[Continuous spinal anesthesia in obstetrics]. / Anestesia subaracnoidea continua en obstetricia.

Despite the theoretical advantages of continuous anesthesia in obstetric patients (good-quality blockade at low doses, good hemodynamic stability, rapid onset of effect, and no risk of toxicity), little has been published on this technique and its use in pregnancy. Moreover, few descriptive studies or comparative trials have evaluated the efficacy and safety of continuous spinal anesthesia, probably because of concerns about potential adverse effects-principally neurologic complications and postdural puncture headache. We review the literature on the use of continuous spinal anesthesia in obstetric patients, analyzing the advantages and disadvantages, indications, and adverse effects of this technique.

Anestesia subaracnoidea continua en obstetricia / Continuous spinal anesthesia in obstetrics

A pesar de las teóricas ventajas de la anestesia continua en la paciente obstétrica (bloqueo de gran calidad con dosis bajas, gran estabilidad hemodinámica, rapidez de acción y ausencia de riesgo de toxicidad), existe poca bibliografía sobre esta técnica y su uso en la mujer embarazada. Tampoco hallamos muchos estudios que valoren su eficacia y seguridad, bien sean descriptivos o comparando con otras técnicas anestésicas. Esto se debe, probablemente, a la incertidumbre que crea esta técnica sobre la aparición de posibles efectos secundarios, principalmente complicaciones neurológicas y cefalea postpunción dural. El objetivo de este artículo es analizar las ventajas y desventajas, indicaciones, efectos secundarios de la anestesia subaracnoidea continua, así como revisar la bibliografía publicada sobre su utilización en la paciente obstétrica(AU)

Despite the theoretical advantages of continuous anesthesia in obstetric patients (good-quality blockade at low doses, good hemodynamic stability, rapid onset of effect, and no risk of toxicity), little has been published on this technique and its use in pregnancy. Moreover, few descriptive studies or comparative trials have evaluated the efficacy and safety of continuous spinal anesthesia, probably because of concerns about potential adverse effects— principally neurologic complications and postdural puncture headache. We review the literature on the use of continuous spinal anesthesia in obstetric patients, analyzing the advantages and disadvantages, indications, and adverse effects of this technique(AU)

Tratamiento de anemia aguda grave por hemorragia vaginal en la testigo de Jehová: a propósito de dos casos / Treating severe acute anemia due to vaginal bleeding in the Jehova’s Witness: a report of 2 cases

Los Testigos de Jehová (TJ) no aceptan la transfusiónsanguínea ni la administración de derivados hemáticosdebido a sus creencias religiosas. En situaciones de anemiaextrema, con riesgo vital para el paciente, si ésterechaza la transfusión puede producirse un grave conflictoético y legal, enfrentándose el principio de autonomíadel paciente, que implica la libertad para rechazaro aceptar un tratamiento médico, y el deber delmédico de salvaguardar la vida del paciente utilizandotodos los medios a su alcance. Presentamos dos casos deanemia grave, uno por menorragia y otro por hemorragiapuerperal, en mujeres TJ. Debemos conocer los tratamientosalternativos a la transfusión de hemoderivados(en nuestras dos pacientes fueron eficaces), y sabercómo actuar ante una situación crítica inesperada eneste tipo de pacientes. En la menorragia, el tratamientohormonal es efectivo cuando la mujer quiere preservarla fertilidad y evitar la cirugía (ablación endometrial ehisterectomía); en la hemorragia postparto refractariaal tratamiento conservador, la embolización selectiva delos vasos sangrantes puede evitar la necesidad de actitudesterapéuticas más agresivas como la histerectomíaobstétrica(AU)

