sábado, 9 de agosto de 2014

Embarazo patológico y anestesia/Pathological pregnancy and anaesthesia

Evolución fetomaterna en mujeres con preeclampsia severa con cesárea urgente con anestesia general o espinal

Fetomaternal outcome in severe preeclamptic women undergoing emergency cesarean section under either general or spinal anesthesia.
Chattopadhyay S, Das A, Pahari S.
J Pregnancy. 2014;2014:325098. doi: 10.1155/2014/325098. Epub 2014 Apr 17.
This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5%) patients underwent spinal anesthesia (SA) and 27 (15.5%) patients had general anesthesia (GA). Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P < 0.001). Patients receiving GA had a higher mortality (25.9% versus 1.4%; P < 0.001). The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P < 0.01) and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P < 0.05). To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.


Manejo anestésico de parturientas con enfermedad renal crónica que son sometidas a cesárea

Anesthetic management in parturients with chronic kidney disease undergoing elective Caesarean delivery: Our experience of nine cases.

Modi MP, Vora KS, Parikh GP, Shah VR, Misra VV, Jasani AF.

Indian J Nephrol. 2014 Jan;24(1):20-3. doi: 10.4103/0971-4065.125051.


In this retrospective study, we describe the anesthetic management and its implications in parturients with chronic kidney disease (CKD; n = 9), who underwent elective caesarean delivery. Nine parturients with CKD of various etiologies, who underwent elective Caesarean delivery, were included in this study. Spinal anest-hesia was administered in all parturients with normal coagulation profile through a 25-gauze spinal needle (Quincke) with 0.5% (H) bupivacaine in L2-3 space and T6 level was achieved. Hemodynamics and side effects such as nausea, vomiting, headache, and backache were record. The mean age was 28.22 ± 4.43 years. The mean levels of serum creatinine and serum potassium were 2.78 ± 1.29 mg/dl and 4.11 ± 0.46 meq/l, respectively. Mean baseline values of systolic blood pressure, diastolic blood pressure, and pulse rate were higher which decreased after spinal anesthesia. However, the incidence of hypotension, which required mephentermine treatment, was 11.1%. One patient had symptoms of nausea and vomiting/dizziness at the time of hypotension, which disappeared after treatment with 5 mg of intravenous mephentermine. Baseline value of PR remained high throughout the operation. Parturients with CKD with normal coagulation profile remained hemodynamically stable under spinalanesthesia with minimal side effects. However, a large number of studies are required to determine the safety of spinal anesthesia in this setting.

KEYWORDS: Caesarean delivery; chronic kidney disease; pregnancy; spinal anesthesia



Anestesia regional en pacientes con hipertensión inducida por el embarazo

Regional anesthesia in patients with pregnancy induced hypertension.
Ankichetty SP, Chin KJ, Chan VW, Sahajanandan R, Tan H, Grewal A, Perlas A.
J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):435-44. doi: 10.4103/0970-9185.119108.
Pregnancy induced hypertension is a hypertensive disorder, which occurs in 5% to 7% of all pregnancies. These parturients present to the labour and delivery unit ranging from gestational hypertension to HELLP syndrome. It is essential to understand the various clinical conditions that may mimic preeclampsia and the urgency of cesarean delivery, which may improve perinatal outcome. The administration of general anesthesia (GA) increases morbidity and mortality in both mother and baby. The provision of regional anesthesia when possible maintains uteroplacental blood flow, avoids the complications with GA, improves maternal and neonatal outcome. The use of ultrasound may increase the success rate. This review emphasizes on the regional anesthetic considerations when such parturients present to the labor and delivery unit.
KEYWORDS: Anesthesia; hypertension; pregnancy; regional


Anestesiología y Medicina del Dolor

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