RESUMO

Objetivos: demostrar el efecto de la infusión de adrenalina en relación con la noradrenalina con el propósito de prevenir la hipotensión materna post anestesia intradural. Métodos: estudio prospectivo, longitudinal, analítico y doble ciego con enfoque cuantitativo. Población de 114, muestra de 46 pacientes dividido en 2 agrupaciones. grupo A (noradrenalina) y grupo B (adrenalina) a dosis de 0,02 mcg/kg/min. Medición de variables continuas se sacó media y aplicación de prueba de normalidad de Shapiro- Wilk. Se aplicó T de student para las medias y U de Mann - Whitney para las medianas. En variables nominales se sacó frecuencia. Resultados: la media de la edad entre 32 a 33 años de ambas agrupaciones, con latido cardiaco significativo en T3 y T4 para el grupo B, valor p 0,045 y 0,000. Sin cambios importantes en la tensión arterial ni en las puntuaciones del APGAR. Los efectos secundarios son la presencia de cefalea posiblemente relacionado con uso de oxitocina. 18 y 16 pacientes no presentaron hipotensión con chi cuadrado de 0,89. Volumen total de cristaloides de 650 ml a 700 ml tanto en el grupo A y B. El costo referencial fue de 0,9 bolivianos. Conclusiones: la adrenalina es un vasopresor sugerente, sin alteraciones en los latidos cardíacos maternos, pero con un mayor control que la noradrenalina, y con una acción similar en la tensión arterial media en ambas agrupaciones.

Objectives: to demonstrate the effect of adrenaline infusion in relation to noradrenaline for the purpose of preventing maternal hypotension post intradural anesthesia. Methods: a total of 114 people, a sample of 46 patients, are distributed in 2 distinct group: A (noradrenaline) and B (adrenaline) at a dose of 0.02 pg/kg/ min. Mean of continuous variables was measured and Shapiro - Wilk normality test was applied. Student's T was applied for the means and Mann-Whitney U for the medians. The frequency was determined for nomina variables. Results: the age was 32 to 33 years, with a significant heartbeat in T3 and T4 for group B, p value 0.045 and 0.000. No significant changes in blood pressure or APGAR scores. Side effects are the presence of headache possibly related to the use of oxytocin. 18 and 16 patients did not present hypotension with chi square of 0.89 Total volume of crystalloids from 650 ml to 700 ml in both groups A and B. The reference cost was 0.9 bolivianos Conclusions: adrenaline is a suggestive vasopressor, without alterations in maternal heartbeat, but with greater control than noradrenaline, and with a similar action on mean arterial pressure in both groups.

RESUMO

SUMMARY OBJECTIVE: This study aimed to evaluate maternal and fetal characteristics and factors affecting fetal outcomes in twin pregnancies delivered by cesarean section. METHODS: This was a cross-sectional study in a tertiary care referral hospital. The primary outcome was to ascertain the effects of independent factors on the 1st and 5th minute APGAR scores, neonatal intensive care unit admissions, the need for mechanical ventilation, and neonatal mortality. RESULTS: A total of 453 pregnant women and 906 newborns were included in the analysis. The final logistic regression model revealed that early gestational weeks and neonates <3rd weight percentile at the time of delivery were the most significant predictors of all poor outcome parameters in at least one of the twins (p<0.05). General anesthesia for cesarean section was associated with 1st minute APGAR<7 and the need for mechanical ventilation, and emergency surgery was correlated with the need for mechanical ventilation (p<0.05) in at least one of the twins. CONCLUSION: General anesthesia, emergency surgery, early gestational weeks, and birth weight <3rd weight percentile were strongly associated with poor neonatal outcomes in at least one of the twins delivered by cesarean section.

