Anestesia obstétrica / Obstetric anaesthesia

Noviembre 21, 2016. No. 2515

Anestesia para cesárea en la parturienta obesa. Perspectivas actuales Managing anesthesia for cesarean section in obese patients: current perspectives. Lamon AM1, Habib AS1. Local Reg Anesth. 2016 Aug 16;9:45-57. doi: 10.2147/LRA.S64279. eCollection 2016. Abstract Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. KEYWORDS: cesarean delivery; neuraxial techniques; obesity PDF Efectos del calentamiento del paciente durante parto por cesárea sobre la evolución materno-fetal. Un Meta-análisis The Effect of patient warming during Caesarean delivery on maternal and neonatal outcomes: a meta-analysis. Sultan P1, Habib AS2, Cho Y3, Carvalho B4. Br J Anaesth. 2015 Oct;115(4):500-10. doi: 10.1093/bja/aev325. Abstract BACKGROUND: Perioperative warming is recommended for surgery under anaesthesia, however its role during Caesarean delivery remains unclear. This meta-analysis aimed to determine the efficacy of active warming on outcomes after elective Caesarean delivery. METHODS: We searched databases for randomized controlled trials utilizing forced air warming or warmed fluid within 30 min of neuraxial anaesthesia placement. Primary outcome was maximum temperature change. Secondary outcomes included maternal (end of surgery temperature, shivering, thermal comfort, hypothermia) and neonatal (temperature, umbilical cord pH and Apgar scores) outcomes. Standardized mean difference/mean difference/risk ratio (SMD/MD/RR) and 95% confidence interval (CI) were calculated using random effects modelling (CMA, version 2, 2005). RESULTS: 13 studies met our criteria and 789 patients (416 warmed and 373 controls) were analysed for the primary outcome. Warming reduced temperature change (SMD -1.27°C [-1.86, -0.69]; P=0.00002); resulted in higher end of surgery temperatures (MD 0.43 °C [0.27, 0.59]; P<0.00001); was associated with less shivering (RR 0.58 [0.43, 0.79]; P=0.0004); improved thermal comfort (SMD 0.90 [0.36, 1.45]; P=0.001), and decreased hypothermia (RR 0.66 [0.50, 0.87]; P=0.003). Umbilical artery pH was higher in the warmed group (MD 0.02 [0, 0.05]; P=0.04). Egger's test (P=0.001) and contour-enhanced funnel plot suggest a risk of publication bias for the primary outcome of temperature change. CONCLUSIONS: Active warming for elective Caesarean delivery decreases perioperative temperature reduction and the incidence of hypothermia and shivering. These findings suggest that forced air warming or warmed fluid should be used for elective Caesarean delivery. PDF Vasopresores en anestesia obstétrica. Perspectiva actual Vasopressors in obstetric anesthesia: A current perspective. Nag DS1, Samaddar DP1, Chatterjee A1, Kumar H1, Dembla A1. World J Clin Cases. 2015 Jan 16;3(1):58-64. doi: 10.12998/wjcc.v3.i1.58. Abstract Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetal acid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today. KEYWORDS: Cesarean section; Hypotension; Obstetrics; Spinal anesthesia; Vasopressor agents PDF Segundo Curso-Taller de Anestesia y Dolor Zapopan Jalisco, México Dic 1-2, 2016 Informes gmoarechiga@hotmail.com  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

Dolor patelofemoral e inestabilidad en atletas adolescentes

Dolor patelofemoral e inestabilidad en atletas adolescentes

Biblioteca Nacional. Noticias

Biblioteca Nacional
Notificaciones diarias ⋅ 18 de noviembre de 2016
NOTICIAS

Fama recibió al director de la Biblioteca Nacional
Diario El Esquiu
El rector de la Unca Flavio Fama recibió al director de la Biblioteca Nacional, Alberto Manguel. Del encuentro surgió la necesidad de rubricar ...



