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.

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