RESUMO

BACKGROUND: Erector spinae plane block (ESPB) is a regional block that may be used for several surgeries. However, the evidence regarding obstetrical procedures is not pooled in the literature. OBJECTIVES: To assess whether ESPB improves the postoperative pain after cesarean section by a systematic review and meta-analysis. METHODS: The protocol of this review was registered on PROSPERO (CRD42020192760). We included randomized controlled trials from databases until August 2020. The primary outcome was pain measured on a visual analogic scale; secondary outcomes were analgesic duration, postoperative opioid dose within the 24 hours, nausea/vomiting. The risk of bias and the GRADE criteria to assess quality of evidence were analyzed. RESULTS: From 436 retrieved studies, three were selected. There was no difference in the pain scores between ESPB and controls at rest after surgery at 4 h (mean difference [MD] = 0.00; 95% CI: -0.72 to 0.72; I² = 0%; very low certainty), 12 h (MD = -1.00; 95% CI: -2.00 to -0.00; I² = 0%, low certainty) and 24 h (MD = -0.68; 95% CI: -1.56 to 0.20; I² = 50%; very low certainty). There was a smaller consumption of tramadol with ESPB compared with controls (MD = -47.66; 95% CI: -77.24 to -18.08; I² = 59%; very low certainty). The analgesic duration of ESPB was longer than the controls (MD = 6.97; 95% CI: 6.30 to 7.65; I² = 58%; very low certainty). CONCLUSION: ESPB did not decrease the postoperative pain scores when compared to other comparators. However, ESPB showed a lower consumption of tramadol and a longer blockade duration, although the quality of evidence of these outcomes were very low.

Assuntos

RESUMO

Abstract: Introduction: Marfan syndrome is an inherited disorder that affects connective tissue. Case: We report the anesthetic management of a parturient with Marfan syndrome scheduled for an elective C-section. Successful use of a combined spinal-epidural technique was used to provide neuraxial anesthesia; however, she presented an unfavorable evolution due to maternal sepsis. Likewise, a literature review of combined spinal-epidural anesthesia for C-sections in Marfan syndrome pregnant women was performed. Conclusion: Anesthetic management of parturients affected by Marfan syndrome during the cesarean section can be challenging. Strict blood pressure control during the intraoperative period has cornerstone importance. Likewise, neuraxial techniques have a significant percentage of failure in these patients.

Resumen: Introducción: El síndrome de Marfan es un desorden hereditario que afecta el tejido conectivo. Caso: Reportamos el manejo anestésico de una parturienta con síndrome de Marfan programada para una cesárea electiva. Para administrar anestesia neuroaxial se utilizó un bloqueo combinado espinal-epidural; sin embargo, la paciente presentó una evolución desfavorable debido a sepsis materna. Asimismo, se realizó una revisión de la literatura del uso de esta técnica anestésica para cesárea en gestantes con síndrome de Marfan. Conclusión: El manejo anestésico de parturientas afectadas por este síndrome puede ser complicado. El control estricto de la presión arterial durante el intraoperatorio tiene importancia fundamental. Además, las técnicas neuroaxiales tienen un porcentaje significativo de fallo en estas pacientes.

RESUMO

INTRODUCCION: en el postoperatorio de anestesia obstétrica, los temblores representan el 54%. Por lo cual, se pretende evitarlo en la sala de recuperación, usando medicamentos que regulen los temblores como ketamina y meperidina. OBJETIVOS: determinar la eficacia de la ketamina y meperidina para prevención de temblores en pacientes sometidas a cesárea bajo anestesia regional. METODOS: se realizó un ensayo clínico, simple ciego, aleatorizado y controlado. En el Hospital Obrero N° 2, Ingresaron en el estudio 40 pacientes cumpliendo criterios de inclusión, 20 pacientes por grupo. Las dosis usadas en el grupo Ketamina de 0.25 mg/kg y grupo meperidina de 0.1 mg/Kg. Se usó la escala de Crossley para determinar temblores, medición de temperatura periférica y efectos secundarios maternos y fetales. Para análisis estadístico se usó Chi x2 de Pearson. RESULTADOS: la edad media del estudio es 29,77±3,35 años; Tiempo quirúrgico media de 50 ± 8,8 minutos;Temperatura en quirófano más frecuente se encontraba entre 22° a 23° C; La temperatura periférica se encontró entre 36.6°C a 37.5 °C; en el grupo de meperidina se presentó más nauseas. No existen efectos secundarios en neonatos. CONCLUSIONES: Los temblores redujeron en los pacientes que recibieron ketamina mientras que en los que recibieron meperidina presentaron más nauseas como efecto secundario.

