Estudios neuroconductuales en recién nacidos con Sufrimiento Fetal según dos técnicas anestésicas / Neurobehavioural studies in newborns with fetal distress based on two anesthetic techniques

La insuficiencia placentaria se invoca como la principal causa de depresión neonatal y el anestesiólogo debe lograr un equilibrio entre la anestesia aplicada y el estado clínico de la paciente y el feto. Valorar el comportamiento neuroconductual del recién nacido con sufrimiento fetal según anestesia espinal o general. Se realizó un estudio de serie de casos en el Hospital General Universitario V I Lenin, en el año 2006, en 158 pacientes del municipio Holguín, a las que le realizaron operación cesárea por sufrimiento fetal. Se analizaron variables hemodinámicas maternas como frecuencia cardiaca, tensión arterial sistólica, diastólica y saturación periférica de oxígeno. Se evaluó el puntaje APGAR al minuto y a los 5 minutos del nacimiento, el estado neuroconductual de los recién nacidos a las 48 horas, a través del test de Scanlon y el desarrollo psicomotor al año de edad con el test Brunet Lezine en relación con la técnica anestésica empleada. La técnica espinal se empleó en el 89,87 por ciento de los casos, con estabilidad hemodinámica materna y el 75 por ciento de los recién nacidos presentaron APGAR 7 - 10. A las 48 horas 149 neonatos resultaron evaluados de normal, con dominio de la anestesia general orotraqueal en los deprimidos con test de Scanlon anormal. Se alcanzó valor predictivo positivo de 0,95 en relación con la evaluación neuroconductual a las 48 horas y el desarrollo psicomotor al año. No hubo diferencias en relación con una u otra técnica anestésica aplicada(AU)

Anesthesia for cesarean section in two patients with brain tumours.

PURPOSE: To describe two patients with brain tumours where general anesthesia was used for cesarean sections under emergency and urgent conditions. CLINICAL FEATURES (CASE #1): The first patient presented at 38 wk gestation with an acute intracranial tumour herniation, requiring emergency craniotomy and simultaneous cesarean section. General anesthesia was induced with thiopental and vecuronium, maintained with enflurane 1% in O2 100%. Maternal P(ET)CO2 was maintained at 25 mmHg. After delivering a healthy infant, she was given syntocinon, mannitol and dexamethasone i.v. anesthesia was maintained with fentanyl, nitrous oxide 50% in O2 and isoflurane 1% during frontal-lobe tumour resection. CLINICAL FEATURES (CASE #2): The second patient presented at 37 wk gestation for urgent cesarean section because of placental insufficiency. She had had a brain tumour resection four years earlier. An increase in intracranial pressure necessitated craniotomy for decompression at 20 wk gestation. She was further treated with dexamethasone, carbamazepine and radiation for control of cerebral oedema at 34 wk. Cesarean section was performed under general anesthesia; rapid-sequence-induction with thiopental and succinylcholine, followed by isoflurane 1% in O2 100%. Syntocinon, fentanyl and atracurium i.v. were administered after delivery of a healthy infant. Although neurosurgeons stood by, their intervention was unnecessary. CONCLUSION: General anesthesia remains safe and dependable for operative delivery in parturients with intracranial tumour. Tracheal intubation allows maternal hyperventilation thereby controlling raised intracranial pressure. Hemodynamic stability is readily achieved to maintain cerebral perfusion. However, a multidisciplinary-team approach is critical for successful patient management.

Cesarean hysterectomy at Louisiana State University, 1975 through 1981.

One hundred four cesarean hysterectomies were done on the obstetric service of Louisiana State University School of Medicine over a six-year period, for an incidence of 1/110 cesarean sections or 1/824 deliveries. We categorize the indications for both nonemergency and emergency cases and present the chief components of perioperative morbidity, with particular reference to intraoperative blood loss and postoperative infection. The mean operating time was 126 minutes, blood loss 1,200 ml, transfusion 1.65 units, and hospital stay after surgery seven days. The postoperative morbidity was 42.9%. Emergency patients had an increased blood loss, a higher transfusion rate, and an increase in intraoperative complications. We emphasize the need to develop and maintain the operative skills required by these challenging emergency cases.