domingo, 24 de mayo de 2015

Anestesia obstétrica/Obstetric anesthesia

¿Que hay de nuevo en anestesia obstétrica? Conferencia 2013 Gerard W. Ostheirmer
What's new in Obstetric Anesthesia? The 2013 Gerard W. Ostheimer lecture.
Palanisamy A
Anesth Analg. 2014 Feb;118(2):360-6. doi: 10.1213/ANE.0000000000000101.
The "What's New in Obstetric Anesthesia?" keynote lecture was established by the Society for Obstetric Anesthesia and Perinatology in memory of the eminent obstetric anesthesiologist, Dr. Gerard W. Ostheimer. From a wide selection of journals encompassing the fields of obstetric anesthesia, obstetrics, and perinatology, the designated lecturer identifies articles of significant impact and interest published in the preceding year. The Ostheimer lecture, delivered this year at the annual meeting of the Society in April 2013 in San Juan, Puerto Rico, included highly relevant papers that have the potential to change obstetric anesthesia practice or impact public health. This review summarizes 5 categories of pertinent articles that were published in 2012 and discussed in the 2013 Ostheimer lecture: maternal diseases, labor and delivery, advances in obstetric anesthesia, obstetric complications, and anesthesia-related complications.
Esencial en paro cardíaco durante la cesárea
Essentials in cardiac arrest during cesarean section.
van Liempt SW, Stoecklein K, Tjiong MY, Schwarte LA, de Groot CJ, Teunissen PW.
Clin Pract. 2015 Feb 17;5(1):668. doi: 10.4081/cp.2015.668. eCollection 2015.
Cardiac arrest during cesarean section is very rare. Obstetrical teams have low exposure to these critical situations necessitating frequent rehearsal and knowledge of its differential diagnosis and treatment. A 40-year-old woman pregnant with triplets underwent cesarean sections because of vaginal bleeding due to a placenta previa at 35.2 weeks of gestation. Spinal anesthesia was performed. Asystole occurred during uterotomy. Immediate resuscitation and delivery of the neonates eventually resulted in good maternal and neonatal outcomes. The differential diagnosis is essential and should include obstetric and non-obstetric causes. We describe the consideration of Bezold Jarisch reflex and amniotic fluid embolism as most appropriate in this case.
KEYWORDS: Bezold Jarisch reflex; cardiac arrest; cesarean section
Un cambio en el manejo de la hemorragia obstétrica intratable en más de 15 años en un centro de atención terciaria.
A change in the management of intractable obstetrical hemorrhage over 15 years in a tertiary care center.
Juneja SK, Tandon P, Mohan B, Kaushal S.
Int J Appl Basic Med Res. 2014 Sep;4(Suppl 1):S17-9. doi: 10.4103/2229-516X.140710.
CONTEXT: Peripartum hysterectomy was the gold standard to save a woman with persistent obstetrical bleeding, but compromised the menstrual and reproductive functions. Bilateral internal iliac artery ligation (BIAL) is a potentially effective, fertility preserving means of controlling pelvic hemorrhage, but with surgical and anesthetic risks and low success. Angiographic embolization has the potential to arrest severe pelvic hemorrhage without removing the uterus and without hazarding general anesthesia in a hemodynamically unstable patient. AIMS:
The aim of this study is to discuss change in the management of intractable obstetrical hemorrhage from removing to conserving the uterus over 15 years. SETTINGS AND DESIGN: A retrospective analysis of 122 cases of intractable obstetrical hemorrhage over a period of 15 years (January 1997 to December 2011) was done. We started uterine artery embolization (UAE) in 2007 for obstetrical hemorrhage. The patients were analyzed for maternal characteristics, indications, treatment modality, maternal morbidity, and mortality. STATISTICAL ANALYSIS USED: Descriptive. RESULTS: We analyzed 12,055 deliveries, (6029 cesarean sections; 6026 vaginal deliveries). One hundred and twenty-two cases of intractableobstetrical hemorrhage were managed with obstetrical hysterectomies in 63, UAE in 53 cases and BIAL in six cases. During the period between 1997 and 2006 intractable obstetrical hemorrhage was managed by hysterectomy/internal iliac artery ligation. The last 5 years of the study period had 80 patients with intractable obstetrical hemorrhage, 53 patients underwent arterial embolization and 35 had a hysterectomy and two had internal artery ligation. There was no mortality and significantly less morbidity in embolization group in our study. CONCLUSIONS: Embolization should be tried in patients with intractable obstetrical hemorrhage before proceeding for surgical intervention.
KEYWORDS: Bilateral internal iliac artery ligation; obstetrical hemorrhage; uterine artery embolization
Anestesia y Medicina del Dolor
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