Anestesia peridural caudal en neonatos: una alternativa segura para el anestesiólogo / Caudal peridural anesthesia in neonates: a safe alternative for the anesthesiologist

Introducción: Las técnicas de anestesia y analgesia regional en la población pediátrica garantizan la estabilidad hemodinámica y respiratoria. El uso de la anestesia caudal ha aumentado enormemente sobre todo para cirugías de abdomen inferior lo que ofrece ventajas sobre la anestesia general. Objetivo: Argumentar sobre la base de la mejor evidencia científica, la opinión de los autores en relación a la efectividad del uso de la anestesia caudal en los pacientes neonatos. Método: El marco inicial de búsqueda bibliográfica se constituyó por los artículos publicados acerca de la utilización de la anestesia caudal en neonatos. Las fuentes de información que se utilizaron fueron: Registro Cochrane central de ensayos clínicos controlados, Pubmed, LILACS, SciELO, Ebsco, Science, Google académico. Resultados: El bloqueo caudal es la aplicación de un anestésico local en el espacio peridural, pero a nivel sacro, lo que ocasiona un bloqueo de conducción en las raíces nerviosas que cubre la analgesia, no solo el período intraoperatorio sino también el posoperatorio, lo cual permite una adecuada estabilidad hemodinámica, reduce el sangrado, evita el uso de opioides, anestésicos generales y relajantes musculares. La necesidad de asistencia respiratoria se ve reducida. Conclusiones: Es una técnica segura y económica en ocasiones subvalorada en el recién nacido. Esto, junto a una más rápida recuperación, lleva a considerar la anestesia regional como una alternativa a la anestesia general(AU)

Introduction: Regional anesthesia and analgesia techniques in the pediatric population guarantee hemodynamic and respiratory stability. The use of caudal anesthesia has increased enormously, especially for lower abdominal surgeries, which offers advantages over general anesthesia. Objective: To argue, based upon the best scientific evidence, the opinion of the authors regarding the effectiveness of the use of caudal anesthesia in neonatal patients. Method: The initial framework for the bibliographic search consisted of the articles published about the use of caudal anesthesia in neonates. The sources of information were the Cochrane Central Register of Controlled Trials, Pubmed, LILACS, SciELO, Ebsco, Science, Google Scholar. Results: Caudal block is the application of a local anesthetic into the epidural space, but at the sacral level, which causes a conduction block in the nerve roots that covers analgesia, not only in the intraoperative period but also in the postoperative one, which allows adequate hemodynamic stability, reduces bleeding, avoids the use of opioids, general anesthetics and muscle relaxants. The need for respiratory support is reduced. Conclusions: It is a safe and economical technique, sometimes undervalued in the newborn. This, together with a faster recovery, leads to considering regional anesthesia as an alternative over general anesthesia(AU)

Horner's syndrome and paresthesia in the trigeminal nerve territory secondary to epidural analgesia for labor / Síndrome de Horner e parestesia do território do nervo trigêmeo secundário a analgesia peridural para trabalho de parto

Abstract Currently, epidural analgesia is a common procedure for labor analgesia. Although it is considered a safe technique, it is not without complications. Horner's syndrome and paresthesia within the trigeminal nerve distribution are rare complications of epidural analgesia. We report a case of a pregnant woman who developed Horner's syndrome and paresthesia within the distribution of the trigeminal nerve following epidural analgesia for the relief of labor pain.

Resumo A analgesia peridural é hoje em dia um procedimento comum para analgesia do trabalho de parto. Embora seja considerada uma técnica segura, não está isenta de complicações. A síndrome de Horner e a parestesia do território do nervo trigêmeo são complicações raras da analgesia peridural. Relatamos um caso de uma grávida que desenvolveu a síndrome de Horner e parestesia do território do nervo trigêmeo após analgesia peridural para o alívio da dor do trabalho de parto.

Observation on Cycling Stability Effect of Methoxamine at Low Dose in Cesarean Section / 中国药师

Objective:To investigate the cycling stability effect of methoxamine at low dose in cesarean section in order to find the optimal regimen for the prevention and treatment of hypotension during cesarean section. Methods:Totally 200 patients with scheduled cesarean section were selected and randomly divided into the experimental group and the control group with 100 ones in each. The ex-perimental group was anesthetized through L3-4 lumbar-peridural puncture immediately followed by the infusion of methoxamine, and the control group was anesthetized in the same way, and only when the blood pressure was dropped by more than 15%, the infusion of me-thoxamine was given immediately (2-3mg diluted to 20ml). The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate ( HR) were compared between the two groups at five time points of before spinal anesthesia ( T0 ) , 5 min after spinal anesthe-sia ( T1 ) , 10 min after spinal anesthesia ( T2 ) , 15 min after spinal anesthesia ( T3 ) and the end of the operation ( T4 ) . The umbilical arterial blood gas and the 1-minute Apgar score of the newborn were recorded, and the adverse reactions in the two groups were com-pared. Results:In T1-T3, SBP and DBP in the two groups were significantly lower than those at T0(P0.05), and HR in the control group was significantly lower than that in the experimental group in T1-T3(P0. 05). The incidence of adverse reactions in the experimental group was significantly lower than that in the control group (P<0. 05). Conclusion: The prophylactic use of methoxamine through micro pump can maintain the cycling stability of cesarean section with higher reliability and without adverse effects on the newborn.

Effects of peridural and general anesthesia on respiration and circulation in gynecological laparoscopic operation / 解放军医学杂志

Objective To compare the influences of peridural and general anesthesia on respiration and circulation in gynecological laparoscopic operation. Methods Fifty-six patients, underwent gynecological laparoscopic operation during June to October, 2003, are divided into two groups. The items of respiration and circulation recorded before and 10, 20, 30, 40min after pneumoperitoneum as well as 5 min after deflation abdomen were as follows: blood pressure (BP), heart rate (HR), sphygmus oxygen saturation (SpO_2), end-expiratory pressure of CO_2 (P_ ETCO_2), tidal volume, frequency of respiration, minute ventilation volume and airway pressure. Results The re-consciousness time after the operation in the peridural anesthesia group is significantly less than that in the general anesthesia group (P0.05). Conclusion In gynecological laparoscopic operation, no significant difference was found concerning the influence of the two anesthesia manners on respiration and circulation.