sábado, 2 de agosto de 2014

Anestesia general en obstetricia/General anesthesia in obstetrics

Remifentanil para inducir la anestesia general en cesárea. Estudio clínico, doble ciego, randomizado



Remifentanil at induction of general anesthesia for cesarean section: Double blind, randomized clinical trial.
Behdad S, Ayatollahi V, Harrazi H, Nazemian N, Heiranizadeh N, Baghianimoghadam B.
Colomb Med (Cali). 2013 Jun 30;44(2):87-91. eCollection 2013.
Abstract
INTRODUCTION: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of Remifentanil during cesarean section surgery. METHODS: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia(ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either an intravenous bolus of 0.5 µg/kg Remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. RESULTS: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the Remifentanil group as compared with the control group (p <0.05). There were no significant differences regarding heart rate between groups at any time (p > 0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxane administration. CONCLUSION: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.
KEYWORDS: Placebo; Remifentanil; caesarean
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4002026/pdf/1657-9534-cm-44-02-00087.pdf



Intubación difícil en anestesia obstétrica


Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management andcomplications associated with general anaesthesia for caesarean section.
McDonnell NJ, Paech MJ, Clavisi OM, Scott KL; ANZCA Trials Group.
Collaborators (19)
Int J Obstet Anesth. 2008 Oct;17(4):292-7. doi: 10.1016/j.ijoa.2008.01.017. Epub 2008 Jul 9.
Abstract
BACKGROUND: Recent developments in anaesthesia and patient demographics have potentially changed the practice of obstetric generalanaesthesia. There are few contemporary data on Australasian practice of general anaesthesia for caesarean section, especially relating to airwaymanagement, anaesthetic techniques and complications. METHODS: Using a standardised case record form, a prospective observational study was conducted during 2005-06 in 13 maternity hospitals dealing with approximately 49 500 deliveries per annum. Patient demographics, airway management, anaesthetic techniques and major complicationswere evaluated in those given general anaesthesia. RESULTS: Data were obtained from 1095 women receiving general anaesthesia for caesarean section, 47% of which were classified as category 1 and 18% as category 4. Tracheal intubation was planned in all cases with rapid-sequence induction used in 97%. A grade 3 or 4 laryngoscopic view was obtained in 3.6 and 0.6% of cases respectively, with 3.3% considered a difficult intubation. There were four failed intubations (0.4%, 95% CI 0.01-0.9%), of which three were subsequently managed using a laryngeal mask airway. Antacid prophylaxis was used in 94% of elective cases and 64% of emergencies. Regurgitation of gastric contents was noted in eight cases (0.7%, 95% CI 0.2-1.2%), with one confirmed case of aspiration (0.1%, 95% CI 0.002-0.5%). There were no cases of serious airway-related morbidity. CONCLUSIONS: General anaesthesia is most commonly used in emergency situations. Tracheal intubation after rapid-sequence induction remains the predominant approach to airway management in Australasia. The incidence of failed intubation is consistent with previous studies. Aspiration prophylaxis is not routinely used for emergency surgery.

http://www.mc.vanderbilt.edu/documents/1anesthesiology/files/McDonnell%202008%20-%20Failed%20Intub.pdf


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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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