Libros y revistas gratuitos / Free journals and books

Septiembre 11, 2015. No. 2082

J Obstet Anaesth Crit Care  Volume 5 | Issue 2. Page Nos. 49-96 July-December 2015 Revista/Journal Journal of Human Reproductive Sciences (J Hum Reprod Sci) 2015 | July-September | Volume 8 | Issue 3 Revista/Journal 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 Libro/Book Contemporary Gynecologic Practice Edited by Atef Darwish , ISBN 978-953-51-1736-0, 242 pages, Publisher: InTech, Chapters published February 04, 2015 under CC BY 3.0 license DOI: 10.5772/58510 Libro/Book

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Obesidad, embarazo y anestesia / Obesity, pregnancy and anesthesia

Septiembre 10, 2015. No. 2081

Preparación para el manejo del embarazo después de cirugía bariátrica Preparing for and managing a pregnancy after bariatric surgery. Kominiarek MA. Semin Perinatol. 2011 Dec;35(6):356-61. doi: 10.1053/j.semperi.2011.05.022. Abstract The number of bariatric surgeries performed in the United States has increased exponentially. Given that most patients are female and of reproductive age, it is important for clinicians who manage women's health issues to be aware of the surgery, its long-term goals, and the potential effect on future pregnancies. Most pregnancies after bariatric surgery have successful outcomes with decreased occurrences of gestational diabetes and hypertension and lower birth weight compared with control patients. Following nutritional guidelines and supplementation in the event of deficiencies are critical in the provision of prenatal care to this unique population. Other important issues include a multidisciplinary team management, a different approach to screening for gestational diabetes, careful evaluation of any gastrointestinal complaints, and appropriate counseling for gravidas who still remain obese during pregnancy. Further research should investigate the long-term maternal outcomes in pregnancies after bariatric surgery as well as the effect on the offspring. PDF     Anestesia regional: todavía una alternativa adecuada en la parturienta con obesidad mórbida Teena Bansala,, Parshant Kumarb, Sarla Hooda Rev Colomb Anestesiol. 2013;41:302-5. - Vol. 41 Núm.04 DOI: 10.1016/j.rca.2013.08.001 Resumen La obesidad se ha identificado como un factor importante de riesgo de morbimortalidad relacionada con anestesia en obstetricia. La obesidad acentúa la mayoría de los cambios fisiológicos del embarazo. Las parturientas obesas tienen un mayor riesgo de presentar problemas médicos concomitantes o enfermedades prenatales, entre ellas la preeclampsia y la diabetes gestacional. Estas pacientes requieren valoración preoperatoria minuciosa, una preparación meticulosa y alistamiento para una vía aérea difícil, puesto que la incidencia de intubación fallida es mucho más alta en ellas. Siempre que sea posible, la anestesia regional es la mejor alternativa en este grupo de pacientes. PDF Obesidad y embarazo: implicancias anestésicas  Claudio Nazar J, Javier Bastidas E, Maximiliano Zamora H, Héctor J. Lacassie. Rev. Chil. Obstet. Ginecol. vol.79 no.6 Santiago  2014 RESUMEN La obesidad es una epidemia a nivel mundial, con más de 2.000 millones de adultos con sobrepeso u obesidad, por lo que cada vez es más probable enfrentarse a una embarazada obesa en la práctica clínica del equipo obstétrico. La obesidad incrementa los cambios fisiológicos del embarazo a nivel cardiovascular, respiratorio, metabólico y gastrointestinal, lo que tiene implicancias clínicas que aumentan los costos en salud y la morbimortalidad materna y fetal. Las embarazadas obesas son un constante desafío para el equipo obstétrico, anestesiológico y de salud, debiendo ser enfrentadas de forma multidisciplinaria para la obtención de mejores resultados obstétricos y perinatales. El anestesiólogo debe tener especial cuidado en el manejo analgésico del trabajo de parto y en la técnica anestésica para la operación cesárea. El objetivo central de la siguiente revisión es explicar, analizar y desarrollar las principales implicancias anestésicas a las cuales se ve enfrentado el especialista en una embarazada obesa. PALABRAS CLAVE: Obesidad, embarazo, trabajo de parto, cesárea, anestesia obstétrica, anestesia general PDF

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Obesidad, embarazo y anestesia / Obesity, pregnancy and anaesthesia

