Znieczulenie do cięcia cesarskiego u rodzących z łożyskiem przodującym z/bez łożyska wrośniętego – badanie retrospektywne

Objectives: The aim of this retrospective study was to review placenta previa cases and determine the prognostic factors effective on morbidity and mortality and to evaluate the strategy of anesthetic management. Material and methods: 65 women with placenta previa scheduled for elective or emergency cesarean sections from 2004 to 2009 were examined. Patient demographic data, surgery and obstetric characteristics, anesthetic techniques, blood transfusions, the values of hemoglobin and complications were recorded. Results: Mostly, general anesthesia was preferred in the parturients with placenta previa (86.2%, 56/65). 9 patients (13.8%), 2 of whom were converted to general anesthesia due to bleeding and prolonged surgery, received regional anesthesia. 37 of 65 women (56.9%) with placenta previa had had cesarean sections previously. More than half of these patients (21/37, 56.7%) had abnormally invasive placentation and 16 of 21 cases underwent cesarean hysterectomy. The incidence of complications in women with previous cesarean section with abnormally invasive placentation was higher than in the other women (pCel pracy: Celem tego retrospektywnego badania była analiza przypadków łożyska przodującego pod kątem oceny czynników prognostycznych wpływających na zachorowalność i śmiertelność oraz ocena postępowania anestezjologicznego. Materiał: Przeanalizowano 65 przypadków kobiet z łożyskiem przodującym zakwalifikowanych do elektywnego lub pilnego cięcia cesarskiego w latach 2004-2009.Zebrano następujące dane: demograficzne, wywiad operacyjny i położniczy, techniki anestezjologiczne, transfuzje krwi, poziomy hemoglobiny i powikłania. Wyniki: Preferowaną metodą znieczulenia u rodzących z łożyskiem przodującym było znieczulenie ogólne (86,2%; 56/65). Przewodowe znieczulenie otrzymało 9 pacjentek (13,8%) ale u 2 z nich trzeba było przejść na znieczulenie ogólne z uwagi na krwawienie i przedłużony czas operacji. 37 z 65 kobiet (56,9%) z łożyskiem przodującym miało cięcie cesarskie w poprzedniej ciąży. Więcej niż połowa tych pacjentek (21/37, 56,7%) miała nieprawidłowo utworzone łożysko a 16 z 21 przeszło histerektomię położniczą. Częstość powikłań u kobiet po cięciu cesarskim w wywiadzie i z nieprawidłowo utworzonym łożyskiem w analizowanym materiale była wyższa niż u innych pacjentek (

Comparação de lornoxicam e fentanil adicionados à lidocaína em anestesia regional intravenosa

JUSTIFICATIVA E OBJETIVO: Comparar os efeitos analgésicos nos períodos intra e pós-operatório de lornoxicam e fentanil adicionados à lidocaína para anestesia regional intravenosa (ARIV) em um grupo de pacientes submetidos à cirurgia de mão. MÉTODOS: Estudo randômico, duplo-cego e controlado. Foram incluídos e randomizados 45 pacientes em três grupos: o Grupo I recebeu 3 mg.kg-1 de lidocaína a 2% (40 mL); o Grupo II recebeu 3 mg.kg-1 de lidocaína (38 mL) + 2 mL de lornoxicam; o Grupo III recebeu 3 mg.kg-1 de lidocaína (38 mL) + 2 mL de fentanil. O desfecho primário avaliado foi o tempo até a primeira necessidade de analgésicos no pós-operatório. RESULTADOS: Lornoxicam adicionado à lidocaína em ARIV aumentou o tempo de recuperação do bloqueio sensorial sem aumentar os efeitos colaterais, e o tempo até a primeira necessidade de analgésicos no pós-operatório em comparação com lidocaína sozinha (p < 0,001, p < 0,001, respectivamente) e fentanil adicionado à lidocaína (p < 0,001, p < 0,001, respectivamente). Além disso, também descobrimos que fentanil diminuiu a dor ocasionada pelo torniquete (p < 0,01) em comparação com lidocaína, mas mostrou efeito analgésico similar ao de lornoxicam (p &gt; 0,05), embora os escores da escala visual analógica (EVA) relacionados à dor ocasionada pelo torniquete tenham sido menores no grupo fentanil. Lornoxicam adicionado à lidocaína em ARIV não foi superior à lidocaína sozinha para diminuir a dor ocasionada pelo torniquete. CONCLUSÃO: A adição de fentanil à lidocaína em ARIV parece ser superior à lidocaína sozinha e ao lornoxicam adicionado à lidocaína para diminuir a dor ocasionada pelo torniquete, apesar de aumentar os efeitos secundários. No entanto, lornoxicam não aumentou os efeitos secundários e proporcionou analgesia nos períodos tanto intraoperatório quanto pós-operatório. Portanto, lornoxicam pode ser mais adequado para o uso clínico

Comparison of Lornoxicam and Fentanyl when added to Lidocaine in Intravenous Regional Anesthesia

