Unexpected obstetric haemorrhage. Krukenberg tumour. / Hemorragia obstétrica de causa inesperada. Tumor de Krukenberg.

Obstetric haemorrhage can endanger the lives of mother and foetus. It often occurs unexpectedly without clear predictors. A high degree of suspicion helps to avoid delaying resuscitation measures. We present the case of a ruptured ovarian metastasis that occurred during labour. It caused a massive bleed forcing a caesarean section due to non-reassuring foetal status. This was an unprecedented and undescribed onset of Krukenberg tumour formation. Malignant tumours in pregnancy are rare and difficult to diagnose due to their clinical manifestations which often overlap with those of pregnancy itself (dyspepsia, nausea and bloating). Despite the available therapeutic measures, a delay in diagnosis is a determining factor for long-term prognosis. We review the causes of obstetric bleeding, and underline how rare Krukenberg tumours concomitant to pregnancy are.

[Labor pain worries future fathers more than the mothers]. / El dolor del parto preocupa más a los futuros padres que a las madres.

OBJECTIVE: To evaluate the concerns of the future father about labor pain and another 9 items which could be important to the well-being of the mother during delivery. To investigate any possible differences in opinion between the future father and mother. PATIENTS AND METHODS: An anonymous and voluntary questionnaire was offered to the father and the pregnant patient during the last month of pregnancy. They had to answer the questionnaire separately, scoring 10 items in a 0-10 point ordinal scale, according to their concerns and the importance for the good development of the delivery (0= not concerned about/insignificant to 10=concerned about/great importance). The items included were: 1) esthetic aftermath, 2) embarassment, 3) continous information, 4) walking during labor, 5) drinking during labor, 6) companionship, 7) labor pain, 8) keeping composure, 9) kindness, 10) room comfortability. Data on age, education, parity and nationality were recorded. RESULTS: A total of 147 questionnaires were completed, 99 by mothers, and 48 by fathers. Pain was the most important concern for the future fathers scoring a mean (SD) of 8.15 (2), while continuous information 7.71 (2.5), kindness 7.9 (2.1), and companionship 8.21 (2.3) were more important than pain for mothers. A statistically significant difference was found between fathers and mothers regarding labor pain (P=.001), walking during labor (P=.003), and drinking during labor (P=.009). CONCLUSIONS: The result of our study suggests that increasing the presence of the father during the delivery process, and taking care of the emotional aspects and the quality of the information given could be very important for the perception of satisfaction.

Gestión de riesgos en anestesia obstétrica / Risk management in obstetric anestesia

El objetivo de este trabajo es analizar la epidemilogía de las complicaciones más graves que pueden presentarse durante la asistencia de pacientes obstétricas, valorando su incidencia, la demanda asistencia que generan y los principales factores de riesgo. Se analizan también los aspectos más generales de la planificación en anestesiología obstétrica, con ejemplos concretos para algunas situaciones

The aim of this piece of work is to analyse the epidemiology of the most serious complications which may appear during the anaesthesia of obstetric patients, assessing their incidence, the health care demand they develop and the main risk factors. The most general aspects in planning obstetric anaesthesia area analysed as well, with some particular examples of certain situations

[Comparative study of recovery times and psychomotor function after anesthesia with desflurane or isoflurane]. / Estudio comparativo de los tiempos de recuperación y función psicomotriz tras anestesia con desflurano o isoflurano.

OBJECTIVE: To compare recovery from anesthesia with desflurane and isoflurane by analyzing awakening and psychomotor function. PATIENTS AND METHODS: In this prospective study of 30 ASA I-II patients undergoing general or urologic surgery the following variables were assessed before surgery: confusion, fatigue, drowsiness, torpor and pain. The Steward and Trieger tests of psychomotor function were also applied. After induction and intubation, maintenance was with isoflurane (0.6 +/- 0.3%) or desflurane (3 +/- 1.5%) and 60% nitrous oxide with fresh gas at a rate of 1 l/min. After withdrawing the halogen and switching to an open circuit (10 l/min), we counted time until appearance of the first sign of awakening. Clinical variables and psychomotor function were assessed 5, 30, 60 and 90 min later. RESULTS: The two groups were similar anthropometrically. Duration of anesthesia and surgery were also similar. Times until awakening, eye opening, extubation and orientation were shorter in the desflurane group. Scores for fatigue (5 min), confusion (5 and 30 min), motor incoordination (5 min) and drowsiness (5 and 30 min) were also more favorable in the desflurane group. Patients receiving desflurane also scored significantly better on the Trieger test at 30 and 60 min. CONCLUSIONS: Recovery times are shorter with desflurane than with isoflurane. Clinical variables are also more favorable with desflurane and psychomotor function returns more quickly during the first hour after anesthesia.

[Late ischemia and carpal tunnel syndrome secondary to catheterization of the radial artery]. / Isquemia tardía y síndrome del túnel del carpo secundarios a cateterización de la arteria radial.

Invasive measurement of blood pressure has many advantages. Although arterial canalization is a low-risk technique of great benefit to the patient, complications must be looked for. We report the case of a man who underwent triple coronary bypass with arterial canalization requiring several punctures to achieve. Two weeks after the procedure the patient showed signs of hand ischemia and acute carpal tunnel syndrome, which evolved favorably after treatment with heparin sodium and prostaglandin E1. We emphasize the importance of an earlier wrist fracture as the predisposing factor for both conditions and the need to examine collateral circulation in the hand and look for carpal tunnel syndrome before canalization.