesso ao tratamento com propofol e 17,2% precisaram de succinilcolina para alívio do laringoespasmo. Conclusão Uma pequena dose de propofol (0,5 mg.kg-1) é marginalmente mais eficaz do que lidocaína (1,5 mg.kg-1) no tratamento de laringoespasmo resistente pós-extubação em pacientes obstétricas, após falha das medidas padrão e antes do uso de relaxantes musculares.


Subject(s)
Humans , Female , Adult , Propofol/administration & dosage , Cesarean Section , Laryngismus/etiology , Laryngismus/drug therapy , Airway Extubation/adverse effects , Hypnotics and Sedatives/administration & dosage , Anesthesia, Obstetrical , Anesthetics, Local/administration & dosage , Lidocaine/administration & dosage , Prospective Studies
14.
Med. Afr. noire (En ligne) ; 65(05): 277-282, 2018. ilus
Article in French | AIM | ID: biblio-1266302

ABSTRACT

Le jumeau parasite est un type de siamois chez lequel un des jumeaux est représenté par une formation rudimentaire parasitant le jumeau principal. L'incidence des siamois est estimée de 1:50.000 à 1:100.000 naissances vivantes. Les siamois sont décrits en fonction des organes conjoints ou éventuellement partagés. La classification de Spencer est la plus classique. La séparation chirurgicale -si envisagée et réalisable- relève d'une prise en charge multidisciplinaire.La séparation d'un jumeau parasite est une intervention à risque per et post-opératoire élevé, nécessitant une exploration clinique, radiologique et physiologique notamment en ce qui concerne les organes conjoints ou fusionnés. Le risque anesthésique porte particulièrement sur l'intubation difficile, l'hémorragie, la transfusion massive, les troubles métaboliques. Pour partager notre expérience et discuter les principes de prise en charge, nous rapportons un cas d'anesthésie pour la séparation d'un cas de Craniopagus parasiticus réussi avec des suites post-opératoires sans complications


Subject(s)
Anesthesia, Obstetrical , Mali , Pregnancy, Twin , Twins, Conjoined/surgery
15.
Article in English | WPRIM | ID: wpr-714061

ABSTRACT

BACKGROUND: Laparoscopic procedures and ultrasonography are now commonly used in the obstetric field, and more non-obstetric procedures are being performed. However, little domestic data has been published on the topic. This present retrospective study investigated the clinical information and the effect on perinatal outcomes of non-obstetric surgery during pregnancy. METHODS: This retrospective study was performed using data of all adult pregnant women that underwent non-obstetric surgery at our institute between from July 2009 to December 2016. Data was collected from the institutional computerized database. The causes, types, and the gestational ages at surgery were collected as our primary outcomes. Basic characteristics of patients, operation times, anesthesia times, anesthetic methods, anesthetic agents, and adverse perinatal outcomes such as abortion or preterm delivery were evaluated as secondary outcomes. RESULTS: During the study period, there were 2,421 deliveries and 60 cases of non-obstetric surgery, an operation rate of 2.48%. The most common cause of non-obstetric surgery was abdominal surgery, followed by orthopedic surgery and neurosurgery. Most of abdominal surgeries were performed laparoscopically during the first trimester. The incidence of adverse perinatal outcomes was increased in the first trimester, was not related with anesthesia. CONCLUSIONS: The rate of non-obstetric surgery was found to be 2.48%, which was higher than those reported in previous domestic studies. This increase seems to have resulted from early diagnosis by ultrasonography and non-invasive surgery using laparoscopy. Adverse perinatal outcomes are not related with age, surgery and anesthetic-related factors but seem to be associated with surgery exposure stage, especially the first trimester.


Subject(s)
Adult , Anesthesia , Anesthesia, Obstetrical , Anesthetics , Early Diagnosis , Female , Gestational Age , Humans , Incidence , Laparoscopy , Neurosurgery , Orthopedics , Patient Outcome Assessment , Pregnancy Trimester, First , Pregnancy , Pregnant Women , Retrospective Studies , Ultrasonography
16.
Anest. analg. reanim ; 30(2): 61-82, dic. 2017. tab, ilus
Article in Spanish | LILACS | ID: biblio-887216