Segundo Foro Global de la Biblioteca Nacional de Israel
InfoPúblico (Comunicado de prensa) (blog)
El Segundo Encuentro del Foro Global de la Biblioteca Nacional de Israel traerá a la vanguardia uno de los temas más pertinentes de nuestro tiempo; ...



La Biblioteca Nacional dedica una exposición a la Historia del Flamenco
Revista de Arte - Logopress
patrimonio-flamenco-1 La Biblioteca Nacional de España dedica entre el 27 de enero y el 2 de mayo de 2017 una exposición que recorre la historia ...
Exposición Historia del Flamenco en la BNE - IberArte
Cobertura total de la noticia



La ópera prima de Carmen Llopis, seleccionada para formar parte de la Biblioteca Nacional
valenciaplaza.com
VALENCIA. La recién estrenada escritora Carmen Llopis Feldman, celebra el ingreso en la colección de la Biblioteca Nacional de España de su ...



Ley de Cultura organizará repositorios de la memoria
El Telégrafo
También se integrará la Biblioteca Nacional Eugenio Espejo, que estaba regida por una transitoria –no ejecutada– de traspaso a los repositorios ...



Sí, una biblioteca es una biblioteca
NTR Zacatecas .com
No es lo mismo la biblioteca para niños que se armó en el campo de ... Entonces, pienso que la Biblioteca Nacionaltendrá que funcionar como una ...



Conoce la Historia del Flamenco a través de una exposición de la Biblioteca Nacional
Revista La Flamenca (Comunicado de prensa) (blog)
La Biblioteca Nacional de España acoge entre el 27 de enero y el 2 de mayo de 2017 una exposición que recorre 400 años de historia de Patrimonio ...



Ramos Mejía: La escritora Nora Coria brinda talleres de literatura a distancia
DiarioNCO
Es convocada como jurado en certámenes literarios nacionales e internacionales, entre ellos Revista Guka, auspiciada por la Biblioteca Nacional ...



Fernando Benzo Sáinz, nuevo secretario de Estado de Cultura
Lainformacion.com
... como el Teatro Real, el Museo Thyssen, la Biblioteca Nacional de España o el Museo Nacional Centro de Arte Reina Sofía (MNCARS), entre otras.
IVA cultural y Ley de Mecenazgo, los retos fallidos de Lassalle como secretario de Estado de Cultura - Lainformacion.com
Fernando Benzo, mano derecha de Méndez de Vigo, Secretario de Cultura - La Vanguardia
Cobertura total de la noticia



“Inseparables”, gran filme nacional en la Biblioteca Popular “Sarmiento”
Diario Democracia
Se trata de un notable filme nacional, que se proyectará como es habitual con entrada libre y gratuita en las inatalaciones que la Biblioteca posee en ...


WEB

2
Biblioteca Nacional
SIWA. REVISTA DE LITERATURA GEOGRÁFICA Jueves 24 de noviembre | 19 hs. | Auditorio Jorge Luis Borges. La quinta entrega de la revista libro ...



Presentación del libro, Les Espagnes de Mérimée, de Jean Canavaggio
Biblioteca Nacional de España
La Biblioteca Nacional de España organiza en colaboración con el Centro de Estudios Europa Hispánica el acto de presentación del libro, Les ...



La Biblioteca Nacional de Colombia realiza en el departamento de
Biblioteca Nacional de Colombia
Estas 32 reuniones se efectuarán con el objetivo de presentar las líneas estratégicas y de inversión de la Red Nacional de Bibliotecas Públicas ...

Libros. Noticias

libros
Notificaciones diarias ⋅ 17 de noviembre de 2016
NOTICIAS

5 libros para conocer a John Berger.
LA NACION (Argentina)
De esa experiencia de vida aún comunitaria, surgió la trilogía de De sus fatigas que incluye los libros Puerca tierra, Una vez en Europa (1987) y Lila y ...



