12 research outputs found
AnestezioloÅ”ke tehnike u jednodnevnoj kirurgiji za zahvate kod displazije vrata maternice ā iskustva u KBC-u Sestre milosrdnice
Danas su anestezija i analgezija tako sigurne i uÄinkovite da se kirurÅ”ki zahvati kod displazije vrata maternice mogu obavljati unutar jednodnevne kirurgije. AnestezioloÅ”ke tehnike u jednodnevnoj kirurgiji povezane su sa znaÄajno manje morbiditeta i mortaliteta. Do 2015. godine svi su se kirurÅ”ki zahvati kod displazije vrata maternice u KliniÄkom bolniÄkom centru Sestre milosrdnice u Zagrebu radili u opÄoj anesteziji, a prosjeÄni boravak u bolnici trajao je duže od 30, a kraÄe od 72 sata. U Klinici za ženske bolesti i porodniÅ”tvo proveli smo retrospektivno istraživanje u periodu od sijeÄnja 2015. do prosinca 2019. godine, buduÄi da su se od tada zahvati konizacije zapoÄeli izvoditi u lokalnoj anesteziji. ProuÄavali smo uÄestalost opÄe i regionalne anestezije u odnosu na vrstu konizacije, uÄestalost vrste anestezije u odnosu na dobnu skupinu i procjenu rizika bolesnica za anesteziju, te duljinu hospitalizacije u odnosu na vrstu kirurÅ”kog zahvata. U periodu od 2015. do 2019. godine zabilježen je stalni porast udjela lokalne anestezije u ukupnom broju elektrodijatermijski odstranjenih transformacijskih zona velikom petljom (engl. Large loop excision of the transformation zone) za 36,5% (49/104 zahvata 2015. u odnosu na 112/134 zahvata 2019.). Od listopada 2018., kada je uveden spinalni blok kao metoda anestezije za konizaciju hladnim nožem, do prosinca 2019. godine udio spinalnog bloka u ukupnom broju konizacija hladnim nožem porastao je za 17,3% (2/65 zahvata 2018. u odnosu na 11/54 zahvata 2019.). Istraživanje prikazuje analizu razlike pojavnosti anestezioloÅ”kih tehnika ovisno o vrsti kirurÅ”kog zahvata, procjeni rizika i životnoj dobi bolesnica za anesteziju kod displazije vrata maternice te duljinu hospitalizacije u odnosu na vrstu konizacije
Dileme oko izbora anestezije za elektivni carski rez u trudnica s miotoniÄnom distrofijom tip 2 i sumnjom na von Willebrandovu bolest: prikaz sluÄaja
With advancement of medicine in the field of diagnostics and treatment of women
suffering from certain genetic disorders, more and more women have attained reproductive age
and desired fertility. Maintaining pregnancy, as well as bringing it to an end poses a real challenge not
only for obstetricians, but also for anesthesiologists involved in the procedure. In our case report, we
describe anesthetic management of a female patient suffering from myotonic dystrophy type 2 and
suspected von Willebrandās disease, and undergoing elective cesarean section. It is acknowledged that
both diseases have their own peculiarities and specificities related to anesthesia and require careful
consideration when it comes to selecting it. Bearing in mind the advantages and disadvantages of certain
types of anesthesia, we believe that in this case, general anesthesia was a better choice compared
to the regional techniques of anesthesia.Napretkom medicine u dijagnostici i lijeÄenju odreÄenih genetskih poremeÄaja sve viÅ”e žena postiže reproduktivnu dob
i željenu plodnost. OÄuvanje trudnoÄe kao i njen zavrÅ”etak predstavlja pravi izazov ne samo za opstetriÄare, nego i za anesteziologe
ukljuÄene u skrb takvih bolesnica. U naÅ”em sluÄaju prikazujemo anestezijski postupak za elektivni carski rez kod
trudnice koja boluje od miÅ”iÄne distrofije tipa 2 i suspektne von Willebrandove bolesti. Poznato je da obje bolesti imaju svoje
osobitosti i specifiÄnosti vezane uz anesteziju te zahtijevaju pažljivo razmatranje oko odabira iste. RazmatrajuÄi prednosti
i nedostatke odreÄene vrste anestezije smatramo da je u ovom sluÄaju opÄa anestezija bolji izbor u odnosu na regionalne
tehnike izvoÄenja anestezije
EPIDURAL ANESTHESIA FOR CESAREAN SECTION IN A PATIENT WITH BRAIN ARTERIOVENOUS MALFORMATION ā A CASE REPORT
Cilj nam je bio pokazati da se carski rez može uspjeÅ”no izvesti u epiduralnoj anesteziji kod trudnice s arteriovenskom malformacijom (AV M). Intrakranijalne arteriovenske malformacije rijetko se viÄaju u trudnoÄi. ZavrÅ”etak trudnoÄe carskim rezom izazov je za anesteziologa koji se skrbi za takve trudnice. Važno je razumjeti hemodinamske