INTRODUCTION: The presence of shiviring in obstetric anesthesia in the postoperative period is up to 54%. Therefore, it is intended to avoid in the recovery room, using medications that regulate shiviring such as ketamine and meperidine. OBJECTIVES: to determine the efficacy of ketamine and meperidine for the prevention of shivering in patients undergoing cesarean section under regional anesthesia. METHODS: a single-blind, randomized, controlled clinical trial was conducted. In Hospital Obrero N ° 2, 40 patients enrolled in the study meeting inclusion criteria, 20 patients per group.The doses used in the Ketamine group of 0.25 mg / kg and meperidine group of 0.1 mg / Kg. The Crossley scale was used to determine shivering, peripheral temperature measurement and maternal and fetal side effects. For statistical analysis, Chi x2 from Pearson was used. RESULTS: the average age of the study is 29.77 ± 3.35 years; Average surgical time of 50 ± 8.8 minutes;Temperature in the most frequent operating room was between 22 ° to 23 ° C;The peripheral temperature was between 36.6 ºC to 37.5 ºC; in the meperidine group there was more nausea; No neonatal side effects. CONCLUSIONS: patients who received ketamine is better at preventing tremors while patients who received meperidine had more nausea as a side effect.

Assuntos

RESUMO

Epidural analgesia is assumed to be the technique of choice for the relief of pain in labor. Multiple adverse neurological effects have been reported, one of which is the so-called Horner syndrome (ptosis, myosis, anhidrosis). Its evolution is usually benign and does not require specific management, except clinical monitoring for the more than probable cephalic spread of local anesthetic. Most of the cases that exist in the literature are isolated; in our work we present a series of 3 clinical cases and review the pathogenesis and management in the obstetric patient.

La analgesia epidural supone la técnica de elección para el alivio del dolor del parto. Se han descrito múltiples efectos adversos a nivel neurológico, uno de ellos es el llamado Síndrome de Horner (ptosis,miosis, anhidrosis), suele presentar evolución benigna y no requiere manejo especifico, salvo vigilancia clínica por la más que probable difusión cefálica del anestésico local. La mayor parte de los casos existentes en la literatura son aislados, en nuestro trabajo presentamos una serie de 3 casos clínico y repasamos su etiopatogenía y manejo en la paciente obstétrica.

Assuntos

RESUMO

As cardiopatias representam a primeira causa não obstétrica de morte materna no ciclo gravídico puerperal. Este artigo tem como objetivo apresentar os principais fatores envolvidos na predição do risco de morbimortalidade cardiovascular em gestantes cardiopatas. Os avanços obtidos ao longo dos anos no diagnóstico, tratamento e correçãocirúrgica de cardiopatias permitiram significativo aumento no número de mulheres portadoras dessas doenças que alcançam a idade fértil e engravidam. Esse grupo de pacientes representa um grande desafio pelas complicações potenciais e pelo fato de que a otimização das condições maternas deve ser cuidadosamente pensada para assegurar a sobrevivência e bem-estar fetais. O cuidado dessas pacientes deve envolver uma equipe multidisciplinar com a participação do anestesiologista. E assim como ocorre em diversas outras situações em anestesia obstétrica, o trabalho em equipe e a comunicação precocesão elementos-chave para garantir a redução da morbimortalidade materna e fetal.

Cardiopathies represent the first non-obstetric cause of maternal death during the pregnancypuerperal cycle. This article aims to present the main factors involved in the prediction of cardiovascular morbidity and mortality risks in pregnant women with heart disease. The progress achieved over the years in the diagnosis, treatment, and surgical correction of cardiopathies allowed for a significant increase in the number of these women who reach child-bearing age and become pregnant. This group of patients represents a major challenge because of potential complications and the optimization of maternal conditions that must be carefully designed to ensure fetal survival and well-being. The care of these patients should involve a multidisciplinary team with the participation of an anesthesiologist. Similarly to several other situations involving obstetric anesthesia, teamwork and early communication are key elements to ensure the reduction of maternal and fetal morbidity and mortality.

RESUMO

A doença cardíaca é a principal causa não obstétrica de morte materna e sua incidência varia entre 0,1 e 4% das gestações.1 No Brasil, 55% dos casos de cardiopatias em gestantes têm como etiologia a doença reumática, com 70 a 80% dos casos representados pela estenose mitral. A evolução da estenose mitral na gravidez envolve complicações tanto maternas quanto fetais, com incidência diretamente relacionada à gravidade da lesão. O objetivo deste artigo é revisar a fisiopatologia, quadro clínico e condução anestésica em gestantes portadoras de estenose mitral.

Heart disease is the leading non-obstetric cause of maternal death and its incidence varies between 0.1 and 4% of pregnancies.1 In Brazil, the etiology for 55% of cardiopathy cases in pregnant women is rheumatic disease with 70 to 80% of cases represented by mitral stenosis. The evolution of mitral stenosis during pregnancy involves both maternaland fetal complications with incidences directly related to the severity of the injury. The purpose of this article is to review the pathophysiology, clinical presentation, and anesthetic approach in pregnant women with mitral stenosis.