Background and objectives: In this study, our goal was to compare intraoperative and postoperative analgesic effects of lornoxicam and fentanyl when added to lidocaine Intravenous Regional Anesthesia (IVRA) in a group of outpatients who underwent hand surgery. Methods: This is a double blind randomized study. A total of 45 patients were included, randomized into three groups. Patients in Group I (L) received 3 mg.kg-1 of 2% lidocaine 40 mL; patients in Group II (LL) received 3 mg.kg-1 lidocaine 38 mL + 2 mL lornoxicam; patients in Group III (LF) received 3 mg.kg-1 lidocaine 38 mL + 2 mL fentanyl. Our primary outcome was first analgesic requirement time at postoperative period. Results: Lornoxicam added to lidocaine IVRA increased the sensory block recovery time without increasing side effects and increased first analgesic requirement time at the postoperative period when compared to lidocaine IVRA (p 0.05) although VAS scores related to tourniquet pain were lower in fentanyl group. Lornoxicam added to lidocaine IVRA was not superior to lidocaine IVRA in decreasing tourniquet pain. Conclusions: Addition of fentanyl to lidocaine IVRA seems to be superior to lidocaine IVRA and lornoxicam added to lidocaine IVRA groups in decreasing tourniquet pain at the expense of increasing side effects. However, lornoxicam did not increase side effects while providing intraoperative and postoperative analgesia. Therefore, lornoxicam could be more appropriate for clinical use. Keywords: Anesthesia, Conduction, Anesthetics, Local, Fentanyl, Lidocaine, Piroxicam/lornoxicam

Abdominal girth has a strong correlation with ultrasound-estimated epidural depth in parturients: a prospective observational study

WOS: 000463163700011PubMed ID: 30734847BackgroundPreprocedural ultrasound examination of vertebral column guides to locate desired intervertebral space and provides a prevision of needle trajectory and estimated needle depth in parturients. The objective of this study was to assess the correlation between ultrasound-estimated epidural depth (ED) with abdominal girth (AG), body mass index (BMI), weight, height, and age.MethodsIn this prospective, observational study, ultrasound imaging was done at L3-4 interspace in transverse median plane (TP) and paramedian sagittal oblique plane (PSO) to obtain ultrasound estimates of skin to epidural space depth. Combined spinal epidural anesthesia was performed at L3-4 interspace. AG, BMI, age, height, and weight were recorded for every parturient.ResultsData from 130 parturients were analyzed. Estimated ED was 56.59.5mm in TP, 57.5 +/- 9.3mm in PSO, and actual epidural depth was 57.9 +/- 9.4mm. Correlation coefficients between ED and AG were 0.797 in TP (95% CI 0.727-0.854, p<0.001) and 0.803 in PSO (95% CI 0.733-0.857, p<0.001). Correlation coefficients between ED and BMI were 0.543 in TP (95% CI 0.405-0.661, p<0.001) and 0.566 in PSO (95% CI 0.428-0.680, p<0.001). Correlation coefficients between ED and weight were 0.593 in TP (CI=0.466-0.695, p<0.001) and 0.615 in PSO (CI=0.500-0.716, p<0.001). Height and age had no significant correlation with ED.ConclusionsAbdominal girth has a strong correlation with ultrasound-estimated epidural depth in parturients

The effects of crystalloid warming on maternal body temperature and fetal outcomes: a randomized controlled trial

WOS: 000453423500003Background and objectives: Hypothermia occurs in about 60% of patients under anesthesia and is generally not managed properly during short lasting surgical procedures. Hypothermia is associated with adverse clinical outcomes. The current study is designed to assess the effects of crystalloid warming on maternal and fetal outcomes in patients undergoing elective cesarean section with spinal anesthesia. Methods: In this prospective randomized controlled trial, sixty parturients scheduled for elective cesarean section with spinal anesthesia were randomly allocated to receive crystalloid at room temperature or warmed at 37 degrees C. Spinal anesthesia was performed at L3-L4 interspace with 10 mg of hyperbaric bupivacaine without adding opioids. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and 5-min intervals until the end of operation. The primary outcome was maternal core temperature at the end of cesarean section. Results: There was no difference for baseline tympanic temperature measurements but the difference was significant at the end of the operation (p = 0.004). Core temperature was 36.8 +/- 0.5 degrees C at baseline and decreased to 36.3 +/- 0.5 degrees C. for isothermic warmed crystalloid group and baseline tympanic core temperature was 36.9 +/- 0.4 degrees C and decreased to 35.8 +/- 0.7 degrees C for room temperature group at the end of the operation. Shivering was observed in 43.3% in the control group. Hemodynamic parameter changes and demographic data were not significant between groups. Conclusions: Isothermic warming crystalloid prevents the decrease in core temperature during cesarean section with spinal anesthesia in full-term parturients. Fetal Apgar scores at first and fifth minute are higher with isothermic warming. (C) 2018 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda

Achalasia case detected during endoscopy application accompanied by anaesthesia

WOS: 000390680400014PubMed ID: 28053688

Evaluation of medical drug and herbal product use before anesthesia

WOS: 000374655200518We aimed to determine the prevalence of herbal product and medical drug use among preoperative patients. Patients over the age of 18 applied for preanesthetic evaluation were directly asked by anesthesiologists if they were using any drug. Patients were also asked whether they use any herbal product. We also asked patients whether they know the side effects of herbal product or any drug they have used. 898 surgical patients were evaluated in the anesthesia assessment unit before surgery for a 3-month period. 43.4% patients were taking medical drugs. 9.5% patients reported taking herbal products and 21 of those patients were consuming more than one. 33 of all patients were using both medical drug and herbal product. The most commonly consumed herbal products, in descending order of frequency, were green tea (n=29), lime (n=20), garlic (n=8), ginger (n=7) nettle (n=7) ye daisy (n=5). 375 patients reported using medical drug in the initial assesment. Whereas only 4 patients reported consuming herbal product in the initial assesment. 38 (9.7%) of patients using medical drug and 3 (3.5%) of patients using herbal product said that they know the side effects of drugs. Usage of herbal product is common among patients undergoing surgery. Anesthesiologists should be aware of the herbal use because the patients may not give information about herbal consumption. Most commonly used herbal products may vary according to regions. Most of the patients do not know the side effects of both medical drug and herbal products