lunes, 16 de junio de 2014

Analgesia obstetrica

Cortisol materno y de arterial umbilical al nacer: relaciones con la analgesia epidural y el estado de alerta del recién nacido.

Maternal and umbilical artery cortisol at birth: relationships with epidural analgesia and newborn alertness.Bell AF, White-Traut R, Wang EC, Schwertz D.
Biol Res Nurs. 2012 Jul;14(3):269-76. doi: 10.1177/1099800411413460. Epub 2011 Jun 30.
BACKGROUND:Newborn alertness soon after birth facilitates mother-infant interaction and may be related to umbilical cortisol levels. Yet, little is known about whether epidural analgesia influences umbilical cortisol at birth. AIM: The aims of this study were to explore relationships between exposure to epidural analgesia and maternal and umbilical cortisol; maternal and umbilical cortisol levels at birth; and umbilical cortisol and infant alertness after birth. METHOD: Forty women were self-selected to unmedicated or epidural labors in this pilot study. Maternal saliva and infant umbilical artery (UA) plasma at birth were enzyme immunoassayed for cortisol. Infant alertness was assessed nearly 1 hr after birth. RESULTS: Maternal cortisol was higher in the unmedicated versus epidural group (p = .003). Umbilical cortisol was not related to epidural analgesiaexposure but was related to duration of labor (higher cortisol with longer labors; p = .026). Maternal cortisol level explained 55% of the variance in umbilical cortisol in the unmedicated group (p = .002), but there was no significant shared variance in the epidural sample (p = .776). There was a positive correlation (r(2) = .17, p = .008) between umbilical cortisol and infant alertness. Latina infants demonstrated a higher frequency of alertness than Black infants. In multivariate analysis, umbilical cortisol (p = .049) and race/ethnicity (p = .024) remained significant predictors of infant alertness. CONCLUSIONS: Our findings indicate that higher umbilical cortisol is related to greater infant alertness soon after birth. While epidural analgesia did not directly relate to infant cortisol, other factors contributed to higher umbilical cortisol.

Bajas dosis de infusión de ketamina para analgesia obstétrica. Estudio clínico doble ciego, randomizado y controlado con placebo

Low-dose ketamine infusion for labor analgesia: A double-blind, randomized, placebo controlled clinical trial.
Joel S, Joselyn A, Cherian VT, Nandhakumar A, Raju N, Kaliaperumal I.
Saudi J Anaesth. 2014 Jan;8(1):6-10. doi: 10.4103/1658-354X.125897.
BACKGROUND:Most primary and secondary level hospitals in developing countries provide inadequate labor analgesia due to various medical, technical and economic reasons. This clinical trial was an effort to study the efficacy, safety and feasibility of intravenous (IV) ketamine to provide labor analgesia. MATERIALS AND METHODS:A total of 70 parturients were consented and randomly assigned to receive either IV ketamine or 0.9% saline. A loading dose of ketamine (0.2 mg/kg) was followed-by an infusion (0.2 mg/kg/h) until the delivery of the neonate. Similar volume of saline was infused in the placebo-group. Intramuscular meperidine was the rescue analgesic in both groups. The pain score, hemodynamic parameters of mother and fetus and the anticipated side-effects of ketamine were observed for. The newborn was assessed by the Neonatologist. RESULTS:The pain score showed a decreasing trend in the ketamine group and after the 1(st) h more than 60% of women in the ketamine group had pain relief, which was statistically significant. There was no significant clinical change in the maternal hemodynamics and fetal heart rate. However, 17 (48.5%) of them had transient light headedness in the ketamine group. All the neonates were breast fed and the umbilical cord blood pH was between 7.1 and 7.2. The overall satisfaction was significantly high in the intervention group (P = 0.028). CONCLUSION:A low-dose ketamine infusion (loading dose of 0.2 mg/kg delivered over 30 min, followed-by an infusion at 0.2 mg/kg/h) could provide acceptable analgesia during labor and delivery.
KEYWORDS:Ketamine infusion; labor analgesia; light headedness; low-dose ketamine; meperidine;year=2014;volume=8;issue=1;spage=6;epage=10;aulast=Joel;type=2

Anestesiología y Medicina del Dolor

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