ABSTRACT

Objetivos: Conocer la incidencia de cefaleas postpunción dural (CPPD) en raquianestesia para cesárea y factores de riesgo reconocidos. Efectividad del tratamiento médico y necesidad de parche hemático peridural. Metodología: Estudio prospectivo, descriptivo, con seguimiento postoperatorio por 72 horas de 914 embarazadas que recibieron raquianestesia para cesárea en el Hospital de la Mujer durante 1 año. Datos registrados por anestesiólogo actuante, seguimiento por un residente. Al diagnosticar una CPPD, se instaló tratamiento según protocolo. Resultados: la incidencia de CPPD fue 2,6 casos/ 100 pacientes, 24 en la población estudiada. 66.7%, aparecieron a las 24 horas; 16,7% a las 48 horas. 54,2% mejoraron a las 24 horas, ninguna requirió parche hemático. 86,3% de las punciones fueron con agujan 25 punta de lápiz, 11,2% con 27 punta de lápiz 23 casos de CPPD para la primera y 1 caso para la segunda, no encontrando asociación estadística (p= 0,759). 76,6% fueron punción única, 15,2% 2 punciones, 7% más de 2. 80,7 % cesáreas urgencia, 65,2% en horario diurno. 42% realizadas por anestesiólogos, 54% por residentes. 8,6% tenían antecedente de cefalea y 2,7% antecedente de CPPD; encontrándose asociación estadística entre la primera y CPPD actual (p=0,001) y entre la segunda y la presencia de CPPD (p=0,004). Conclusiones: obtuvimos una incidencia de CPPD de 2,6%, concordante con datos de la literatura; la mayoría apareció a las 24 horas y todas mejoraron con tratamiento médico. Las pacientes con cefalea y CPPD previa presentaron un RR 5,8 y 5,4 respectivamente (IC 95%), no encontrando asociación con otros factores de riesgo.


Objectives: To know the incidence of post-dural puncture headaches (CPPD) in spinal anesthesia for caesarean section and recognized risk factors. Effectiveness of medical treatment and need for an epidural blood patch Methodology: Prospective, descriptive, postoperative follow-up for 72 hours of 914 pregnant women who received spinal anesthesia for cesarean section, Women 's Hospital during one year study. Data recorded by acting anesthesiologist monitoring by a resident. CPPD to diagnose, treatment was installed according to protocol. Results: CPPD incidence was 2.6 cases / 100 patients, 24 in the study population. 66.7% appeared at 24 hours; 16.7% at 48 hours. 54.2% improved within 24 hours, none required blood patch. 86.3% of punctures were 25G tip pen, 11.2% with 27G tip pen, 23 cases of CPPD for the first and 1 case for the second, finding no statistical association (p = 0.759). 76.6% were single puncture, 15.2% two punctures, 7% more than two. 80.7% cesarean urgency, 65.2% in daytime. 42% made by anesthesiologists, 54% by residents. 8.6% had a history of headache and 2.7% history of CPPD; statistical association was found between the first and current CPPD (p = 0.001) and between the second and the presence of CPPD (p = 0.004). Conclusions: We obtained a CPPD incidence of 2.6%, consistent with data from the literature; Most appeared within 24 hours and all improved with medical treatment. Patients with headache and previous PDCH presented RR 5.8 and 5.4 respectively (95% CI), and found no association with other risk factors.


Subject(s)
Humans , Cesarean Section , Post-Dural Puncture Headache/etiology , Post-Dural Puncture Headache/epidemiology , Anesthesia, Obstetrical/adverse effects , Postoperative Period , Epidemiology, Descriptive , Incidence , Prospective Studies , Risk Factors
17.
Rev. bras. anestesiol ; 67(5): 480-486, Sept-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-897763

ABSTRACT

Abstract Background and objectives Ultrasound-guided transversus abdominis plane block demonstrated efficacy in providing post-operative analgesia by prolonging the time to first analgesic requirement and reducing the total analgesic consumption. The surgical transversus abdominis plane block, a novel technique, can be performed safely in obese patients in whom muscle layers cannot be sufficiently exposed. Here, we compared applicability, efficacy and complications of surgical transversus abdominis plane and ultrasound-guided transversus abdominis plane blocks in obese pregnant women following cesarean section under general anesthesia. Methods Seventy-five pregnant women with pre- and post-pregnancy body mass index > 30 were randomized and allocated into two groups: Ultrasound-guided transversus abdominis plane block (UT group; n = 38) and surgical TAP block (ST group; n = 37). Visual analogue scale scores at post-operative 0, 2, 6, 12 and 24 hours (h), time to first analgesic requirement, total analgesic consumption amount in 24 h, post-operative side effects, complications and patient satisfaction were recorded. Results and conclusions Age, American Society of Anesthesiologist score, operative duration, body mass index, mean time to first analgesic requirement and total analgesic consumption in 24 h were similar between groups, while significant differences in pre- and post-pregnancy body mass index were observed between groups. Block procedure durations were 7 and 10 minutes in ST and UT groups, respectively. No significant differences in visual analogue scale scores were observed between the groups at all times; itching and nausea was observed in one (UT group) and four (UT and ST groups) patients, respectively. Surgical transversus abdominis plane block was safe in obese pregnant patients and provided similar post-operative analgesia to ultrasound-guided transversus abdominis plane block.


