Remifentanilo en obstetricia / Remifentanil in obstetrics

Noviembre 24, 2016. No. 2518

Efecto analgésico de remifentanil en trabajo de parto. Revisión sistémica de la literatura reciente The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature. Stourac P1,2, Kosinova M3, Harazim H3, Huser M4, Janku P4, Littnerova S5, Jarkovsky J5. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016 Mar;160(1):30-8. doi: 10.5507/bp.2015.043. Epub 2015 Oct 7. Abstract BACKGROUND AND AIMS: Although epidural analgesia is still regarded as the gold standard for labour analgesia due to its efficacy, in cases of contraindication, systemic remifentanil is an alternative. Since the first demonstration of the safety of remifentanil in obstetric analgesia in 1996, this has been repeatedly confirmed for both mother and newborn. The aim of this meta-analysis is to evaluate recently published studies (up to December 2014) on the analgesic efficacy of remifentanil during labour (as a Visual Analogue Scale (VAS) decrease in the first hour by 2 or more). METHODS: Search of the US National Library of Medicine, National Institutes of Health (www.pubmed.gov), SCOPUS database (www.scopus.com) and Web of Science database (www.webofknowledge.com) using the key words "labour" and "remifentanil". 44 identified articles were included in the review and 15 published randomised controlled studies were incorporated into the meta-analysis. This was based on the fixed model and described by differences in the VAS between t=0 and t=1 hour after remifentaniladministration using the 95% confidence interval (CI). The analysis was computed using the Comprehensive meta-analysis version 2.2.064. RESULTS: The combined data from the meta-analysis showed a statistically significant decrease in VAS in the remifentanil group. From a comparison of the CIs of summary estimates with a cut-off decrease of VAS 2, for the fixed model, there was a statistically significantly greater decrease in VAS than the cut-off. In the systematic review, we describe possible modes of application, dosage and side-effects for mother, fetus/ newborn. CONCLUSION: The meta-analysis presented here confirms that remifentanil for labour analgesia is effective but questions remain which can only be answered by further randomized trials. KEYWORDS: labour analgesia; meta-analysis; patient-controlled analgesia; remifentanil; systemic opioid analgesia PDF Remifentanil en dolor de trabajo de parto Remifentanil for labour pain relief. Solek-Pastuszka J1, Zagrodnik-Ulan E, Bohatyrewicz R, Celewicz Z. Anaesthesiol Intensive Ther. 2015;47(1):82-6. doi: 10.5603/AIT.2015.0008. Abstract Labour is thought to be one of the most intense and painful experiences in a woman's life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as "unbearable" and 60% describe the pain as "very intense". Since the mid-1980s, continuous epidural analgesia during labour has been considered the gold standard of labour anaesthesia and is currently the most frequently used. There are situations in which this type of analgesia could not be used. An alternative pain management is administration of parenteral opioids, the most frequently used of which is pethidine. Its use is associated with adverse effects and unsatisfactory analgesia. Since the second half of the 20th century, a new generation of opioids, such as fentanyl or remifentanil, has been used. Despite their much better pharmacokinetic and pharmacodynamic parameters, obstetricians, midwives and neonatologists are most aware of pethidine, probably because it has been used for the longest period of time, despite its disadvantages and the risk that its use entails. The drug that is nearest to ideal is remifentanil. The countries in which it is widely used as an alternative type of labour anaesthesia have developed practice standards or guidelines practice. Guidelines and alternatives to pethidine protocols for effective labour analgesia in Poland might be merited. PDF Efecto neonatal de remifentanilo en anestesia general para cesárea. Estudio randomizado Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial. Noskova P1, Blaha J1, Bakhouche H2, Kubatova J1, Ulrichova J1, Marusicova P1, Smisek J3, Parizek A4, Slanar O2, Michalek P1. BMC Anesthesiol. 2015 Mar 26;15:38. doi: 10.1186/s12871-015-0020-1. eCollection 2015. Abstract BACKGROUND: Remifentanil has been suggested for its short duration of action to replace standard opioids for induction of general anaesthesia in caesarean section. While the stabilizing effect of remifentanil on maternal circulation has been confirmed, its effect on postnatal adaptation remains unclear, as currently published studies are not powered sufficiently to detect any clinical effect of remifentanil on the newborn. CONCLUSION: At a dose of 1 μg/kg, remifentanil prior to induction of general anaesthesia increases the risk of neonatal respiratory depression during first minutes after caesarean delivery but duration of clinical symptoms is short. KEYWORDS: Caesarean delivery; General anaesthesia; Neonatal effect; Remifentanil 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