La casa en la que vivían los libros
La Razón
«Lacasa de los Veinte mil libros» es la narración de un nieto que recrea la vida, las ideas y, sobre todo, la pasión literaria de su abuelo, Chimen ...



Libros que andan en la vuelta
Diario El País
Desde los tiempos de Horangel pasando por Ludovica Squirru, libros como este siempre han encontrado un público curioso y La Torre conoce la ...



Presentaron dos libros sobre el pensamiento y obra del papa Francisco
Aica On line
El pasado viernes 11 de noviembre, en el Complejo Cultural Plaza, de la ciudad bonaerense de San Martín, se presentaron dos libros considerados ...



CAMBALACHEANDO: presentan los libros “Gente de tango”
Galvezhoy (Comunicado de prensa)
cambalacheando El taller de tango “Cambalacheando” sigue sumando cultura a la ciudad, y este viernes estará presentando en la Biblioteca Popular ...



Artista crea señaladores con personajes de películas y libros
Cultura Geek
Olena Mysnyk es una artista ucraniana que encontró en los señaladores la forma de inmortalizar a sus personajes favoritos de libros y películas.



Enfoque de China: Desigual recepción de libros escondidos en metro de ciudades chinas
Xinhua
La iniciativa 'Libros en el metro' no era muy conocida en China hasta que la actriz británica Emma Watson se afilió al proyecto en su país para ...
Exclusiva de China: Libros ocultos en metro buscan fomentar lectura entre chinos - Xinhua
Cobertura total de la noticia



Descubren el extravío de libros de Denuncias 2014 y 2015 en Crimen 1ª
El Liberal Digital
Las autoridades judiciales habrían establecido la "ausencia" de libros en que se registran detenciones


Libros de José Saramago se mantienen vigentes a 94 años de su natalicio
El Nacional.com
Este miércoles recordamos al Nobel de Literatura José Saramago, en su natalicio número 94. Nacido un 16 de noviembre de 1922 en Portugal, este ...
Los 7 libros indispensables que debes leer de José Saramago - La Razon
Los libros esenciales en la obra de José Saramago - Reporte Indigo
Cobertura total de la noticia



La UPB conmemoró 10 años de la colección de libros que donó el expresidente Belisario Betancur
RCN Radio (blog)
En la presentación de esa “joya” como él la llamó, el expresidente amagaseño Belisario Betancur señaló que la importancia de los libros es que ...


WEB

Partenón de libros
Deutschland.de
La artista argentina Marta Minujín construye un Partenón de libros para la próxima documenta de Kassel.



CLACSO - Libros
CLACSO - Libros
Educación Superior y Pueblos Indígenas en América Latina Experiencias, interpelaciones y desafíos. Daniel Mato [Coordinador] Antonio Hilario ...



Un rio de libros se desborda en las calles de Toronto
PMCanal5.com
Miles de libros fueron donados por Salvation Army y 50 voluntarios estuvieron trabajando durante 12 días para llenar Hagerman Street con un “río” ...



Biblioteca Virtual: los salteños ya pueden descargar libros gratis en sus teléfonos móviles
Gobierno de la Provincia de Salta
En un corto plazo, los libros se podrán descargar en los colectivos y en lugares públicos; sobre la bibliografía, se trabaja con las universidades ...



Festival de literatura infantil en el CCE y Escaramuza Libros
Radio Uruguay
Escuchar la entrevista. El viernes 18 y sábado 19 se segunda edición del Festival Internacional de Literatura Infantil en Uruguay. Es una actividad ...

