lunes, 4 de mayo de 2015

Obesidad y embarazo

IMC pre-embarazo y mortalidad por enfermedad cardiovascular. Estudios para el desarrollo y la salud del niño.
Prepregnancy body mass index and cardiovascular disease mortality: the Child Health and Development Studies.
Mongraw-Chaffin ML1, Anderson CA, Clark JM, Bennett WL.
Obesity (Silver Spring). 2014 Apr;22(4):1149-56. doi: 10.1002/oby.20633. Epub 2013 Dec 4.
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Efectos del IMC materno sobre las concentraciones de eritropoyetina en el cordón umbilical
Effect of maternal body mass index on cord blood erthropoietin concentrations
Barak S, Mimouni FB, Stern R, Cohen N, Marom R.
J Perinatol. 2015 Jan;35(1):29-31. doi: 10.1038/jp.2014.140. Epub 2014 Aug 7.
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Nutrición y embarazo después de cirugía bariátrica
Nutrition and pregnancy after bariatric surgery.
Kaska L, Kobiela J, Abacjew-Chmylko A, Chmylko L, Wojanowska-Pindel M, Kobiela P, Walerzak A, Makarewicz W, Proczko-Markuszewska M,Stefaniak T.
ISRN Obes. 2013 Jan 30;2013:492060. doi: 10.1155/2013/492060. eCollection 2013.
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Diagnóstico de obesidad materna y riesgo de parálisis cerebral en el niño
Maternal diagnosis of obesity and risk of cerebral palsy in the child.
Crisham Janik MD, Newman TB, Cheng YW, Xing G, Gilbert WM, Wu YW.
J Pediatr. 2013 Nov;163(5):1307-12. doi: 10.1016/j.jpeds.2013.06.062. Epub 2013 Aug 6.
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Superobesidad materna y evolución perinatal
Maternal superobesity and perinatal outcomes.
Marshall NE, Guild C, Cheng YW, Caughey AB, Halloran DR.
Am J Obstet Gynecol. 2012 May;206(5):417.e1-6. doi: 10.1016/j.ajog.2012.02.037. Epub 2012 Mar 7.
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Intervenciones para reducir y prevenir la obesidad en mujeres antes de la concepción y embarazadas. Revisión sistemática y meta-análisis
Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: a systematic review and meta-analysis.
Agha M, Agha RA, Sandell J.
PLoS One. 2014 May 14;9(5):e95132. doi: 10.1371/journal.pone.0095132. eCollection 2014.
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Efectos del bypass gástrico sobre la función reproductiva
Effects of gastric bypass surgery on female reproductive function.
Legro RS1, Dodson WC, Gnatuk CL, Estes SJ, Kunselman AR, Meadows JW, Kesner JS, Krieg EF Jr, Rogers AM, Haluck RS, Cooney RN.
J Clin Endocrinol Metab. 2012 Dec;97(12):4540-8. doi: 10.1210/jc.2012-2205. Epub 2012 Oct 12.
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Anestesia y Medicina del Dolor

Ictericia y rechazo al pecho dos causas de destete incorrecto



Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 6 de Mayo 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Ictericia y rechazo al pecho dos causas de destete incorrecto” por el “Dr. José María Paricio Talayero”, Pediatra de España. La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador http://connectpro60196372.adobeconnect.com/ictercia_rechazo/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia
6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.


Henrys


Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La clinica 2520-310
Colonia Sertoma ,Mty N.L. México
CP 64710
Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx

mas sobre embarazo, obesidad y anestesia.