promjene koje se dogaÄaju u trudnoÄi i moždanu fiziologiju kao preduvjete za uspjeÅ”no izvoÄenje anestezioloÅ”kih postupaka i izbjegavanje moguÄih komplikacija. Radi se o prikazu tridesetdvogodiÅ”nje trudnice s arteriovenskom malformacijom V. stupnja prema Spetzler-Martinovoj klasifikaciji. Primljena je u bolnicu zbog pogorÅ”anja neuroloÅ”kog statusa s ataksijom kao glavnim simptomom. UzimajuÄi u obzir njezin neuroloÅ”ki status i progresiju opstetriÄkog nalaza, odluÄili smo zavrÅ”iti trudnoÄu carskim rezom u epiduralnoj anesteziji. Literaturni podaci o anestezioloÅ”kom zbrinjavanju trudnice s intrakranijalnom arteriovenskom malformacijom malobrojni su i kontradiktorni. UsporeÄujuÄi opÄu i spinalnu anesteziju s epiduralnom, smatrali smo da je epiduralna anestezija u ovom sluÄaju bolji izbor. Hemodinamska i respiratorna stabilnost majke i djeteta bile su održane tijekom operacije i u postpartalnom periodu. Nije bilo znakova pogorÅ”anja majÄina neuroloÅ”kog statusa. Držimo da se carski rez kod trudnice s arteriovenskom malformacijom može sigurno izvesti u epiduralnoj anesteziji.Our goal was to demonstrate that cesarean section in a pregnant woman with arteriovenous malformation (AV M) can be successfully performed under epidural anesthesia. Intracranial arteriovenous malformations are rarely encountered in pregnancy. Completion of pregnancy by cesarean section imposes a great challenge for anesthesiologist taking care of these parturients. It is essential to understand hemodynamical changes during pregnancy and cerebral physiology in order to optimise anesthetic management and avoid possible complications. We report a case of a 32-year- -old pregnant woman with arteriovenous malformation grade V according to Spetzler Martin classification. She was admitted to hospital due to deterioration in her neurological status with ataxia as the leading symptom. Considering her neurological status and progression of obstetrical finding it was decided to complete the pregnancy by cesarean section under epidural anesthesia. The literature data about anesthetic management of parturients with intracranial AV M undergoing cesarean section are scarce and conflicting. In comparison with general and spinal anesthesia epidural anesthesia was considered as a better choice in this case. Hemodynamic and respiratory stability of mother and infant was maintained throughout the operation and in postpartal period. There were no signs of deterioration in maternal neurological status. Cesarean section in a woman with AV M grade V can be safely performed under epidural anesthesia
The Efficacy of Dural Puncture Epidural Performed by 27-gauge Whitacre Needle in Labour Epidural Analgesia: Randomized Single-Blinded Controlled Study
Objective:Dural puncture epidural technique is refinement of standard epidural technique. Its goal is to overcome drawbacks of standard epidural. We assessed whether dural puncture epidural technique performed by 27-gauge spinal needle would provide higher quality of labour epidural analgesia by using 10 mL epidural bolus of 0.125% bupivacaine. Additionally, the impact of dural puncture epidural on epidural analgesia onset, course of labour and occurrence of maternal side effects was examined.Methods:We designed prospective, randomized, single-blind study. A total of 76 healthy nulliparous parturients were randomly allocated to dural puncture or standard epidural group. After identification of epidural space, spinal Whitacre needle was used for dural puncture. Intrathecal drug administration was omitted at that point. Both groups received a bolus of local anaesthetic mixture, followed by a continuous infusion of diluted local anaesthetic via epidural catheter. Pain was assessed by numeric pain rating scale. The number of top-ups and mode of delivery were recorded in both groups.Results:After 10 minutes, there was a statistically significant difference in numeric pain rating scale ā¤3 reported (P=0.028), with 97.4% subjects in dural puncture epidural group achieving adequate analgesia after 10 minutes. There was no statistically significant difference in the number of additional boluses, time to delivery, Bromage scale achieved or maternal outcomes between groups.Conclusion:Dural puncture epidural technique appears to be effective in providing faster onset of epidural analgesia. However, the need for additional boluses remains unchanged. It can be safely used in obstetrics, without deleterious effect on the course of labour
Epiduralna analgezija u porodniÅ”tvu - proturjeÄja