Cesárea / C- Section

Noviembre 22, 2016. No. 2516

Eficacia de opioides lipofílicos vs opioides lipofóbicos adicionados a bupivacaína hiperbárica en cesárea del segmento inferior Efficacy of lipophilic vs lipophobic opioids in addition to hyperbaric bupivacaine for patients undergoing lower segment caeserean section. Agrawal A1, Asthana V1, Sharma JP1, Gupta V2. Anesth Essays Res. 2016 Sep-Dec;10(3):420-424. Abstract BACKGROUND:  Subarachnoid block is the preferred technique for providing anesthesia for patients undergoing cesarean section. Various pharmacological agents in added to local anesthetics (LA) modify their original effects in terms of block characteristics and quality of analgesia. However, there is ongoing debate about this practice of using adjuncts with LA. We tested whether addition of lipophilic versus lipophobic opioids to LA gives any clinical benefits to maternal and fetal outcome when used in these patients requiring spinal anesthesia. SUBJECTS AND METHODS: Sixty American Society of Anesthesiologists I and II parturients, undergoing elective cesarean sectionrequiring subarachnoid block, were included in our study. The parturients were allocated randomly to three groups of 20 each to receive bupivacaine 12.5 mg (Group I), bupivacaine 12.5 mg + morphine 0.2 mg (Group II), bupivacaine 12.5 mg + fentanyl 25 μg (Group III), preservative free physiological saline 0.9% was added to all the solutions to achieve a total volume of 4 ml. The parameters studied were the time of onset, sensory level of the block achieved, total duration of analgesia, any need of rescue analgesics, maternal side effects, and fetal outcome. RESULTS: Onset of block was early 4.30 ± 0.12 min in Group III as compared to Group I 4.64 ± 0.28 min and Group II 4.505 ± 0.22 min. Mean duration of analgesia (hours) was higher in Group II 15.91 ± 0.96 h as compared to Group I 1.95 ± 0.55 h and Group III 4.39 ± 0.2 h. Incidence of nausea, vomiting, and shivering was more in the control group as compared to study groups, whereas sedation and pruritus were seen more in the study groups. No adverse effects on fetus were seen with use of opioids and comparable Apgar scores were noted. CONCLUSION: Addition of intrathecal fentanyl causes rapid onset of block whereas intrathecal morphine provides prolonged analgesia with comparable neonatal wellbeing. KEYWORDS: Anesthesia; fentanyl; intrathecal; morphine; spinal PDF Hetastarch 6% vs solución Ringer lactado para precarga antes de raquia en cesárea Six percent hetastarch versus lactated Ringer's solution - for preloading before spinal anesthesia for cesarean section. Upadya M1, Bhat S1, Paul S1. Anesth Essays Res. 2016 Jan-Apr;10(1):33-7. doi: 10.4103/0259-1162.164729. Abstract BACKGROUND: Regional anesthesia has been the choice of preference for elective cesarean sections. This study was designed to determine whether preoperative administration of 6% hetastarch decreases the incidence of hypotension. MATERIALS AND METHODS: This study was conducted on 50 nonlaboring American Society of Anesthesiologists class I and II women undergoing elective cesarean section. Patients were randomly divided into two groups and were preloaded either with 1000 ml Ringer's lactate (RL) or 500 ml of 6% hetastarch 30 min prior to the surgery. Spinal anesthesia was performed with patients in the left lateral position and 2 cc (10 mg) of 0.5% of bupivacaine injected into subarachnoid space. Hemodynamic variables (heart rate, noninvasive blood pressure, and SpO2) were recorded from prior to preloading until the recovery from the subarachnoid blockade. RESULTS: Our study showed the incidence of hypotension to be 28% in the hetastarch group and 80% in the RL group. Rescue ephedrine requirements for the treatment of hypotension were significantly less in patients who were preloaded with 6% hetastarch prior to cesarean section. The neonatal outcome, as determined by Apgar scores was good and similar in both groups. CONCLUSION: Hence, we conclude that 6% hydroxyl ethyl starch is more effective than lactated Ringers solution and that its routine use for preloading prior to spinal anesthesia should be considered. KEYWORDS: Cesarean; preloading; spinal PDF Estudio retrospectivo para correlacionar la presentación de nalgas y el aumento del riesgo de hipotensión post-espinal durante la cesárea. A retrospective study to correlate breech presentation and enhanced risk of postspinal hypotension during cesarean delivery. Jain A1, Pandey S1, Kumar R1, Sethi C1, Sharma S2. Local Reg Anesth. 