Raquia continua en obstetricia / Continuous spinal anesthesia in obstetrics

Noviembre 8, 2017. No. 2896

Anestesia espinal continua para analgesia y anestesia 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 LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information 17h World Congress of Anaesthesiologists, WFSA Prague, Czech Republic, Sep 6-11, 2020 Informes / Information

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

Nivel sensitivo e hipotension en obstetricia /Sensory block and hypotension in parturient

Julio 1, 2017. No. 2736

Nivel del bloqueo sensitive después de raquia como predictor de hipotensión en las parturientas Level of sensory block after spinal anesthesia as a predictor of hypotension in parturient. Zhang N1, He L, Ni JX. Medicine (Baltimore). 2017 Jun;96(25):e7184. doi: 10.1097/MD.0000000000007184. Abstract When the sensory block level (SBL) is ≥T5 or T4, a high incidence of hypotension occurs in parturients after spinal anesthesia. A rapidly ascending SBL is another risk factor for spinal anesthesia-induced hypotension. However, the relationship between the ascension rate of the SBL and spinal anesthesia-induced hypotension remains unclear. The earliest and most complete records of the SBL started from the 3rd minute after spinal injection. The threshold spread rate corresponding to the highest accuracy for occurrence of hypotension was an SBL of ≥T8 at the 3rd minute after spinal injection, with 82% and 88% sensitivity and specificity, respectively.The ascension rate of an SBL of ≥T8 at the 3rd minute after spinal injection is as a predictor of hypotension in parturients. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Encuentro Internacional de Manejo de la Vía Aérea Bariloche. Argentina. Nov 30-Dic 2, 20l7 Información / Information

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

Opioides neuroaxiales en obstetricia / Neuraxial opioids in obstetrics

Abril 27, 2017. No. 2672

Analgesia con opioides neuroaxiales en trabajo de parto y en el postoperatorio de cesárea y de histerectomía. Una encuesta de cuestionario en Suecia. Neuraxial opioids as analgesia in labour and postoperative after caesarean section and hysterectomy: A questionnaire survey in Sweden. Hein A1, Gillis-Haegerstrand C1, Jakobsson JG1. F1000Res. 2017 Feb 13;6:133. doi: 10.12688/f1000research.10705.1. eCollection 2017. Abstract Background: Neuraxial opioids improve labour analgesia and analgesia after caesarean section (CS) and hysterectomy. Undesirable side effects and difficulties in arranging postoperative monitoring might influence the use of these opioids. The aim of the present survey was to assess the use of intrathecal and epidural morphine in gynaecology and obstetrics in Sweden. Methods: A questionnaire was sent to 47 anaesthesiologists at obstetric units in Sweden concerning the use and postoperative monitoring of morphine, sufentanil and fentanyl in spinal/epidural anaesthesia. Results: A total of 32 units responded representing 83% of annual CS in Sweden. In CS spinal anaesthesia, 20/32 units use intrathecal morphine, the most common dose of which was 100 μg (17/21). Intrathecal fentanyl (10-20 μg) was used by 21 units and sufentanil (2.5 -10 μg) by 9/32 of the responding units. In CS epidural anaesthesia, epidural fentanyl (50-100 μg) or sufentanil (5-25 μg) were commonly used (25/32), and 12/32 clinics used epidural morphine, the majority of units used a 2 mg dose. Intrathecal morphine for hysterectomy was used by 20/30 units, with 200 μg as the most common dose (9/32). Postoperative monitoring was organized in adherence to the National Guidelines; the patient is in postoperative care or an obstetrical ward over 2-6 hours and up-to 12 hours in an ordinary surgical ward. Risk of respiratory depression/difficult to monitor was a reason for not using intrathecal opioids. Conclusions: Neuraxial morphine is used widely in Sweden in CS and hysterectomy, but is still restricted in some units because of the concern for respiratory depression and difficulties in monitoring. KEYWORDS: Caesarean Section; epidural morphine; fentanyl; hysterectomy; intrathecal morphine; labour pain; postoperative pain; sufentanil PDF