Más de obstetricia / More on obstetrics

Noviembre 23, 2016. No. 2517

Evaluando la altura del bloqueo en cesárea en las últimas tres décadas: tendencias en la literatura Assessing the height of block for caesarean section over the past three decades: trends from the literature. Hoyle J1, Yentis SM. Anaesthesia. 2015 Apr;70(4):421-8. doi: 10.1111/anae.12927. Epub 2014 Nov 10. Abstract There are multiple methods of assessing the height of block before caesarean section under regional anaesthesia, and surveys of practice suggest considerable variation in practice. So far, little emphasis has been placed on the guidance to be gained from published research literature or textbooks. We therefore set out to investigate the methods of block assessment documented in published articles and textbooks over the past 30 years. We performed two searches of PubMed for randomised clinical trials with caesarean section and either spinal anaesthesia or epidural anaesthesia as major Medical Subject Headings. A total of 284 papers, from 1984 to 2013, were analysed for methods of assessment of sensory and motor block, and the height of block deemed adequate for surgery. We also examined 45 editions of seven anaesthetic textbooks spanning 1950-2014 for recommended methods of assessment and height of block required for caesarean section. Analysis of published papers demonstrated a wide variation in techniques, though there has been a trend towards the increased use of touch, and an increased use of a block height of T5 over the study period. Only 115/284 (40.5%) papers described the method of assessing motor block, with most of those that did (102/115; 88.7%) describing it as the 'Bromage scale', although only five of these (4.9%) matched the original description by Bromage. The required height of block recommended by textbooks has risen over the last 30 years to T4, although only four textbooks made any recommendation about the preferred sensory modality. The variation in methods suggested by surveys of practice is reflected in variation in published trials, and there is little consensus or guidance in anaesthetic textbooks. PDF Anestesia regional en pacientes con hipertensión inducida por el embarazo Regional anesthesia in patients with pregnancy induced hypertension. Ankichetty SP1, Chin KJ, Chan VW, Sahajanandan R, Tan H, Grewal A, Perlas A. J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):435-44. doi: 10.4103/0970-9185.119108. Abstract Pregnancy induced hypertension is a hypertensive disorder, which occurs in 5% to 7% of all pregnancies. These  parturients  present to the labour and delivery unit ranging from gestational hypertension to HELLP syndrome. It is essential to understand the various clinical conditions that may mimic preeclampsia and the urgency of cesarean delivery, which may improve perinatal outcome. The administration of general anesthesia (GA) increases morbidity and mortality in both mother and baby. The provision of regional anesthesia when possible maintains uteroplacental blood flow, avoids the complications with GA, improves maternal and neonatal outcome. The use of ultrasound may increase the success rate. This review emphasizes on the regional anesthetic considerations when such parturients present to the labor and delivery unit. KEYWORDS: Anesthesia; hypertension; pregnancy; regional 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

Supervivencia a cinco años de 20.946 reemplazos de rodilla unicondilares y factores de riesgo para el fracaso: un análisis de datos de seguros alemanes.

Supervivencia a cinco años de 20.946 reemplazos de rodilla unicondilares y factores de riesgo para el fracaso: un análisis de datos de seguros alemanes.