viernes, 20 de junio de 2014

Embarazo patológico/Pathological pregnancy

Revisión anestésica de histerectomía periparto de emergencia después de un parto vaginal y por cesárea: estudio retrospectivo

Anesthetic review of emergency peripartum hysterectomy following vaginal and cesarean delivery: a retrospective study.
Lee IH, Son JH, Shin YC, Byun JH, Yoon HJ, Jee YS.
Korean J Anesthesiol. 2012 Jul;63(1):43-7. doi: 10.4097/kjae.2012.63.1.43. Epub 2012 Jul 24.
BACKGROUND: The purpose of this study was to review incidence, indications, complications, and the anesthetic management of emergency obstetric hysterectomies. METHODS: This was a retrospective study of the cases of emergency obstetric hysterectomies performed at the Woman's Hospital over a 3 yearperiod between January 2008 and December 2010. The indication for surgery, anesthetic management, operating time, estimated blood loss, pre- and postoperative hemoglobin and hematocrit values, need for blood transfusion, and perioperative complications were obtained. RESULTS: During the study period there were 46 emergency obstetric hysterectomies for 20147 deliveries, giving an incidence of 2.28/1000 deliveries. The number of emergency hysterectomies was significantly higher with the cesarean deliveries than with the vaginal deliveries. The most common indication for emergency obstetric hysterectomy was placenta accreta. Postoperatively, Dissemimated Intravascular Coagulation (DIC) was the most common complication. CONCLUSIONS: Abnormal placenta has been an main indication of emergency hysterectomy. Anesthesiologists should be eligible to aware of high risk of emergency hysterectomy and deal with massive hemorrhage.
KEYWORDS: Anesthesiologists; Emergency obstetric hysterectomy; Massive hemorrhage; Placenta accreta

Informe de caso y revisión de la literatura. Manejo anestésico de cariopatía periparto severa complicada con preeclampsia usando sufentanil y anestesia raquídea-peridural combinada

Case report and mini literature review: anesthetic management for severe peripartum cardiomyopathy complicated with preeclampsia using sufetanil in combined spinal epidural anesthesia.
Bhakta P, Mishra P, Bakshi A, Langer V.

Yonsei Med J. 2011 Jan;52(1):1-12. doi: 10.3349/ymj.2011.52.1.1.


Peripartum cardiomyopathy (PPCM) is a rare entity, and anesthetic management for cesarean section of a patient with this condition can be challenging. We hereby present the anesthetic management of a patient with PPCM complicated with preeclampsia scheduled for cesarean section, along with a mini review of literature. A 24 year-old primigravida with twin gestation was admitted to our hospital with severe PPCM and preeclampsia for peripartum care, which finally required a cesarean section. Preoperative optimization was done according to the goal of managing left ventricular failure. Combined spinal epidural (CSE) anaesthesia with bupivacaine and sufentanil was used for cesarean section under optimal monitoring. The surgery was completed without event or complication. Postoperative pain relief was adequate and patient required only one epidural top up with sufentanil 6 hours after operation. To the best of our knowledge there is no report in literature of the use of sufentanil as a neuraxial opioid in theanesthetic management of cesarean section in a patient with PPCM. CSE with sufentanil may be a safer and more effective alternative in such cases.

Manejo de angina de Ludwig en el embarazo. Revisión de 10 casos

Management of Ludwig's angina in pregnancy: A review of 10 cases.
Osunde O D, Bassey G O, Ver-or NAnn Med Health Sci Res [serial online] 2014 [cited 2014 May 30];4:361-4.
Background: Ludwig's angina is a rapidly spreading cellulitis that may produce upper airway obstruction often leading to death. Aim: The present paper reviews the management of Ludwig's angina in the third trimester of pregnancy. The inherent dangers to the mother and her unborn child are highlighted. Materials and Methods: The case files of pregnant patients who had emergent incision and drainage for life-threatening facial cellulitis at the maxillofacial unit of the Murtala Mohammed Specialist Hospital in Kano, Nigeria, over a 2 year period were retrieved and demographic and clinical characteristics were retrospectively obtained and analyzed descriptively using the statistical package for social sciences (SPSS version 13.0, for Windows, September 2004, Chicago, Illinois). Comparative statistics were determined using Pearson's Chi-square, Fisher's exact tests and independent t tests as appropriate. A P value of less than 0.05 was considered significant. Results: A total of 10 patients were seen within the study period, age ranges from 23 to 40 years, mean 29.5 (5.3) years. Majority of the women were in their third decade [60% (6/10)] while the remaining 40% (4/10) were in their fourth decade of life. Two of the patients presented within the period of less than 1 week of onset of symptoms while those who presented within the periods of 1-2 weeks and periods of over 2 weeks accounted for 50% (5/10) and 30% (3/10) respectively. All the patients presented during the third trimester of their pregnancy and odontogenic infections were responsible for 80% (8/10) of the Ludwig's angina. There were 20% mortality among the patients and this was significant for those with underlying systemic conditions (P = 0.02). The time of presentation was not significant for the survival rate of the gravid patient (P = 0.36) but was significant for survival of the fetus (P = 0.01). Conclusion:During a life-threatening infectious situation such as Ludwig's angina, risks of maternal and fetal morbidity include both septicemia and asphyxia. Attending clinicians must consider the risks that the condition and the possible treatments may cause the mother and her unborn child.
Keywords: Ludwigs angina, Management, Pregnancy

Anestesiología y Medicina del Dolor
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