Septiembre 9, 2015. No. 2080

Índice de masa corporal y tiempo quirúrgico en cesárea Body mass index and operative times at cesarean delivery. Girsen AI, Osmundson SS, Naqvi M, Garabedian MJ, Lyell DJ. Obstet Gynecol. 2014 Oct;124(4):684-9. doi: 10.1097/AOG.0000000000000462. Abstract OBJECTIVE: To examine the relationship between body mass index (BMI, kg/m) and incision-to-delivery interval and total operative time at cesarean delivery. METHODS: Women with singleton gestations undergoing uncomplicated primary and repeat cesarean deliveries were identified from the Maternal-Fetal Medicine Units Network Cesarean Registry. Women were classified by BMI category at time of delivery (normal 18.5-24.9, overweight 25.0-29.9, obese 30.0-39.9, and morbidly obese 40 or greater). Incision-to-delivery interval and total operative times during cesarean delivery were compared among the three groups. Primary outcome was prolonged incision-to-delivery interval as defined by 90th percentile or greater of the study population or 18 minutes or longer. RESULTS: Of the 21,372 women included in the analysis, 9,928 were obese (46.5%) and 2,988 (14.0%) were morbidly obese. Longer operative times were found among women with overweight (median [interquartile range] incision-to-delivery: 9.0 [6.0] and total operative time: 45.0 [21.0] minutes), obese (10.0 [7.0]; 48.0 [22.0] minutes), and morbidly obese BMIs (12.0 [8.0]; 55.0 [26.0] minutes) compared with women with normal BMI at delivery (9.0 [5.0]; 43.0 [20.0] minutes) (P<.001). Morbidly obese women had a more frequent incision-to-delivery interval that was 18 minutes or longer (n=602 [20%] compared with 127 [6%] in normal BMI). After adjustments including number of prior cesarean deliveries, incision-to-delivery interval 18 minutes or longer was significantly related to obese (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.31-2.03) and morbidly obese (OR 2.81, 95% CI 2.24-3.56) BMI at delivery. CONCLUSION: Increasing BMI is related to increased incision-to-delivery interval and total operative time at cesarean delivery with morbidly obese BMI exposing women to the highest risk of prolonged incision-to-delivery interval. PDF   Colocación del catéter peridural en parturientas con obesidad mórbida con el uso de una ecuación de profundidad epidural antes de visualización con ultrasonido. Epidural catheter placement in morbidly obese parturients with the use of an epidural depth equation prior to ultrasound visualization. Singh S, 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. Abstract BACKGROUND: Previously, Balki determined the Pearson correlation coefficient with the use of ultrasound (US) was 0.85 in morbidly obese parturients. We aimed to determine if the use of the epidural depth equation (EDE) in conjunction with US can provide better clinical correlation in estimating the distance from the skin to the epidural space in morbidly obese parturients. METHODS: One hundred sixty morbidly obese (≥40 kg/m(2)) parturients requesting labor epidural analgesia were enrolled. Before epidural catheter placement, EDE was used to estimate depth to the epidural space. This estimation was used to help visualize the epidural space with the transverse and midline longitudinal US views and to measure depth to epidural space. The measured epidural depth was made available to the resident trainee before needle insertion. Actual needle depth (ND) to the epidural space was recorded. RESULTS: Pearson's correlation coefficients comparing actual (ND) versus US estimated depth to the epidural space in the longitudinal median and transverse planes were 0.905 (95% CI: 0.873 to 0.929) and 0.899 (95% CI: 0.865 to 0.925), respectively. CONCLUSION: Use of the epidural depth equation (EDE) in conjunction with the longitudinal and transverse US views results in better clinical correlation than with the use of US alone. PDF

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Sedacion fuera del quirofano/Sedation outside OR

Agosto 30, 2015. No. 2070

Sedación y anestesia fuera del quirófano Anesthesia and sedation outside of the operating room. Youn AM, Ko YK, Kim YH. Korean J Anesthesiol. 2015 Aug;68(4):323-31. Abstract Due to rapid evolution and technological advancements, medical personnel now require special training outside of their safe zones. Anesthesiologists face challenges in practicing in locations beyond the operating room. New locations, inadequate monitoring devices, poor assisting staff, unfamiliarity of procedures, insufficient knowledge of basic standards, and lack of experience compromise the quality of patient care. Therefore, anesthesiologists must recognize possible risk factors during anesthesia in nonoperating rooms and familiarize themselves with standards to improve safe practice. This review article emphasizes the need for standardizing hospitals and facilities requiring nonoperating room anesthesia, and encourages anesthesiologists to take the lead in applying these practice guidelines to improve patient outcomes and reduce adverse events. KEYWORDS: Anesthesia; Complication; Deep sedation; Intraoperative monitoring; Risk PDF Ketamina, propofol y dosis bajas de remifentanil versus propofol y remifentanil para colangiopancreatografia retrograda endoscópica fuera del quirófano Ketamine, propofol and low dose remifentanil versus propofol and remifentanil for ERCP outside the operating room: is ketamine not only a "rescue drug"? Fabbri LP, Nucera M, Marsili M, A Malyan M, Becchi C. Med Sci Monit. 2012 Sep;18(9):CR575-80. Abstract BACKGROUND: Endoscopic retrograde cholangiopancreatography ERCP is a painful and long procedure requiring transient deep analgesia and conscious sedation. An ideal anaesthetic that guarantees a rapid and smooth induction, good quality of maintenance, lack of adverse effects and rapid recovery is still lacking. This study aimed to compare safety and efficacy of a continuous infusion of low dose remifentanil plus ketamine combined with propofol in comparison to the standard regimen dose of remifentanil plus propofol continuous infusion during ERCP. MATERIAL/METHODS: 322 ASAI-III patients, 18-85 years old and scheduled for planned ERCP were randomized. Exclusion criteria were a predictable difficult airway, drug allergy, and ASA IV-V patients. We evaluated Propofol 1 mg/kg/h plus Remifentanil 0.25 µg/kg/min (GR) vs. Propofol 1 mg/kg/h plus Ketamine 5 µg/kg/min and Remifentanil 0.1 µg/kg/min (GK). Main outcome measures were respiratory depression, nausea/vomiting, quality of intraoperative conditions, and discharge time. P≤0.05 was statistically significant (95% CI). RESULTS: Respiratory depression was observed in 25 patients in the GR group compared to 9 patients in the GK group (p=0.0035). ERCP was interrupted in 9 cases of GR vs. no cases in GK; patients ventilated without any complication. Mean discharge time was 20±5 min in GK and 35±6 min in GR (p=0.0078) and transfer to the ward delayed because of nausea and vomiting in 30 patients in GR vs. 5 patients in GK (p=0.0024). Quality of intraoperative conditions was rated highly satisfactory in 92% of GK vs. 67% of GR (p=0.028). CONCLUSIONS: The drug combination used in GK confers clinical advantages because it avoids deep sedation, maintains adequate analgesia with conscious sedation, and achieves lower incidence of postprocedural nausea and vomiting with shorter discharge times. PDF

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