Obesidad y embarazo: implicancias anestésicas
Claudio Nazar J, Javier Bastidas E, Maximiliano Zamora H, Héctor J. Lacassie.
REV CHIL OBSTET GINECOL 2014; 79(6): 537 - 545
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Colocación de catéteres epidurales en parturientas obesas con el uso de una ecuación de la profundidad epidural antes de vizualización con ultrasonido
Epidural catheter placement in morbidly obese parturients with the use of an epidural depth equation prior to ultrasound visualization.
Singh S1, Wirth KM, Phelps AL, Badve MH, Shah TH, Sah N, Vallejo MC.
ScientificWorldJournal. 2013 Jul 25;2013:695209. doi: 10.1155/2013/695209. eCollection 2013.
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Raquia para cesárea urgente en un obesa mórbida con eclampsia severa
Spinal anaesthesia for emergency caesarean section in a morbid obese woman with severe preeclampsia.
Longinus EN, Benjamin L, Omiepirisa BY.
Case Rep Anesthesiol. 2012;2012:586235. doi: 10.1155/2012/586235. Epub 2012 Oct 14
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Retos anestésicos y obstétricos en obesidad mórbida y parto por cesárea. Estudio en el sureste Nigeriano
Anaesthetic and obstetric challenges of morbid obesity in caesarean deliveries--a study in South-eastern Nigeria.
Okafor UV, Efetie ER, Nwoke O, Okezie O, Umeh U.
Afr Health Sci. 2012 Mar;12(1):54-7
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Cesárea en la obesa mórbida. Implicaciones prácticas y complicaciones
Cesarean section in morbidly obese parturients: practical implications and complications.
Machado LS.
N Am J Med Sci. 2012 Jan;4(1):13-8. doi: 10.4103/1947-2714.92895.
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Comparación aleatorizada controlada entre anestesia combinada epidural-espinal y raquia simple en embarazadas con obesidad mórbida. Tiempo para el inicio de la anestesia
A randomized controlled comparison between combined spinal-epidural and single-shot spinal techniques in morbidly obese parturients undergoing cesarean delivery: time for initiation of anesthesia.
Ross VH, Dean LS, Thomas JA, Harris LC, Pan PH.
Anesth Analg. 2014 Jan;118(1):168-72. doi: 10.1213/ANE.0000000000000022.
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Anestesia y Medicina del Dolor

Embarazo, obesidad y anestesia/Pregnancy, obesity and anaesthesia

No.1961                                                                                   Mayo 4, 2015