2015 Dec 16;8:129-34. doi: 10.2147/LRA.S91991. eCollection 2015. Abstract BACKGROUND: Subarachnoid blockade for cesarean section still poses a threat of profound hypotension and can result in unstable maternal and fetal hemodynamics. The correlation of fetal breech and vertex presentation with the occurrence of hypotension under spinal anesthesia is reviewed in this retrospective, double-blind study. PATIENTS AND METHODS: The study was conducted on pregnant females scheduled for a lower segment cesarean section between January 2014 and December 2014. After applying inclusion criteria, 568 patients were recruited in the study out of which 363 had vertex and 184 patients had breech presentation. They were divided into two groups, Group I and Group II. The monitoring and therapeutic data (blood pressure, heart rate, arterial oxygen saturation, and dose of vasopressor/atropine) recovered from automated data analysis were analyzed retrospectively for prevalence of hypotension, bradycardia, and hypotension with bradycardia and nausea ± vomiting. RESULTS: Among Group I, prevalence of hypotension, bradycardia, and hypotension together with bradycardia was 152 (41.83%) patients, eight (2.20%) patients, and seven (1.92%) patients, respectively. In Group II, the prevalence of hypotension, bradycardia, and hypotension with bradycardia was 93 (50.5%) patients, five (2.71%) patients, and six (3.2%) patients, respectively. The difference between the two groups was statistically significant for hypotension. For Group I, 152 patients (41.87%) experienced one, 23 patients (6.33%) experienced two, and three patients (0.82%) experienced three episodes of hypotension. In Group II, 93 (50.5%), 19 (7.89%), and two (1.08%) patients experienced such episodes. The difference was significant with respect of one and two episodes. The prevalence of intraoperative nausea was 11.01% (40 patients) in Group I, whereas 11.41% (21 patients) in Group II. Intraoperative vomiting occurred in 19 patients (5.23%) of Group I and 14 patients (7.60%) of Group II. The height of the block was comparable in both the groups for T6, and the difference was significant in respect to T4 level. CONCLUSION: Incidence of hypotension is more in pregnant females with breech fetal presentation. KEYWORDS: breech; cesarean section; hypotension; spinal anesthesia PDF Aditivos espinales en anestesia subaracnoidea para cesárea Spinal Additives in Subarachnoid Anaesthesia for Cesarean Section Hala M. Goma, Juan C. Flores-Carrillo and Víctor Whizar-Lugo PDF Parto por cesárea Cesarean Delivery Edited by Raed Salim, ISBN 978-953-51-0638-8, 210 pages, Publisher: InTech, Chapters published May 23, 2012 under CC BY 3.0 license DOI: 10.5772/1459 Edited Volume This book provides broad, science-based information regarding the most common major surgical procedure performed, i.e. Cesarean Delivery. The book provides relevant scientific literature regarding epidemiology and rates of cesarean delivery in low and high income countries and the impact of the disparities in the rate of cesarean delivery between countries. In addition, the book systematically reviews the relevant scientific literature regarding all perioperative considerations with a broad cover of anesthetic techniques, drugs and difficulties that anesthesiologists may encounter during cesarean delivery. Care of the neonate after cesarean and crucial guidelines for obese women undergoing cesarean are also provided. The book was written by distinguished experts from different disciplines to ensure complete and accurate coverage of the recent scientific and clinical advances and to bring care providers and purchasers up to date including essential information to help improve health care quality. Libro / Book Segundo Curso-Taller de Anestesia y Dolor Zapopan Jalisco, México Dic 1-2, 2016 Informes gmoarechiga@hotmail.com  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