For reasons of religious belief, Jehova’s Witnesses donot accept blood transfusions or the infusion of bloodproducts. In situations in which severe, life-threateninganemia develops, patient refusal to receive a transfusioncan create serious ethical and legal problems. Theprinciple of patient autonomy, which implies the freedomto accept or reject treatment, comes into conflict with thephysician’s obligation to safeguard the patient’s life usingall means possible. We report 2 cases of severe anemia inJehova’s Witnesses. One was due to menorrhagia and theother to postpartum bleeding. The physician should beaware of alternatives to infusion of blood products andknow how to cope with an unexpected critical event inthese patients. The measures we took were effective in ourpatients. In the case of menorrhagia, hormone treatmentis effective when the woman wishes to preserve the abilityto conceive and avoid surgery (endometrial ablation andhysterectomy). In postpartum bleeding refractory toconservative treatment, selective embolization of bleedingvessels may make it unnecessary to resort to moreaggressive treatment, such as obstetric hysterectomy(AU)

[Treating severe acute anemia due to vaginal bleeding in the Jehovah's Witness: a report of 2 cases]. / Tratamiento de anemia aguda grave por hemorragia vaginal en la testigo de Jehová: a propósito de dos casos.

For reasons of religious belief, Jehova's Witnesses do not accept blood transfusions or the infusion of blood products. In situations in which severe, life-threatening anemia develops, patient refusal to receive a transfusion can create serious ethical and legal problems. The principle of patient autonomy, which implies the freedom to accept or reject treatment, comes into conflict with the physician's obligation to safeguard the patient's life using all means possible. We report 2 cases of severe anemia in Jehova's Witnesses. One was due to menorrhagia and the other to postpartum bleeding. The physician should be aware of alternatives to infusion of blood products and know how to cope with an unexpected critical event in these patients. The measures we took were effective in our patients. In the case of menorrhagia, hormone treatment is effective when the woman wishes to preserve the ability to conceive and avoid surgery (endometrial ablation and hysterectomy). In postpartum bleeding refractory to conservative treatment, selective embolization of bleeding vessels may make it unnecessary to resort to more aggressive treatment, such as obstetric hysterectomy.

Feocromocitoma y embarazo / Pheocromocytoma and pregnancy

Los objetivos del tratamiento de un feocromocitoma asociado al embarazo son: el diagnóstico precoz del mismo, evitar las crisis hipertensivas durante el nacimiento y el tratamiento quirúrgico definitivo del mismo. Son fundamentales el diagnóstico prenatal del tumor, la localización del mismo y el bloqueo adrenérgico preoperatorio. El tratamiento por un equipo médico con experiencia es muy importante. Para el parto es de elección la cesárea si todavía no se ha extirpado el feocromocitoma. La decisión de cuándo intervenir depende de la edad gestacional a la cual se diagnostica el feocromocitoma

The primary goals in the management of pheochromocytoma in pregnancy are early diagnosis, avoidance of a hypertensive crisis during delivery and definitive surgical treatment. Antenatal diagnosis, tumour localization, preoperative adrenergic blockade and team planning are fundamental. Cesarean section is the preferred mode of delivery when the tumour is still present. Timing of surgical resection will depend on the gestational age at which diagnosis is made

[Postpartum seizures in 2 epileptic patients]. / Crisis convulsiva en el postparto de dos pacientes epilépticas.

We report the cases of 2 women with epilepsy who suffered generalized postpartum seizures on the first day after giving birth. The first had a history of febrile convulsions in childhood and had a seizure in the 36th week of gestation due to sleep deprivation. She had received epidural analgesia for labor pain. The second patient had had her most recent crisis at the beginning of the third trimester of pregnancy. Both patients had low serum levels of antiepileptic drugs. The pharmacokinetics of antiepileptic drugs can change during pregnancy, making seizures more difficult to control. Serum levels of these drugs should therefore be monitored more often, given that a generalized maternal seizure can have devastating consequences for the fetus. More careful planning and management of pregnancy is necessary for epileptic patients to ensure successful outcomes for both mother and fetus.

Implicaciones anestésicas en dos casos de inversión uterina / Anesthetic implications of uterine inversion: 2 cases

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