Mostrando entradas con la etiqueta obstetrics. Mostrar todas las entradas
Mostrando entradas con la etiqueta obstetrics. Mostrar todas las entradas

viernes, 18 de mayo de 2018

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.
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
Anestesia espinal continua para anestesia y analgesia obstétrica
Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia.
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
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.
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

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

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. 
V Congreso Internacional de Vía Aérea, EVALa, México
Junio 7-9, 2018. Guadalajara. México
Safe Anaesthesia Worldwide
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Anestesiología y Medicina del Dolor

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viernes, 22 de diciembre de 2017

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.
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.
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
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.
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

Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
International Anesthesia Research Society Annuals Meetings
USA
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Anestesiología y Medicina del Dolor

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miércoles, 8 de noviembre de 2017

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.
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

LI Congreso Mexicano de Anestesiología
Mérida Yucatán, Noviembre 21-25, 2017
17h World Congress of Anaesthesiologists, WFSA
Prague, Czech Republic, Sep 6-11, 2020
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Anestesiología y Medicina del Dolor

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