¿Es la investigación ultrasónica del diámetro transverso traqueal razonable para la evaluación de vía aérea difícil en la embarazada? Estudio prospectivo comparativo.
Is ultrasonic investigation of transverse tracheal air shadow diameter reasonable for evaluation of difficult airwayin pregnant women: A prospective comparative study.
Turkay Aydogmus M1, Erkalp K2, Nadir Sinikoglu S3, Usta TA4, O Ulger G5, Alagol A6.
Pak J Med Sci. 2014 Jan;30(1):91-5. doi: 10.12669/pjms.301.3972.
Abstract
OBJECTIVE: The aim of this study was to compare clinical screening tests (modified Mallampati score, Cormack-Lehane score, thyromental distance, and sternomental distance) with ultrasonic measurements of the upper airway in predicting difficult intubation in pregnant women whose Body Mass Index (BMI) is higher and lower than 30 kg m-2. METHODS:
This study was designed as a prospective observational trial, and consisted of 40 pregnant women of American Society of Anesthesiologists (ASA) 1-2 groups. Patients with a BMI lower than 30 kg m-2 were included in Group 1 (n=20), and patients with a BMI higher than 30 kg m-2 were included in Group 2 (n=20). In the supine position with head in mild extension, the diameter of the transverse tracheal air shadow in the subglottic area of the front neck was measured using ultrasonography. Modified Mallampati score, Cormack-Lehane score, thyromental distance and sternomental distance measurements were recorded. RESULTS:
No statistically significant difference was detected between groups regarding mean age, mean number of pregnancy, ASA scores and comorbid disease. Mean body weight (p=0.0001) and mean pre-pregnancy weight (p=0.0001) were significantly higher in Group 2. There was no statistically significant difference between groups regarding mean modified Mallampati score, thyromental distance, sternomental distance measurements, Cormack-Lehane score, and mean ultrasonic measurements. CONCLUSION: It was found that BMI higher or lower than 30 kg m-2 has no effect on ultrasonic measurements and clinical airway tests. We thought that ultrasonic measurement could not give us valuable information in obese or non-obese pregnant women.
KEYWORDS: Pregnancy; airway evaluation; body mass index; diameter of transverse tracheal air shadow; obesity; ultrasonography
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Consideraciones anestésicas en parturientas con obesidad y apnea obstructiva del sueño
Anesthetic considerations of parturients with obesity and obstructive sleep apnea.
Ankichetty SP1, Angle P, Joselyn AS, Chinnappa V, Halpern S.
J Anaesthesiol Clin Pharmacol. 2012 Oct;28(4):436-43. doi: 10.4103/0970-9185.101895.
Abstract
Obstructive sleep apnea (OSA) is characterized by upper airway collapse and obstruction during sleep. It is estimated to affect nearly 5% of the general female population. Obesity is often associated with OSA. The physiological changes associated with pregnancy may increase the severity of OSA with a higher risk of maternal and fetal morbidity. However, very few parturients are diagnosed during pregnancy. These undiagnosed parturients pose great challenge to the attending anaesthesiologist during the perioperative period. Parturients at risk should be screened for OSA, and if diagnosed, treated. This review describes the anaesthetic concerns in obese parturients at risk for OSA presenting to the labor and delivery unit.
KEYWORDS: Obesity; obstructive sleep apnea management; perioperative period; pregnancy
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Parturientas con obesidad mórbida. Retos para el anestesiólogos, incluyendo el manejo de la vía aérea en obstetricia.¿Que hay de nuevo?
Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new?
Rao DP, Rao VA.
Indian J Anaesth. 2010 Nov;54(6):508-21. doi: 10.4103/0019-5049.72639.
Abstract
The purpose of this article is to review the fundamental aspects of obesity, pregnancy and a combination of both. The scientific aim is to understand the physiological changes, pathological clinical presentations and application of technical skills and pharmacological knowledge on this unique clinical condition. The goal of this presentation is to define the difficult airway, highlight the main reasons for difficult or failed intubation and propose a practical approach to management Throughout the review, an important component is the necessity for team work between the anaesthesiologist and the obstetrician. Certain protocols are recommended to meet the anaesthetic challenges and finally concluding with "what is new?" in obstetric anaesthesia.
KEYWORDS: Adipocyte; complications; difficult airway; morbidly obese; parturient; regional; team work
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Anestesia y Medicina del Dolor