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

Obstetricia / Obstetrics

Enero 16, 2017. No. 2571

Alteraciones de la coagulación en el embarazo Disorders of coagulation in pregnancy. Katz D1, Beilin Y2. Br J Anaesth. 2015 Dec;115 Suppl 2:ii75-88. doi: 10.1093/bja/aev374. Abstract The process of haemostasis is complex and is further complicated in the parturient because of the physiological changes of pregnancy. Understanding these changes and the impact that they have on the safety profile of the anaesthetic options for labour and delivery is crucial to any anaesthetist caring for the parturient. This article analyses current theories on coagulation and reviews the physiological changes to coagulation that occur during pregnancy and the best methods with which to evaluate coagulation. Finally, we examine some of the more common disorders of coagulation that occur during pregnancy, including von Willebrand disease, common factor deficiencies, platelet disorders, the parturient on anticoagulants, and the more KEYWORDS: blood coagulation disorders; epidural anaesthesia; pregnancy; spinal anaesthesia PDF  Intubación traqueal fallida en anestesia obstétrica. Revisión de la literatura Failed tracheal intubation during obstetric general anaesthesia: a literature review. Kinsella SM1, Winton AL2, Mushambi MC3, Ramaswamy K4, Swales H5, Quinn AC6, Popat M7. Int J Obstet Anesth. 2015 Nov;24(4):356-74. doi: 10.1016/j.ijoa.2015.06.008. Epub 2015 Jun 30. Abstract We reviewed the literature on obstetric failed tracheal intubation from 1970 onwards. The incidence remained unchanged over the period at 2.6 (95% CI 2.0 to 3.2) per 1000 anaesthetics (1 in 390) for obstetric general anaesthesia and 2.3 (95% CI 1.7 to 2.9) per 1000 general anaesthetics (1 in 443) for caesarean section. Maternal mortality from failed intubation was 2.3 (95% CI 0.3 to 8.2) per 100000 general anaesthetics for caesarean section (one death per 90 failed intubations). Maternal deaths occurred from aspiration or hypoxaemia secondary to airway obstruction or oesophageal intubation. There were 3.4 (95% CI 0.7 to 9.9) front-of-neck airway access procedures (surgical airway) per 100000 general anaesthetics for caesarean section (one procedure per 60 failed intubations), usually carried out as a late rescue attempt with poor maternal outcomes. Before the late 1990s, most cases were awakened after failed intubation; since the late 1990s, general anaesthesia has been continued in the majority of cases. When general anaesthesia was continued, a laryngeal mask was usually used but with a trend towards use of a second-generation supraglottic airway device. A prospective study of obstetric general anaesthesia found that transient maternal hypoxaemia occurred in over two-thirds of cases of failed intubation, usually without sequelae. Pulmonary aspiration occurred in 8% but the rate of maternal intensive care unit admission after failed intubation was the same as that after uneventful general anaesthesia. Poor neonatal outcomes were often associated with preoperative fetal compromise, although failed intubation and lowest maternal oxygen saturation were independent predictors of neonatal intensive care unit admission. KEYWORDS: Failed intubation; General anaesthesia; Obstetric anaesthesia PDF  Cambios fisiológicos en el embarazo Physiological changes in pregnancy. Soma-Pillay P1, Nelson-Piercy C2, Tolppanen H3, Mebazaa A4. Cardiovasc J Afr. 2016 Mar-Apr;27(2):89-94. doi: 10.5830/CVJA-2016-021. Abstract Physiological changes occur in pregnancy to nurture the developing foetus and prepare the mother for labour and delivery. Some of these changes influence normal biochemical values while others may mimic symptoms of medical disease. It is important to differentiate between normal physiological changes and disease pathology. This review highlights the important changes that take place during normal pregnancy. PDF 5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Ciudad de México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com  Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015