Trauma en obstetricia / Obstetric trauma

Mayo 26, 2018. No. 3092

Cirugía general urgente durante el embarazo Emergency general surgery in pregnancy. Skubic JJ1, Salim A1. Author information Trauma Surg Acute Care Open. 2017 Nov 2;2(1):e000125. doi: 10.1136/tsaco-2017-000125. eCollection 2017. Abstract It is often that the acute care surgeon will be called on to evaluate the pregnant patient with abdominal pain. Most of the diagnostic and management decisions regarding pregnant patients will follow the usual tenets of surgery; however, there are important differences in the pregnant patient to be aware of to avoid pitfalls which can lead to complications for both mother and fetus. This review hopes to describe the most common emergencies facing the surgeon caring for the pregnant patient and the latest management options. KEYWORDS: emergency general surgery; emergency surgery; pregnancy; pregnant PDF  Indicadores clínicos de shock hemorrágico en el embarazo Clinical indicators of hemorrhagic shock in pregnancy. Jenkins PC1, Stokes SM1, Fakoyeho S1, Bell TM1, Zarzaur BL1. Author information Trauma Surg Acute Care Open. 2017 Nov 7;2(1):e000112. doi: 10.1136/tsaco-2017-000112. eCollection 2017 Abstract BACKGROUND: Several hemodynamic parameters have been promoted to help establish a rapid diagnosis of hemorrhagic shock, but they have not been well validated in the pregnant population. In this study, we examined the association between three measures of shock and early blood transfusion requirements among pregnant trauma patients.  We found that patients with SI>1 were significantly more likely to receive blood transfusions compared with patients with SI<1 (OR 10.35; 95% CI 1.80 to 59.62), whereas ROPE>3 was not associated with blood transfusion compared with ROPE≤3 (OR 2.92; 95% CI 0.28 to 30.42). Furthermore, comparison of area under the ROC curve for SI (0.68) and ROPE (0.54) suggested that SI was more predictive than ROPE of blood transfusion. CONCLUSION: We found that an elevated SI was more closely associated with early blood product transfusion than SBP and ROPE in injured pregnant patients. KEYWORDS: hemorrahgic shock; pregnancy; shock management PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Congreso Nacional de Residentes de Anestesiología 7 al 9 de junio, 2018. Lima, Perú  Informes / Information  V Congreso Internacional de Vía Aérea, EVALa, México Junio 7-9, 2018. Guadalajara. México Información / Information X Foro Internacional de Medicina del Dolor y Paliativa Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información/ Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Más de obstetricia / More on obstetrics

Mayo 18, 2018. No. 3084

Comparando el efecto de agregar fentanilo, sufentanilo y placebo con bupivacaína intratecal en la duración de la analgesia y las complicaciones de la anestesia espinal en pacientes programados para cesárea Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section. Farzi F1, Mirmansouri A2, Naderi Nabi B3, Atrkar Roushan Z4, Ghazanfar Tehran S5, Nematollahi Sani M6, Makhlooghi Azad S6, Nemati M6. Author information Anesth Pain Med. 2017 Aug 27;7(5):e12738. doi: 10.5812/aapm.12738. eCollection 2017 Oct. Abstract BACKGROUND: Spinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics. METHODS: This was a double-blind clinical trial performed on 99 patients. Women were divided into 3 groups of fentanyl, sufentanil, and placebo. For fentanyl group, 12.5 mg of bupivacaine and 25 micrograms of fentanyl; for sufentanil group, 12.5 mg of bupivacaine and 2.5 micrograms of sufentanil; and for placebo group, 12.5 mg of bupivacaine and a half mL of normal saline were injected in subarachnoid space. The sensory and motor block, hemodynamic status (mean blood pressure and heart rate), and probable complications were assessed. RESULTS: There was no significant difference between the groups in demographic characteristics. Durations of analgesia were, respectively, 314 ± 42.95, 312.5 ± 34.44, and 116.1 ± 42.24 minutes in the fentanyl, sufentanil, and placebo groups (P = 0.0001). Duration of sensory and motor block was higher in fentanyl and sufentanil groups compared with the placebo group. The highest duration of sensory and motor block was noted in sufentanil group (P = 0.0001). No significant difference was found between the groups in the hemodynamic parameters (P > 0.05). The frequency of itching in the fentanyl group was higher than sufentanil and placebo groups (P = 0.003). Also, shivering was higher in the placebo group compared with other groups (P = 0.036). CONCLUSIONS: According to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesareansection surgery. KEYWORDS: Bupivacaine; Cesarean Sections; Fentanyl; Spinal Anesthesia; Sulfentanil PDF Anestesia espinal continua para anestesia y analgesia obstétrica Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia. Veličković I1, Pujic B2, Baysinger CW3, Baysinger CL4. Author information Front Med (Lausanne). 2017 Aug 15;4:133. doi: 10.3389/fmed.2017.00133. eCollection 2017. Abstract The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used. Small doses of drug can be administered and extension of labor analgesia for emergency cesarean delivery may occur more rapidly compared to continuous epidural techniques. KEYWORDS: intrathecal catheters; labor analgesia; neuraxial blockade; obstetric anesthesia; post-dural puncture headache; spinal catheters PDF El enfoque de control óptimo del dolor para el trabajo de parto: una revisión de la literatura actual. The Optimal Pain Management Approach for a Laboring Patient: A Review of Current Literature. Kelly A1, Tran Q1. Author information Abstract Cureus. 2017 May 10;9(5):e1240. doi: 10.7759/cureus.1240. There is a general agreement that a patient in labor should be given the option to have an epidural block for pain management. Despite this consensus, there are differences in practice patterns as to when to initiate an epidural and how to minimize its impact on the duration and outcome of a patient's labor. A review of the literature suggests epidural analgesia does prolong stages one and two of labor, but not significantly. Cesarean delivery rates are not affected by the early initiation of epidural analgesia. The use of various adjuvants such as opioids, clonidine, and neostigmine in conjunction with local anesthetics solution can significantly reduce the severity of motor blockade and the need for assisted vaginal delivery. KEYWORDS: labor analgesia; labor epidural; regional anesthesia PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information X Foro Internacional de Medicina del Dolor y Paliativa Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información / Information V Congreso Internacional de Vía Aérea, EVALa, México Junio 7-9, 2018. Guadalajara. México Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Obstetricia / Obstetrics