lunes, 27 de abril de 2015

Ketamina en Cesárea/Ketamine in C-section

No.1952                                                                                   Abril 25, 2015
Efecto de dosis bajas de ketamina sobre el dolor postoperatorio después de cesárea con raquia. Estudio clínico randomizado
The effect of low-dose intravenous ketamine on postoperative pain following cesarean section with spinal anesthesia: a randomized clinical trial.
Rahmanian M1, Leysi M1, Hemmati AA2, Mirmohammadkhani M3.
Oman Med J. 2015 Jan;30(1):11-6. doi: 10.5001/omj.2015.03.
Abstract
OBJECTIVES: Low-dose ketamine has been considered a good substitute for opioids for controlling postoperative pain. The purpose of this study was to determine the effect of low-dose intravenous ketamine following cesarean section with spinal anesthesia on postoperative pain and its potential complications. METHODS: One hundred and sixty pregnant women volunteered to participate in this randomized controlled trial. Participants were randomly divided into two groups (n=80 for each group). Five minutes after delivery, the experimental group received 0.25mg/kg ketamine while the control group received the same amount of normal saline. RESULTS: There was a significant difference between the two groups in the severity of pain at one, two, six, and 12 hours following surgery. Postoperative pain was significantly less severe in the experimental group. Compared to the control group, the experimental group felt pain less frequently and therefore asked for analgesics less often. On average, the number of doses of analgesics used for the participants in the experimental group was significantly less than the number of doses used for the control group. Analgesic side effects (including nausea, itching, and headache) were not significantly different between the two groups. However, vomiting was significantly more prevalent in the control group and hallucination was more common in the experimental group. CONCLUSION: We conclude that administration of low doses of ketamine after spinal anesthesia reduces the need for analgesics and has fewer side effects than using opioids. Further studies are required to determine the proper dose of ketamine which offers maximum analgesic effect. Furthermore, administration of low-dose ketamine in combination with other medications in order to minimize its side effects warrants further investigation.
KEYWORDS: Anesthesia, Spinal; Cesarean Section; Ketamine; Pain, Postoperative
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Efectos analgésicos de ketamina intravenosa durante raquia en embarazadas programadas para cesárea. Estudio clínico randomizado
Analgesic Effects of Intravenous Ketamine during Spinal Anesthesia in Pregnant Women Undergone Caesarean Section; A Randomized Clinical Trial.
Behdad S1, Hajiesmaeili MR, Abbasi HR, Ayatollahi V, Khadiv Z, Sedaghat A.
Anesth Pain Med. 2013 Sep;3(2):230-3. doi: 10.5812/aapm.7034. Epub 2013 Sep 1.
Abstract
BACKGROUND: Suitable analgesia after cesarean section helps mothers to be more comfortable and increases their mobility and ability to take better care of their infants.
OBJECTIVES: Pain relief properties of ketamine prescription were assessed in women with elective cesarean section who underwent spinal anesthesia with low dose intravenous ketamine and midazolam and intravenous midazolam alone. PATIENTS AND METHODS:Sixty pregnant women scheduled for spinal anesthesia for cesarean section were randomized into two study groups.Ketamine (30 mg) + midazolam (1 mg = 2CC) or 1mg midazolam (2CC) alone, was given immediately after spinal anesthesia. Pain scores at first, second and third hours after CS operation, analgesic requirement and drug adverse effects were recorded in all patients. RESULTS: Ketamine group had significant pain relief properties in compare with control group in first hours after cesarean section (0.78 ± 1.09 vs. 1.72 ± 1.22, VAS score, P = 0.00). Total dose of meperidine consumption in women of ketamine group was significantly lower than women of control group (54.17 ± 12.86 vs. 74.44 ± 33.82 mg, P = 0.02). There were no significant drug side effects in participated patients. CONCLUSIONS: Intravenous low-dose ketamine combined with midazolam for sedation during spinal anesthesia for elective Caesarean sectionprovides more effective and long lasting pain relief than control group.
KEYWORDS: Analgesia; Anesthesia, Spinal; Cesarean Section; Ketamine; Pain Clinics
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Efectos de dosis bajas de ketamina en la analgesia post cesárea con anestesia subaracnoidea
The Effect of Low-dose Ketamine on Post-caesarean Delivery Analgesia after Spinal Anesthesia.
Han SY1, Jin HC, Yang WD, Lee JH, Cho SH, Chae WS, Lee JS, Kim YI.
Korean J Pain. 2013 Jul;26(3):270-6. doi: 10.3344/kjp.2013.26.3.270. Epub 2013 Jul 1.
Abstract
BACKGROUND: Ketamine, an N-methyl-D-aspartate receptor antagonist, might play a role in postoperative analgesia, but its effect on postoperative pain after caesarean section varies with study design. We investigated whether the preemptive administration of low-dose intravenous ketamine decreases postoperative opioid requirement and postoperative pain in parturients receiving intravenous fentanyl with patient-controlled analgesia (PCA) following caesarean section. METHODS: Spinal anesthesia was performed in 40 parturients scheduled for elective caesarean section. Patients in the ketamine group received a 0.5 mg/kg ketamine bolus intravenously followed by 0.25 mg/kg/h continuous infusion during the operation. The control group received the same volume of normal saline. Immediately after surgery, the patients were connected to a PCA device set to deliver 25-µg fentanyl as an intravenousbolus with a 15-min lockout interval and no continuous dose. Postoperative pain was assessed using the cumulative dose of fentanyl and visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively. RESULTS: Significantly less fentanyl was used in the ketamine group 2 h after surgery (P = 0.033), but the difference was not significant at 6, 12, and 24 h postoperatively. No significant differences were observed between the VAS scores of the two groups at 2, 6, 12, and 24 h postoperatively. CONCLUSIONS: Intraoperative low-dose ketamine did not have a preemptive analgesic effect and was not effective as an adjuvant to decrease opioid requirement or postoperative pain score in parturients receiving intravenous PCA with fentanyl after caesarean section.
KEYWORDS: caesarean delivery; ketamine; patient-controlled analgesia; preemptive analgesia; spinal anesthesia
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Anestesia y Medicina del Dolor

Medwave abril 2015

A continuación le informamos los artículos recientemente publicados en Medwave.


