Comparative study between suprasternal and apical windows: a user-friendly cardiac output measurement for the anesthesiologist

Abstract Introduction Transthoracic echocardiography is a safe and readily available tool for noninvasive monitoring of Cardiac Output (CO). The use of the suprasternal window situated at the sternal notch can be an alternative approach for estimating blood flow. The present study aimed to compare two methods of CO calculation. We compared the descending aorta Velocity-Time Integral (VTI) measurement from the suprasternal window view with the standard technique to determine CO that uses VTI measurements from the LVOT (Left Ventricular Outflow Tract) view. We also aimed to find out whether after basic training a non-echocardiographer operator can obtain reproducible measurements of VTI using this approach. Methods In the first part of the study, 26 patients without known cardiovascular diseases were evaluated and VTI data were acquired from the suprasternal window by a non-echocardiographer and an echocardiographer. Next, 17 patients were evaluated by an echocardiographer only and VTI and CO measurements were obtained from suprasternal and apical windows. Data were analyzed using the Bland and Altman method (BA), correlation and regression. Results We found a strong correlation between measurements obtained by a non-expert and an expert echocardiographer and detected that an inexperienced trainee can acquire VTI measurements from the suprasternal window view. Regarding agreement between CO measurements, data obtained showed a positive correlation and the Bland and Altman analysis presented a total variation of 38.9%. Conclusion Regarding accuracy, it is likely that TTE (Transthoracic Echocardiogram) measurements of CO from the suprasternal window view are comparable to other minimally invasive techniques currently available. Due to its user-friendliness and low cost, it can be a convenient technique for obtaining perioperative hemodynamic measurements, even by inexperienced operators.

Anestesia geral para cesariana / General anesthesia for cesarean section

As técnicas neuroaxiais são a primeira escolha anestésica para cesariana. Elas permitem a participação da mãe na hora do nascimento e são mais seguras em vários aspectos. Em algumas situações, entretanto, podem falhar ou ter contraindicações absolutas e relativas. Nestes casos, a anestesia geral passa a ter mais benefícios que riscos. As principais dificuldades da anestesia geral para cesariana são o manejo de vias aéreas (potencialmente mais difícil), alto risco de aspiração pulmonar, alta incidência de consciência intraoperatória da gestante e de depressão neonatal no pós-parto imediato. Esta revisão examina conhecimentos recentes desses tópicos, descreve benefícios e riscos de novas drogas e propõe um protocolo clínico de anestesia geral para cesárea.

The neuroaxial techniques are the first choice for cesarean section. They allow mother?s participation during the birth and are safer in many aspects. Neuroaxial techniques, however, may fail and have absolute and relative contraindications, situations in which a cesarean under general anesthesia would have benefits outweigh the risks. The main difficulties of general anesthesia for cesarean section are concerning to potentially difficultairway, increased risk of pulmonary aspiration and higher incidence of mother?s intraoperative awareness and neonatal depression in the immediate postpartum period. This review examines the current knowledge of these topics, describes the benefits and risks of new drugs and proposes a protocol of general anesthesia for cesarean section.

Conduta anestésica em cesariana em gestante com aneurisma intracraniano não roto / Conducta anestésica en cesárea en embarazada con aneurisma cerebral íntegro / Anesthetic conduct in cesarean section in a parturient with unruptured intracranial aneurysm

Justificativa e objetivos: O manuseio anestésico para cesariana programada em gestante com aneurisma intracraniano não roto é particularmente interessante, pois apresenta diversas particularidades relacionadas às alterações fisiológicas da gestação acrescida dos riscos de ruptura do aneurisma durante o procedimento anestésico. A literatura é escassa nesse assunto, sendo assim importante a divulgação dos casos. .

Background and objectives: The anesthetic management of a parturient with unruptured intracranial aneurysm scheduled to undergo cesarean section is interesting, since it has several particularities associated with pregnancy-related physiologic changes that are associated with the risk of aneurismal rupture during the anesthetic procedure. Studies on this subject are rare in the literature and, therefore, the dissemination of those cases...

Justificativa y objetivos: El manejo anestésico para la cesárea programada en embarazada con aneurisma cerebral íntegro es particularmente interesante, porque presenta diversas particularidades relacionadas con las alteraciones fisiológicas del embarazo y por añadidura, con los riesgos de ruptura del aneurisma durante el procedimiento anestésico. La literatura es parca en ese asunto, siendo muy importante la divulgación...

Anestesia para cirurgia não-obstétrica durante a gravidez / Anesthesia for nonobstetric surgery during pregnancy

Anestesiologistas em cada subespecialidade encontram, com variada regularidade, pacientes se apresentando para cirurgias durante o curso de uma gravidez. Até 2% de todas as mulheres grávidas são submetidas à cirurgia não-obstétrica durante a gravidez, que pode ser indicada em qualquer idade gestacional. O estágio da gestação e o procedimentocirúrgico indicado parecem ter influências prognósticas maternas e fetais. Em geral, o segundo estágio é tido como o mais oportuno para aqueles procedimentos que não podem esperar até depois do parto, porque a organogênese já está completa e o risco de parto prematuro é mais baixo do que no terceiro trimestre. A escolha da anestesia para a cirurgia não-obstétrica em grávidas possui características clínicas únicas, já que envolve dois pacientes e a fisiologia específica da gravidez. O objetivo final é promover uma anestesia segura para a mãe, enquanto simultaneamente minimiza-se o risco de comprometimento fetal. Manutenção da perfusão útero-placentária e adequada oxigenação materna preservam a oxigenação fetal e são de importância máximapara qualquer anestesia durante a gravidez.

Anesthesiologists in every subspecialty encounter, with varying regularity, patients presenting for surgery during the course of pregnancy. About 2% of pregnant women undergo nonobstetric surgery during pregnancy, which may be required at any gestational age. Timing and indications for the surgical procedure seem critical to the maternal and fetal outcome. In general, the second trimester is regarded as the most opportune for those procedures which cannot be delayed until after delivery, as organogenesis is complete and the risk of preterm labor is lower than in the third trimester. The choice of anesthesia for nonobstetric surgery in pregnancy have unique clinical concern, since involves two patients and physiology specific to pregnancy. The ultimate goal is to provide safe anesthesia to the mother while simultaneously minimizing the risks to the fetus. Maintenance of uterine perfusion and adequate maternal oxigenation preserves fetal oxygenation and are of utmost importance to any anesthesia during pregnancy.