RESUMO

JUSTIFICATIVA E OBJETIVOS: A Síndrome de Guillain-Barré durante a gestação é considerada uma CIRURGIA, Cesárea; complicação neurológica rara e o manejo anestésico para a cesariana nessas pacientes ainda não é consenso na literatura. O objetivo deste artigo é relatar o caso de uma paciente gestante portadora da Síndrome de Guillain-Barré submetida à cesariana. RELATO DO CASO: Paciente feminina, 22 anos, com 35 semanas e cinco dias de idade gestacional, da celularidade. A técnica anestésica empregada foi a anestesia geral, induzida com propofol 1,5 mg.kg-1 e mantida com sevofiurano 2% em oxigênio e fentanil 3 µg.kg-1. O procedimento transcorreu sem complicações, tanto para a gestante quanto para o concepto. A paciente obteve alta no décimo dia de internação, após melhora progressiva do quadro neurológico. CONCLUSÕES: A técnica anestésica a ser empregada em gestantes portadoras da Síndrome de Guillain-Barré que necessitam fazer cesariana permanece como escolha do anestesiologista, que deve ser guiado pelo quadro clínico e pelas comorbidades de cada paciente.

BACKGROUND AND OBJECTIVES: Guillain-Barre syndrome during pregnancy is considered a rare neurological complication, and there is no consensus in literature for anesthetic management for cesarean section in such patients. The objective of this paper is to report the case of a pregnant woman with Guillain-Barre syndrome undergoing cesarean section. CASE REPORT: Female patient, 22-year old, 35 weeks and 5 days of gestation, undergoing cesarean section, hospitalized, reporting decreased strength and lower limb paresthesias. Cerebrospinal fl uid (CSF) analysis showed increased protein (304 mg.dL-1) without increased cellularity. The anesthetic technique used was general anesthesia induced with propofol (1.5 mg.kg-1) and maintained with 2% sevofl urane in oxygen and fentanyl (3 µg.kg-1). The procedure was uneventful for both mother and neonate. The patient was discharged 10 days after admission, after progressive improvement of neurological symptoms. CONCLUSION: The anesthetic technique for pregnant women with Guillain-Barre syndrome requiring cesarean section remains at the discretion of the anesthesiologist, who should be guided by the clinical conditions and comorbidities of each patient.

JUSTIFICATIVA Y OBJETIVOS: El Síndrome de Guillain-Barré durante la gestación se considera una complicación neurológica rara y todavía no se ha llegado a un consenso en la literatura sobre el manejo anestésico para la cesárea en esas pacientes. El objetivo de este artículo, es relatar el caso de una paciente gestante portadora del Síndrome de Guillain-Barré sometida a la cesárea. RELATO DEL CASO: Paciente femenina con 22 años, con 35 semanas y cinco días de edad gestacional, sometida a cesárea e ingresada, relatando una disminución de fuerza y parestesias en los miembros inferiores. El examen del líquido cefalorraquídeo arrojó elevación de proteínas (304 mg.dL-1) sin el aumento de la celularidad. La técnica anestésica usada fue la anestesia general, inducida con propofol 1,5 mg.kg-1 y mantenida con sevofl urano al 2% en oxígeno y fentanilo 3 µg.kg-1. El procedimiento trascurrió sin complicaciones, tanto para la gestante como para el feto. Se le dio el alta a la paciente al décimo día del ingreso, posteriormente a la mejoría progresiva del cuadro neurológico. CONCLUSIONES: La técnica anestésica que se usa en las gestantes portadoras del Síndrome de Guillain-Barré que necesitan cesárea, permanece como siendo una elección del anestesiólogo, que debe dejarse guiar por el cuadro clínico y por las comorbilidades de cada paciente.

