Revisiones_bibliográficas TyO

Obesity is an epidemic, with approximately 35% of the US population affected. This rate is unlikely to decline and may increase the demand for total knee arthroplasty (TKA). Data regarding the risks, benefits, and potential complications of TKA in this patient population are conflicting. Preoperative considerations are optimization of nutritional status, safe weight loss strategies, and bariatric surgery. Intraoperative concerns unique to this population include inadequate exposure, implant alignment, and durable implant fixation; postoperative issues include tibial loosening, wound complications, cardiovascular events, and respiratory complications. A thorough understanding of the medical and surgical complications associated with TKA in the obese patient will facilitate research efforts and improve outcomes.

Resumen
La obesidad es una epidemia, con aproximadamente el 35% de la población estadounidense afectada. Esta tasa es poco probable que disminuya y puede aumentar la demanda de artroplastia total de rodilla (TKA). Los datos relativos a los riesgos, beneficios y posibles complicaciones de TKA en esta población de pacientes son conflictivos. Las consideraciones preoperatorias son la optimización del estado nutricional, estrategias seguras de pérdida de peso y cirugía bariátrica. Las preocupaciones intraoperatorias exclusivas de esta población incluyen exposición inadecuada, alineación del implante y fijación duradera del implante; Las cuestiones postoperatorias incluyen aflojamiento tibial, complicaciones de la herida, eventos cardiovasculares y complicaciones respiratorias. Una comprensión completa de las complicaciones médicas y quirúrgicas asociadas con TKA en el paciente obeso facilitará los esfuerzos de investigación y mejorar los resultados.

PMID: 28146438 DOI:

10.5435/JAAOS-D-15-00684

#obesidad #artroplastia total de rodilla #rodilla #paciente obeso #TKA

Analgesia obstétrica / Obstetric analgesia

Abril 7, 2017. No. 2652

Dolor, alivio del dolor, satisfacción y excelencia en anestesia obstétrica. Una relación sorprendentemente compleja.

Pain, Pain Relief, Satisfaction and Excellence in Obstetric Anesthesia: A Surprisingly Complex Relationship.

Camann W1.

Anesth Analg. 2017 Feb;124(2):383-385. doi: 10.1213/ANE.0000000000001676.

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Efecto de entonox en la reducción de la necesidad de petidina y las complicaciones fetales y maternas relevantes para el trabajo indoloro.

Effect of Entonox on reducing the need for Pethidine and the Relevant Fetal and Maternal Complications for Painless Labor.

Attar AS1, Feizabadi AS2, Jarahi L3, Feizabadi LS4, Sheybani S5.

Electron Physician. 2016 Dec 25;8(12):3325-3332. doi: 10.19082/3325. eCollection 2016.

Abstract

BACKGROUND: Pain relief during labour is one of the major concerns in obstetrics; severe labor pain causes fear of the next pregnancy, and interferes with the mother's family relationship. OBJECTIVE:

The aim of this study was to evaluate the analgesic effects of Entonox during labor on reducing the need for pethidine (Meperidine) and fetal-maternal complications. METHODS: This double-blind randomized clinical trial was conducted on pregnant women who were candidates for vaginal delivery in Educational Hospitals of Mashhad University of Medical Sciences, Iran between January 2014 and November 2015. After entering into the inactive phase of labor, participants were randomly allocated to receive inhaled Entonox gas (n=200) or inhale Oxygen (n=200) as a control group. Mothers inhaled the gas at commencement of pain, and ceased as soon as the pain diminished, up to the end of the second stage of labor which was the neonate's birth. Main outcomes were pain score based on NRS (numerical rating scale), duration of delivery, required pethidine, maternal complications and satisfaction during labour. Chi-square and Independent T-test were used via SPSS for data analysis and P-value less than 0.05 was considered statistically significant. RESULTS: Four-hundred pregnant women with a mean age of 26.4±5.9 years were studied. Complications such as nausea, vomiting, dizziness, and drowsiness were reported in 25% of the Entonox group and 23% in the control group (p=0.640). Mean of pain severity score during labor in the Entonox and control groups was 4.5±1.2 and 5.2±1.4, respectively (p<0.001). Pethidine requirement, significantly was lower in the Entonox group (31.6±11.8 versus 35.7±12.4; p<0.001). CONCLUSION: In our study, Entonox significantly reduced pain during delivery without significant increase in maternal and neonatal complications.

KEYWORDS: Analgesia; Entonox; Inhalation; Narcotics; Obstetrical; Pethidine

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Un ensayo controlado aleatorio que compara el uso de entonox con petidina para el alivio del dolor en primigestas durante la fase activa del trabajo.

A Randomized Controlled Trial Comparing Use of Enthonox With Pethidine for Pain Relief in Primigravid Women During the Active Phase of Labor.

Mobaraki N1, Yousefian M2, Seifi S1, Sakaki M3.

Anesth Pain Med. 2016 Jul 24;6(4):e37420. eCollection 2016.

Abstract

BACKGROUND: The use of pain-relieving drugs during labor is now part of standard care in many countries throughout the world. Each method of pain relief has its own risks and benefits, variations in effectiveness, and availability and acceptability. OBJECTIVES: This study aimed to assess the efficacy and safety of intramuscular pethidine as an analgesic during labor by comparing it to inhaled 50% nitrous oxide (Entonox). METHODS: In this clinical trial study, 100 women who expected to have a natural childbirth were observed. The inclusion criteria for this study were the commencement of spontaneous labor pain along with appropriate maternal and fetal indications for vaginal delivery. By using random numbers, each subject was randomly allocated to one of two groups, with one group using Entonox and the other receiving an intramuscular injection of 0.5 mg/kg of pethidine for pain relief. The intensity of labor pain experienced by the subjects and the outcomes of the deliveries were collected with questionnaires. RESULTS: The average pain scores in the Entonox and pethidine groups were 3.94 ± 1.4 and 5.6 ± 1.1, respectively, 30 minutes after intervention (P = 0.001), but there was not a significant difference in the severity of the pain (5.06 ± 1.4 and 4.7 ± 1.1 for the Entonox and pethidine groups, respectively) between the subjects in each group 60 minutes after the intervention (P = 0.592). No significant differences were seen in the duration and interval of uterine contractions, maternal complications, Apgar scores, and the duration of the first and second stage of labor between the two studied groups (P > 0.05). An analysis of the pooled risk differences showed that none of the side effects investigated were significantly different between the two groups except for mouth dryness, which was significantly higher in nitrous oxide users (P = 0.044). CONCLUSIONS: Inhaled nitrous oxide seems to give better pain relief in the short term compared to a single dose of pethidine. Entonox, which is more convenient to administer than an intramuscular injection of pethidine, is also regarded as safe both for mothers and neonates.

KEYWORDS: Entonox; Labor Pain; Pethidine

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