RESUMEN EPISTEMONIKOS

¿Es beneficiosa la profilaxis antibiótica en la pancreatitis aguda?: primera actualización
Gabriel Rada, José Peña (Chile)

Medwave 2015 Abr;15(3):e6125
http://dx.doi.org/10.5867/medwave.2015.03.6125


EDITORIAL
La evidencia y la región - ¿conversan o colisionan?
Vivienne C. Bachelet

Medwave 2015 Abr;15(3):e6127
http://dx.doi.org/10.5867/medwave.2015.03.6127


ESTUDIO PRIMARIO

Estudio transversal sobre tabaquismo y su relación con valores espirométricos en estudiantes de tercer año de medicina
Victor Hugo Fernández, Mariela Edith Beligoy, Yessica Vanesa Lima, Pablo Federico Barissi (Argentina)

Medwave 2015 Abr;15(3):e6124
http://dx.doi.org/10.5867/medwave.2015.03.6124


RESUMEN EPISTEMONIKOS

¿Debe indicarse acetilcisteína para prevenir la nefropatía por contraste?
Ariel Izcovich, Gabriel Rada (Argentina, Chile)

Medwave 2015 Abr;15(3):e6122
http://dx.doi.org/10.5867/medwave.2015.03.6122


ARTÍCULO DE REVISIÓN

Plantas latinoamericanas como fuente de nuevos antineoplásicos, situación actual y nuevas oportunidades contra el cáncer
Eduardo Freddy Orrego Escobar (Chile)