Diciembre 22, 2017. No. 2940

Libro de Obstetricia Obstetrics Edited by Hassan Salah Abduljabbar, ISBN 978-953-51-3704-7, Print ISBN 978-953-51-3703-0, 198 pages, Publisher: InTech, Chapters published December 20, 2017 under CC BY 3.0 license DOI: 10.5772/66054 Edited VolumeObstetrics is the field that deals with the well-being of the pregnant women as well as the labor and delivery of a healthy baby. Obstetricians work closely as neonatologists who deal with the care of the newborn baby to reduce chances of morbidity and mortality. The objective of obstetrics is to deal with diagnosis and treatment of pregnancy, antenatal care, and prevention of complication, collaborating with midwives to monitor pregnant women in labor, facilitating delivery and performing assisted procedures if needed as episiotomy, forceps delivery, vacuum extraction, and Cesarean section if indicated. Libro / Book Prevención de nausea y vomito en mujeres con anestesia regional en cesárea. Retos y soluciones Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions. Jelting Y1, Klein C1, Harlander T1, Eberhart L2, Roewer N1, Kranke P1. Author information Local Reg Anesth. 2017 Aug 9;10:83-90. doi: 10.2147/LRA.S111459. eCollection 2017. Abstract BACKGROUND: Intraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids. METHODS: Given the high and even increasing rate of cesarean sections and the sparse information on the etiology, incidence and severity of nausea and vomiting and the impact of prophylactic measures on the incidence of PONV/IONV, this article aims to review the available information and provide pragmatic suggestions on how to prevent nausea and vomiting in this patient cohort. Current literature and guidelines were identified by electronic database searching (MEDLINE via PubMed and Cochrane database of systematic reviews) up to present, searching through reference lists of included literature and personal contact with experts. DISCUSSION AND CONCLUSION: Taking into account the current guidelines and literature as well as everyday clinical experience, the first step for decreasing the incidence of IONV and PONV is a comprehensive management of circulatory parameters. This management includes liberal perioperative fluid administration and the application of vasopressors as the circumstances require. By using low-dose local anesthetics, an additional application of intrathecal or spinal opioids or hyperbaric solutions for a sufficient controllability of neuraxial distribution, maternal hypotension might be reduced. Performing a combined spinal-epidural anesthesia or epidural anesthesia may be considered as an alternative to spinal anesthesia. Antiemetic drugs may be administered restrainedly due to off-label use in pregnant women for IONV or PONV prophylaxis and may be reserved for treatment. KEYWORDS: PONV; antiemetics; hypotension; neuraxial anesthesia; obstetrics PDF Comparación de fenilefrina y efedrina en el manejo de la hipotensión inducida por raquia en embarazo de alto riesgo. Revisión narrativa Comparison of Phenylephrine and Ephedrine in Treatment of Spinal-Induced Hypotension in High-Risk Pregnancies: A Narrative Review. Dusitkasem S1, Herndon BH2, Somjit M3, Stahl DL2, Bitticker E4, Coffman JC2. Author information Front Med (Lausanne). 2017 Jan 20;4:2. doi: 10.3389/fmed.2017.00002. eCollection 2017. Abstract PURPOSE: To compare maternal and fetal effects of intravenous phenylephrine and ephedrine administration during spinal anesthesia for cesarean delivery in high-risk pregnancies. SOURCE: An extensive literature search was conducted using the US National Library of Medicine, MEDLINE search engine, Cochrane review, and Google Scholar using search terms "ephedrine and phenylephrine," "preterm and term and spinal hypotension," "preeclampsia and healthy parturients," or "multiple and singleton gestation and vasopressor." PRINCIPLE FINDINGS: Both phenylephrine and ephedrine can be safely used to counteract hypotension after spinal anesthesia in patients with uteroplacental insufficiency, pregnancy-induced hypertension, and in non-elective cesarean deliveries. Vasopressor requirements before delivery in high-risk cesarean sections are reduced compared to healthy parturients. Among the articles reviewed, there were no statistically significant differences in umbilical arterial pH, umbilical venous pH, incidence of fetal acidosis, Apgar scores, or maternal hypotension when comparing maternal phenylephrine and ephedrine use. CONCLUSION: From the limited existing data, phenylephrine and ephedrine are both appropriate selections for treating or preventing hypotension induced by neuraxial blockade in high-risk pregnancies. There is no clear evidence that either medication is more effective at maintaining maternal blood pressure or has a superior safety profile in this setting. Further investigations are required to determine the efficacy, ideal dosing regimens, and overall safety of phenylephrine and ephedrine administration in high-risk obstetric patients, especially in the presence uteroplacental insufficiency. KEYWORDS: ephedrine; fetal compromise; hypotension; phenylephrine; preeclampsia; uteroplacental insufficiency PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org