Labor pain is one of the most severe pains. Labor is a complex and individual process with varying maternal requesting analgesia. Labor analgesia must be safe and accompanied by minimal amount of unwanted consequences for both the mother and the child, as well as for the delivery procedure. Epidural analgesia is the treatment that best meets these demands. According to the American Congress of Obstetrics and Gynecology and American Society of Anesthesiologists, motherās demand is a reason enough for the introduction of epidural analgesia in labor, providing that no contraindications exist. The application of analgesics should not cease at the end of the second stage of labor, but it is recommended that lower concentration analgesics be then applied. Based on the latest studies, it can be claimed that epidural analgesia can be applied during the major part of the first and second stage of labor. According to previous investigations, there is no definitive conclusion about the incidence of instrumental delivery, duration of second stage of labor, time of epidural analgesia initiation, and long term outcomes for the newborn. Cooperation of obstetric and anesthesiology personnel, as well as appropriate technical equipment significantly decrease the need of instrumental completion of a delivery, as well as other complications encountered in the application of epidural analgesia. Our hospital offers 24/7 epidural analgesia service. The majority of pregnant women in our hospital were aware of the advantages of epidural analgesia for labor, however, only a small proportion of them used it, mainly because of inadequate level of information.Bol kod poroÄaja smatra se jednom od najjaÄih boli. PoroÄaj je složen i individualan proces s razliÄitim željama žena za analgezijom. Analgezija u poroÄaju mora biti sigurna i s minimalnim neželjenim posljedicama za majku, dijete i za tijek poroÄaja. Tim uvjetima najbolje udovoljava epiduralna analgezija (EA). Prema American College of Obstetrics and Gynecology i American Society of Anesthesiologists za primjenu EA u poroÄaju dovoljna je želja rodilje ako ne postoji kontraindikacija. Davanje analgetika ne treba prestati na kraju drugog poroÄajnog doba, ali se tada preporuÄuju niske koncentracije lokalnog anestetika te dodavanje adjuvansa. Novije studije ukazuju na to da se EA može primijeniti u najveÄem dijelu prvog i drugog poroÄajnog doba. Bez obzira na dosadaÅ”nja iskustva i istraživanja ne postoji slaganje oko uÄestalosti instrumentalnog dovrÅ”enja poroÄaja, trajanja drugog poroÄajnog doba uz EA i vremena uvoÄenja EA te dugoroÄnog utjecaja na dijete. Dobra suradnja opstetriÄkog i anestezioloÅ”kog osoblja i dobra tehniÄka opremljenost znatno smanjuju potrebu za instrumentalnim dovrÅ”enjem poroÄaja, kao i druge komplikacije EA. NaÅ”a bolnica nudi EA za olakÅ”ani poroÄaj tijekom 24 sata. VeÄina trudnica je svjesna prednosti primjene EA za vaginalni poroÄaj, meÄutim, samo mali broj trudnica iskoristi tu moguÄnost, uglavnom zbog nedovoljne obavijeÅ”tenosti o toj metodi
Trend and development of epidural analgesia and epidural anesthesia in the maternitiy ward of UHC Sestre milosrdnice over the past ten years
Tijekom posljednjih godina epiduralna analgezija za obezboljavanje vaginalnog poroÄaja primjenjuje se sve ÄeÅ”Äe i jedna je od najÄeÅ”Äe rabljenih regionalnih tehnika. Epiduralna anestezija uglavnom se rabi za hitni carski rez u rodilja koje veÄ imaju postavljen epiduralni kateter za epiduralnu analgeziju tijekom vaginalnog poroÄaja. U rodiliÅ”tu KliniÄkoga bolniÄkog centra Sestre milosrdnice proveli smo retrospektivnu kohortnu studiju od 2008. do 2018. godine. ProuÄavali smo desetogodiÅ”nji trend incidencije epiduralne analgezije u odnosu prema ukupnom broju poroÄaja i incidencije epiduralne anestezije za hitni carski rez u odnosu prema ukupnom broju hitnih carskih rezova. U 2008. godini uÄestalost epiduralne analgezije u odnosu prema ukupnom broju poroÄaja bila je 21% (662/3125), a u 2018. godini 34% (1059/3083). U 2008. godini broj epiduralnih anestezija u odnosu prema ukupnom broju anestezija za hitni carski rez bio je 9% (51/552), a u 2018. 27% (172/639). Trend porasta vidljiv je kod obaju postupaka i iznosi 13% za epiduralne analgezije i 18% pri epiduralnim anestezijama.Over the years, epidural analgesia for pain relief of vaginal delivery is increasingly being applied and is one of the most frequently used regional techniques. Epidural anesthesia is mainly used in emergency cesarean section in parturients who already have an epidural catheter for epidural analgesia during vaginal delivery. In the delivery ward at the Sestre milosrdnice University Hospital Center we have conducted a retrospective cohort study from 2008 to 2018.We studied the incidence of epidural analgesia in relation to the total number of births and the
