| Diagnóstico y manejo de la pre-eclampsia: una actualización |
Diagnosis and management of pre-eclampsia: an update.
Turner JA.
Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Int J Womens Health. 2010 Sep 30;2:327-37.
Abstract
Pre-eclampsia is a significant, multifactorial, multiorgan disease affecting 5%-8% of all pregnancies in the US where it is the third leading cause of maternal mortality. Despite improvements in the diagnosis and management of pre-eclampsia, severe complications can occur in both the mother and the fetus, and there is no effective method of prevention. Early detection and identification of pregnant women most at risk of developing the disease have proven challenging, but recent efforts combining biochemical and biophysical markers are promising. Efforts at prevention of pre-eclampsia with aspirin and calcium have had limited success, but research on modifiable risk factors, such as obesity surgery, are encouraging. Obstetric management of severe pre-eclampsia focuses on medical management of blood pressure and prevention of seizures using magnesium sulfate, but the ultimate cure remains delivery of the fetus and placenta. Timing of delivery depends on several factors, including gestational age, fetal lung maturity, and most importantly, disease severity. Anesthetic management includes regional anesthesia with careful evaluation of the patient's airway, volume status, and coagulation status to reduce morbidity and mortality. The potential complications of general anesthesia, including intracranial hemorrhage, in these patients make regional anesthesia the preferred choice in many cases. Nevertheless, it is important to be aware of the contraindications to neuraxial anesthesia and to prepare always for the possibility of encountering a difficult airway.
|
| Efectos del remifentanilo sobre las respuestas cardiovascular y del BIS a la intubación endotraqueal en pacientes con pre eclampsia severa que se operan de cesárea con anestesia general |
Effects of remifentanil on cardiovascular and bispectral index responses to endotracheal intubation in severe pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia.
Yoo KY, Jeong CW, Park BY, Kim SJ, Jeong ST, Shin MH, Lee J.
Department of Anaesthesiology, National University Medical School, 8 Hak-dong, Gwangju 501-190, South Korea. kyyoo@jnu.ac.kr
Br J Anaesth. 2009 Jun;102(6):812-9. Abstract
BACKGROUND: We examined the effects of remifentanil on cardiovascular and bispectral index (BIS) responses to tracheal intubation and neonatal outcomes in pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia.METHODS: Forty-two women with severe pre-eclampsia were randomly assigned to receive either remifentanil 1 microg kg(-1) (n=21) or saline (n=21) over 30 s before induction of anaesthesia using thiopentone 4 mg kg(-1) and suxamethonium 1.5 mg kg(-1). Mean arterial pressure (MAP), heart rate (HR) and BIS values as well as plasma catecholamine concentrations were measured. Neonatal effects were assessed using Apgar scores and umbilical cord blood gas analysis. RESULTS: Induction with thiopentone caused a reduction in MAP and BIS in both remifentanil and control groups. Following the tracheal intubation MAP and HR increased in both groups, the magnitude of which was lower in the remifentanil group. BIS values also increased, of which magnitude did not differ between the groups. Norepinephrine concentrations increased significantly following the intubation in the control, while remained unaltered in the remifentanil group. The neonatal Apgar scores at 1 min were significantly lower in the remifentanil group than in the control. However, Apgar scores at 5 min, and umbilical artery and vein blood gas values were similar between the groups. CONCLUSIONS: These results suggest that a single bolus of 1 microg kg(-1) remifentanil effectively attenuates haemodynamic but not BIS responses to tracheal intubation in pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia. However, its use was associated with maternal hypotension and neonatal respiratory depression requiring resuscitation.
Enlace para leer el PDF: |
|
No hay comentarios:
Publicar un comentario