Assuntos

RESUMO

JUSTIFICATIVA E OBJETIVOS: A palpação foi demonstrada não ser muito precisa para identificar espaços interespinhosos lombares em anestesia neuroaxial. O objetivo deste estudo foi avaliar a precisão para determinar os espaços interespinhosos lombares pela palpação por anestesiologistas com o uso de radiografias pós-operatórias em pacientes obstétricas. MÉTODOS: Revisamos os registros anestésicos e as radiografias abdominais pós-operatórias de cesarianas. Inserimos o cateter epidural para analgesia pós-operatória com dose única. Incluímos casos de anestesia combinada raqui-peridural e comparamos o nível interespinhoso registrado pelo anestesiologista e o nível de inserção do cateter peridural confirmado pela radiografia abdominal de cada caso. Também avaliamos os fatores (idade, peso, altura, Índice de Massa Corporal, idade gestacional e tipo de cirurgia [programada/emergência]) que levaram à identificação errônea do nível interespinhoso. RESULTADOS: Foram avaliadas 835 cesarianas de 967 feitas. Os níveis das punções documentados pelos anestesiologistas estavam de acordo com os níveis reais de inserção dos cateteres em 563 casos (67%). Quando os anestesiologistas objetivaram identificar o nível L2-3, descobrimos que a inserção do cateter foi em L1-2 em cinco casos (4,9%), dos quais nenhum apresentou qualquer déficit neurológico pós-operatório. Nenhuma das variáveis avaliadas estava significativamente associada à identificação errônea do nível interespinhoso pelos anestesiologistas. CONCLUSÃO: Houve uma discrepância entre o nível estimado pela palpação dos anestesiologistas e o nível real de inserção do cateter mostrado nas radiografias. Parece ser mais seguro escolher o nível interespinhoso L3-4, ou mais baixo, em raquianestesia.

BACKGROUND AND OBJECTIVES: Palpation has been shown to be rather inaccurate at identifying lumbar interspinous spaces in neuraxial anesthesia. The aim of this study is to assess the accuracy of the determination of the lumbar interspinous spaces by anesthesiologist's palpation using post-operative X-rays in obstetric patients. METHODS: We reviewed the anesthetic record and the post-operative abdominal X-rays of the cesarean sections. We indwelled the epidural catheter for post-operative one-shot analgesia. We included combined spinal and epidural anesthesia cases and compared the interspinous level which the anesthesiologist recorded and the epidural catheter insertion level confirmed by abdominal X-ray for each case. We also evaluated the factors (age, body weight, height, Body Mass Index, gestational age, and the type of surgery [planned / emergency]) leading to misidentification of interspinous level. RESULTS: Nine hundred and sixty seven cesarean sections were performed and a total of 835 cases were evaluated. The levels of the puncture documented by the anesthesiologists were in agreement with the actual catheter insertion levels in 563 (67%) cases. When the anesthesiologists aimed at L2-3 level, we found the catheter insertion at L1-2 in 5 cases (4.9%), none of which had any post-operative neurological deficits. No variables evaluated were significantly associated with misidentification of interspinous level by the anesthesiologists. CONCLUSIONS: There was a discrepancy between the anesthesiologists' estimation by palpation and the actual catheter insertion level shown in X-rays. It seems to be safer to choose the interspinous level L3-4 or lower in spinal anesthesia.

JUSTIFICATIVA Y OBJETIVOS: Está comprobado que la palpación no es muy exacta para identificar los espacios interespinosos lumbares en la anestesia neuroaxial. El objetivo de este estudio, fue evaluar la precisión para determinar los espacios interespinosos lumbares a través de la palpación por anestesiólogos con el uso de radiografías postoperatorias de pacientes obstétricas. MÉTODOS: Revisamos los registros anestésicos y las radiografías abdominales postoperatorias de cesáreas. Insertamos el catéter epidural para la analgesia postoperatoria con una dosis única. Incluimos casos de anestesia combinada raqui-epidural y comparamos el nivel interespinoso registrado por el anestesiólogo y el nivel de inserción del catéter epidural confirmado por la radiografía abdominal de cada caso. También evaluamos los factores (edad, peso, altura, Índice de Masa Corporal, edad gestacional y tipo de cirugía [programada/emergencia]), que que levaram à identifi cação errônea do nível interespinhoso. RESULTADOS: Se evaluaron 835 cesáreas de las 967 que se hicieron. Los niveles de las punciones documentados por los anestesiólogos estaban a tono con los niveles reales de inserción de los catéteres en 563 casos (67%). Cuando los anestesiólogos quisieron identificar el nivel L2-3, descubrimos que la inserción del catéter fue en L1-2 en cinco casos (4,9%), de los cuales ninguno tuvo ningún déficit neurológico postoperatorio. Ninguna de las variables evaluadas estaba significativamente asociada con la identificación equivocada del nivel interespinoso por los anestesiólogos. CONCLUSIONES: Hubo una discrepancia entre el nivel estimado por la palpación de los anestesiólogos y el nivel real de inserción del catéter mostrado en las radiografías. Parece ser más seguro escoger el nivel interespinoso L3-4, o más bajo, en raquianestesia.

Assuntos