Resumo Justificativa e objetivos O bloqueio do plano transverso abdominal (TAP) guiado por ultrassom (US) demonstrou eficácia no fornecimento de analgesia no pós-operatório ao prolongar o tempo até a primeira necessidade de analgésico e reduzir o consumo total de analgésico. O bloqueio TAP cirúrgico (uma nova técnica) pode ser realizado com segurança em pacientes obesas nas quais as camadas musculares não podem ser suficientemente expostas. Comparamos a aplicabilidade, a eficácia e as complicações do bloqueio TAP cirúrgico e do bloqueio TAP-US em gestantes obesas submetidas à cesárea sob anestesia geral. Método Setenta e cinco mulheres grávidas com índice de massa corporal (IMC) pré e pós-gravidez > 30 foram randomicamente alocadas em dois grupos: bloqueio TAP-US (Grupo TAP-US, n = 38) e bloqueio TAP cirúrgico (Grupo TAP-C, n = 37). Os escores da escala visual analógica (VAS) nos tempos 0, 2, 6, 12 e 24 horas de pós-operatório, o tempo até a primeira necessidade de analgésico, o consumo total de analgésico em 24 horas, os efeitos colaterais no pós-operatório, as complicações e a satisfação do paciente foram registrados. Resultados e conclusões Idade, estado físico ASA, tempo cirúrgico, IMC, média de tempo até a primeira necessidade de analgésico e consumo total de analgésico em 24 horas foram semelhantes entre os grupos, enquanto diferenças significativas foram observadas entre os grupos em relação ao IMC pré- e pós-gravidez. As durações dos procedimentos de bloqueio foram de 7 e 10 minutos nos grupos TAP-US e TAP-C, respectivamente. Não houve diferença significativa nos escores VAS entre os grupos em todos os momentos; prurido e náusea foram observados em um paciente (Grupo TAP-US) e em quatro (Grupo TAP-C), respectivamente. O bloqueio TAP cirúrgico foi seguro nas pacientes grávidas obesas e forneceu analgesia similar à do bloqueio TAP-US no pós-operatório.


Subject(s)
Humans , Female , Pregnancy , Adult , Pain, Postoperative/prevention & control , Pregnancy Complications , Cesarean Section , Ultrasonography, Interventional , Anesthesia, General , Anesthesia, Obstetrical/methods , Nerve Block/methods , Obesity , Prospective Studies , Abdominal Muscles
18.
Rev. bras. anestesiol ; 67(5): 535-537, Sept-Oct. 2017.
Article in English | LILACS | ID: biblio-897760

ABSTRACT

Abstract I report a case of hypotension and bradycardia before spinal anesthesia in a pregnant woman with mild to moderate hypertension treated with nifedipine and methyldopa, scheduled for an elective cesarean delivery. She had the history of neurally-mediated syncopes. Two main factors (increased vagal tone and adverse effects of antihypertensive drugs) could explain the hypotension and bradycardia before spinal anesthesia. Monitoring allowed recognizing the problem and corrected it. Thus, it was avoided a disaster in anesthesia, as hemodynamic changes after spinal anesthesia, they would have joined to previous hypotension and bradycardia, which would have caused even a cardiac arrest.


Resumo Relato de um caso de hipotensão e bradicardia antes da raquianestesia em uma mulher grávida com hipertensão leve a moderada tratada com nifedipina e metildopa, programada para parto cesáreo eletivo. A paciente apresentava história de síncopes neuralmente mediadas. Dois fatores principais (aumento do tônus vagal e efeitos adversos de medicamentos anti-hipertensivos) poderiam explicar a hipotensão e bradicardia antes da raquianestesia. O monitoramento permitiu reconhecer o problema e corrigi-lo. Dessa forma, foi evitado um desastre em anestesia; assim como as alterações hemodinâmicas após a raquianestesia, esses fatores teriam se juntado à hipotensão e bradicardia anterior, o que poderia até ter causado uma parada cardíaca.


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications, Cardiovascular/diagnosis , Bradycardia/complications , Bradycardia/diagnosis , Cesarean Section , Elective Surgical Procedures , Hypertension, Pregnancy-Induced , Hypotension/complications , Hypotension/diagnosis , Anesthesia, Obstetrical , Anesthesia, Spinal , Preoperative Period
19.
Rev. bras. anestesiol ; 67(5): 538-540, Sept-Oct. 2017.
Article in English | LILACS | ID: biblio-897754

ABSTRACT

Abstract Dexmedetomidine is a highly selective α-2 agonist which has recently revolutionized our anesthesia and intensive care practice. An obstetric patient presented for emergency cesarean delivery under general anesthesia, with pre-eclampsia and postpartum hemorrhage. In carefully selected cases with refractory hypertension and postpartum hemorrhage, dexmedetomidine can be used for improving overall patient outcome. It was beneficial in controlling both the blood pressure and uterine bleeding during cesarean section in our patient.


Resumo Dexmedetomidina é um α2-agonista altamente seletivo que recentemente revolucionou a nossa prática de anestesia e tratamento intensivo. Uma paciente obstétrica foi admitida para cesariana de emergência sob anestesia geral, com pré-eclâmpsia e hemorragia pós-parto. Em casos cuidadosamente selecionados com hipertensão refratária e hemorragia pós-parto, dexmedetomidina pode ser usada para melhorar o resultado geral da paciente. O fármaco foi benéfico no controle tanto da pressão arterial quanto do sangramento uterino durante cesariana em nossa paciente.


Subject(s)
Humans , Female , Pregnancy , Adult , Analgesics, Non-Narcotic/therapeutic use , Dexmedetomidine/therapeutic use , Hypertension, Pregnancy-Induced , Postpartum Hemorrhage/etiology , Anesthesia, Obstetrical , Cesarean Section/methods , Emergency Treatment
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