Medwave 2015 Abr;15(3):e6121
http://dx.doi.org/10.5867/medwave.2015.03.6121


PORTADA MEDWAVE
www.medwave.cl

Analgesia obstétrica con remifentanil / Labor analgesia with remifentanil

No.1953                                                                                   Abril 26, 2015
Analgesia controlada por paciente con remifentanil vs bloqueo peridural en analgesia obstétrica. Estudio multicéntrico randomizado
Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial.
Freeman LM, Bloemenkamp KW, Franssen MT, Papatsonis DN, Hajenius PJ, Hollmann MW, Woiski MD, Porath M, van den Berg HJ, van Beek E,Borchert OW, Schuitemaker N, Sikkema JM, Kuipers AH, Logtenberg SL, van der Salm PC, Oude Rengerink K, Lopriore E, van den Akker-van Marle ME, le Cessie S, van Lith JM, Struys MM, Mol BW, Dahan A, Middeldorp JM.
BMJ. 2015 Feb 23;350:h846. doi: 10.1136/bmj.h846.
Abstract
OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands.
PARTICIPANTS: Women with an intermediate to high obstetric risk with an intention to deliver vaginally. To exclude a clinically relevant difference in satisfaction with pain relief of more than 10%, we needed to include 1136 women. Because of missing values for satisfaction this number was increased to 1400 before any analysis. We used multiple imputation to correct for missing data. INTERVENTION: Before the onset of active labour consenting women were randomised to a pain relief strategy with patient controlled remifentanil or epidural analgesia if they requested pain relief during labour. MAIN OUTCOME MEASURES: Primary outcome was satisfaction with pain relief, measured hourly on a visual analogue scale and expressed as area under the curve (AUC), thus providing a time weighted measure of total satisfaction with pain relief. A higher AUC represents higher satisfaction with pain relief. Secondary outcomes were pain intensity scores, mode of delivery, and maternal and neonatal outcomes. Analysis was done by intention to treat. The study was defined as an equivalence study for the primary outcome. RESULTS: 1414 women were randomised, of whom 709 were allocated to patient controlled remifentanil and 705 to epidural analgesia. Baseline characteristics were comparable. Pain relief was ultimately used in 65% (447/687) in the remifentanil group and 52% (347/671) in the epidural analgesia group (relative risk 1.32, 95% confidence interval 1.18 to 1.48). Cross over occurred in 7% (45/687) and 8% (51/671) of women, respectively. Of women primarily treated with remifentanil, 13% (53/402) converted to epidural analgesia, while in women primarily treated with epidural analgesia 1% (3/296) converted to remifentanil. The area under the curve for total satisfaction with pain relief was 30.9 in the remifentanilgroup versus 33.7 in the epidural analgesia group (mean difference -2.8, 95% confidence interval -6.9 to 1.3). For who actually received pain relief the area under the curve for satisfaction with pain relief after the start of pain relief was 25.6 in the remifentanil group versus 36.1 in the epidural analgesia group (mean difference -10.4, -13.9 to -7.0). The rate of caesarean section was 15% in both groups. Oxygen saturation was significantly lower (SpO2 <92%) in women who used remifentanil (relative risk 1.5, 1.4 to 1.7). Maternal and neonatal outcomes were comparable between both groups. CONCLUSION: In women in labour, patient controlled analgesia with remifentanil is not equivalent to epidural analgesia with respect to scores on satisfaction with pain relief. Satisfaction with pain relief was significantly higher in women who were allocated to and received epidural analgesia.
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Remifentanil intravenoso vs ropivacaína epidural con sufentanil para analgesia de parto. Estudio retrospectivo
Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia: a retrospective study.
Lin R, Tao Y, Yu Y, Xu Z, Su J, Liu Z.
PLoS One. 2014 Nov 11;9(11):e112283. doi: 10.1371/journal.pone.0112283. eCollection 2014.
Abstract
Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA) compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0 ∼ 180 min) (P < 0.0001), and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P < 0.0001) and a higher sedation score (P < 0.0001) within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.007) and pain relief score (2.9 ± 0.3 vs. 2.8 ± 0.4, P < 0.0001) compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P < 0.0001) was observed duringremifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. RemifentanilIVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative option for labor analgesia under the condition of one-to-one bedside care, continuous monitoring, oxygen supply and preparation for neonatal resuscitation.
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Comparación de remifentanil-etonox vs etononox en analgesia de parto
Comparison of remifentanil: Entonox with Entonox alone in labor analgesia.
Varposhti MR, Ahmadi N, Masoodifar M, Shahshahan Z, Tabatabaie MH.
Adv Biomed Res. 2013 Nov 30;2:87. doi: 10.4103/2277-9175.122511. eCollection 2013.
Abstract
BACKGROUND: We designed a study to evaluate the effectiveness of continuous low dose infusion of remifentanil adding to self-administration of entonox administered for pain relief during the active phase of first stage of labor. MATERIALS AND METHODS: Thirty healthy term pregnant women recruited in our randomized double-blind, cross over study. They received the study medicines during two 30-min periods with a 15-min wash-out sequence after each period. Fifteen parturient used remifentanil as a single bolus dose followed by constant low dose infusion and self-administration of entonox (group R) during the first period and entonox and saline (group P) during the second period, while the remainder of the parturient used the drugs in a reverse order. Pain and Ramsay score, maternal and fetal hemodynamic, and ventilation were assessed during each intervention. RESULTS: In this study, mean pain severity scores were 8 ± 0.9 before and 5.4 ± 1.7 after intervention in group P, and 7.8 ± 0.1, 3.5 ± 1.3 in group R, respectively. Mean pain severity difference was 2.6 ± 1.5 in group P, while 4.3 ± 1.5 in group R; so, use of entonox and remifentanil can decreaselabor pain two times more in comparison with entonox/placebo (normal saline). However, hemodynamic and ventilation parameter inremifentanil/entonox period were same as in entonox/placebo period. No statistical differences were seen in mean Ramsay score between group R and P. There was no episode of maternal bradycardia, hypotension, or hypoxemia. CONCLUSION: Not only adding low dose infusion of remifentanil to self-administration of entonox was notable in labor pain reduction, it did n't make more parturient and neonatal side-effects.
KEYWORDS: Entonox; labor pain; remifentanil
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Anestesia y Medicina del Dolor