incidence of epidural anesthesia for emergency cesarean section in relation to the total number of emergency cesarean sections. In 2008, the incidence of epidural analgesia in the relation to the total number of births was 21% (662/3125),and in 2018 it was 34% (1059/3083). In 2008, the number of epidural anesthesia for emergency cesarean section in the relation to the total number of emergency cesarean sections was 9% (51/552), andn in 2018 it was 27% (172/639). An increasing trend is seen in both procedures and is 13% for epidural analgesiaand 18% for epidural anesthesia
UTJECAJ PREPARTALNE AKUPUNKTURE (PPAC) NA POROÄAJ
Delivery is a natural process associated with a certain level of pain. With todayās range of various pain relieving methods during labor, it is possible to shorten laboring, thus ensuring better compliance of parturient woman. Prepartal acupuncture is one of these methods. The results of this prospective study showed that prepartal acupuncture had a positive infl uence on pain experience of parturient women. There was no difference in duration of the fi rst stage of labor between comparable groups, even in the primipara group. This study found acupuncture to have a positive infl uence on psychological state of the parturient women and general compliance during labor. Acupuncture should be considered as one of the possible methods for pain relief in labor and preparation for labor.PoroÄaj je prirodni proces povezan s odreÄenom jaÄinom boli. Uz danaÅ”nji raspon raznih metoda za ublažavanje boli moguÄe je poroÄaj i vremenski skratiti te time osigurati bolju suradnju rodilje. Prepartalna priprema akupunkturom jedna je od takvih metoda. Rezultati ovoga prospektivnog istraživanja pokazali su da prepartalna priprema akupunkturom djeluje pozitivno na rodilje u smislu subjektivno manjeg osjeÄaja boli, no nismo uspjeli potvrditi da skraÄuje prvu poroÄajnu dob. U skupini rodilja koje su bile na prepartalnoj pripremi akupunkturom 7/26 rodilja je poroÄaj smatralo laganim za razliku od skupine rodilja koje nisu proÅ”le prepartalnu pripremu akupunkturom, gdje je samo 1/25 rodilja poroÄaj smatrala laganim. Analizom trajanja prve poroÄajne dobi nije bilo statistiÄki znaÄajne razlike meÄu skupinama (trajanje prve poroÄajne dobi kraÄe od 4 sata imalo je 14/25 žena u kontrolnoj skupini, a samo 4/13 žena u akupunkturnoj skupini). IzmeÄu skupina nije bilo ni statistiÄki znaÄajne razlike u trajanju prve poroÄajne dobi ni kada su se uzele u obzir samo prvorotkinje (trajanje prve poroÄajne dobi kraÄe od 4 sata imalo je 6/13 žena u kontrolnoj skupini i samo 4/16 žena u akupunkturnoj skupini). Ovo istraživanje ukazuje na pozitivan utjecaj prepartalne pripreme akupunkturom na psihiÄku stabilnost rodilje i dobru suradljivost te na važnost podizanja svijesti o akupunkturi kao moguÄnosti jedne od metoda pripreme za poroÄaj
Oxidative Stress Reduction by Midazolam Premedication during Oocyte Retrieval Procedure: Pilot Study
Infertility is one of the major medical problems nowadays. Couples who opt for In Vitro Fertilization (IVF) face a great deal of stress which certainly affects the outcome of the procedure. Therefore, we aimed to reduce the stress during the oocyte retrieval procedure by applying midazolam. Total oxidant (TOC) and antioxidant (TAC) capacities of serum, as well as glutathione (GSH) content and catalase activity, were measured in both control and midazolam groups. Follicular fluid was also tested for oxidant capacity and IL1Ī². Results implied that the midazolam group increased TAC at the end of the procedure. At the same time, the control group decreased GSH at the beginning of the procedure, and both groups decreased catalase activity at the end of the procedure. The results imply that stress during the procedure affects oxidative and antioxidative parameters of the patients, but did not affect the frequency of the pregnancy at the end of this pilot study. Yet, the results imply that oxidative and antioxidative mechanisms during IVF should be investigated in detail as they could affect the outcome of IVF