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[PMID]:29444394
[Ti] Título:Hearing loss after spinal anesthesia : A comparative prospective randomized cohort study.
[So] Source:Acta Anaesthesiol Belg;67(2):87-95, 2016.
[Is] ISSN:0001-5164
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: In this comparative randomized cohort study, we aimed at evaluating the occurrence of sensorineural hearing loss after general and spinal anesthesia using both subjective and objective tests. MATERIAL AND METHODS: Fifty patients scheduled for elective cesarean section were approached, of which 21 patients received spinal anesthesia (group S), and 16 patients received general anesthesia (group G). In group S, a 27 G pencil point spinal needle was used. Pure tone audiometry and Distortion Product OtoAcoustic Emissions (DPOAE) were performed before and 48 hours after surgery. RESULTS: No between-group significant difference in pre and postoperative audiometric hearing threshold and pure tone average value were noticed, as well as in pre and postoperative DPOAE amplitude and signal-to-noise ratio (SNR). CONCLUSION: In this study, we did not observe any hearing loss after cesarean section under general or spinal anesthesia. Using the non-traumatic 27 gauge pencil point needle for performing spinal anesthesia does not seem to be associated with a risk of hearing loss, similarly to general anesthesia.
[Mh] Termos MeSH primário: Anestesia Obstétrica/efeitos adversos
Raquianestesia/efeitos adversos
Perda Auditiva Neurossensorial/etiologia
[Mh] Termos MeSH secundário: Adulto
Anestesia Geral
Audiometria de Tons Puros
Cesárea
Feminino
Seres Humanos
Emissões Otoacústicas Espontâneas
Gravidez
Estudos Prospectivos
Razão Sinal-Ruído
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE


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[PMID]:29181841
[Au] Autor:Ray A; Ray S
[Ad] Endereço:Department of Obstetrics and Gynaecology, DM Wayanad Institute of Medical Sciences, Naseera Nagar ,Meppadi (PO), Wayanad, Wayanad, Kerala, India, 673577.
[Ti] Título:Epidural therapy for the treatment of severe pre-eclampsia in non labouring women.
[So] Source:Cochrane Database Syst Rev;11:CD009540, 2017 11 28.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pre-eclampsia is a pregnancy-specific multi-organ disorder, which is characterised by hypertension and multisystem organ involvement and which has significant maternal and fetal morbidity and mortality. Failure of the placental vascular remodelling and reduced uteroplacental flow form the etiopathological basis of pre-eclampsia. There are several established therapies for pre-eclampsia including antihypertensives and anticonvulsants. Most of these therapies aim at controlling the blood pressure or preventing complications of elevated blood pressure, or both. Epidural therapy aims at blocking the vasomotor tone of the arteries, thereby increasing uteroplacental blood flow. This review was aimed at evaluating the available evidence about the possible benefits and risks of epidural therapy in the management of severe pre-eclampsia, to define the current evidence level of this therapy, and to determine what (if any) further evidence is required. OBJECTIVES: To assess the effectiveness, safety and cost of the extended use of epidural therapy for treating severe pre-eclampsia in non-labouring women. This review aims to compare the use of extended epidural therapy with other methods, which include intravenous magnesium sulphate, anticonvulsants other than magnesium sulphate, with or without use of the antihypertensive drugs and adjuncts in the treatment of severe pre-eclampsia.This review only considered the use of epidural anaesthesia in the management of severe pre-eclampsia in the antepartum period and not as pain relief in labour. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (13 July 2017) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) or quasi-RCTs comparing epidural therapy versus traditional therapy for pre-eclampsia in the form of antihypertensives, anticonvulsants, magnesium sulphate, low-dose dopamine, corticosteroids or a combination of these, were eligible for inclusion. Trials using a cluster design, and studies published in abstract form only are also eligible for inclusion in this review. Cross-over trials were not eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS: The two review authors independently assessed trials for inclusion and trial quality. There were no relevant data available for extraction. MAIN RESULTS: We included one small study (involving 24 women). The study was a single-centre randomised trial conducted in Mexico. This study compared a control group who received antihypertensive therapy, anticonvulsant therapy, plasma expanders, corticosteroids and dypyridamole with an intervention group that received epidural block instead of the antihypertensives, as well as all the other four drugs. Lumbar epidural block was given using 0.25% bupivacaine, 10 mg bolus and 5 mg each hour on continuous epidural infusion for six hours. This study was at low risk of bias in three domains but was assessed to be high risk of bias in two domains due to lack of allocation concealment and blinding of women and staff, and unclear for random sequence generation and outcome assessor blinding.The included study did not report on any of this review's important outcomes. Meta-analysis was not possible.For the mother, these were: maternal death (death during pregnancy or up to 42 days after the end of the pregnancy, or death more than 42 days after the end of the pregnancy); development of eclampsia or recurrence of seizures; stroke; any serious morbidity: defined as at least one of stroke, kidney failure, liver failure, HELLP syndrome (haemolysis, elevated liver enzymes and low platelets), disseminated intravascular coagulation, pulmonary oedema.For the baby, these were: death: stillbirths (death in utero at or after 20 weeks' gestation), perinatal deaths (stillbirths plus deaths in the first week of life), death before discharge from the hospital, neonatal deaths (death within the first 28 days after birth), deaths after the first 28 days; preterm birth (defined as the birth before 37 completed weeks' gestation); and side effects of the intervention. Reported outcomesThe included study only reported on a single secondary outcome of interest to this review: the Apgar score of the baby at birth and after five minutes and there was no clear difference between the intervention and control groups.The included study also reported a reduction in maternal diastolic arterial pressure. However, the change in maternal mean arterial pressure and systolic arterial pressure, which were the other reported outcomes of this trial, were not significantly different between the two groups. AUTHORS' CONCLUSIONS: Currently, there is insufficient evidence from randomised controlled trials to evaluate the effectiveness, safety or cost of using epidural therapy for treating severe pre-eclampsia in non-labouring women.High-quality randomised controlled trials are needed to evaluate the use of epidural agents as therapy for treatment of severe pre-eclampsia. The rationale for the use of epidural is well-founded. However there is insufficient evidence from randomised controlled trials to show that the effect of epidural translates into improved maternal and fetal outcomes. Thus, there is a need for larger, well-designed studies to come to an evidence-based conclusion as to whether the lowering of vasomotor tone by epidural therapy results in better maternal and fetal outcomes and for how long that could be maintained. Another important question that needs to be answered is how long should extended epidural be used to ensure any potential clinical benefits and what could be the associated side effects and costs. Interactions with other modalities of treatment and women's satisfaction could represent other avenues of research.
[Mh] Termos MeSH primário: Anestesia Epidural/métodos
Anestesia Obstétrica/métodos
Anestésicos Locais/administração & dosagem
Bupivacaína/administração & dosagem
Pré-Eclâmpsia/terapia
[Mh] Termos MeSH secundário: Corticosteroides/uso terapêutico
Anticonvulsivantes/uso terapêutico
Anti-Hipertensivos/uso terapêutico
Dipiridamol/uso terapêutico
Feminino
Seres Humanos
Substitutos do Plasma/uso terapêutico
Gravidez
Vasodilatadores/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Anesthetics, Local); 0 (Anticonvulsants); 0 (Antihypertensive Agents); 0 (Plasma Substitutes); 0 (Vasodilator Agents); 64ALC7F90C (Dipyridamole); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009540.pub2


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[PMID]:29252474
[Au] Autor:Allen TK; Habib AS
[Ad] Endereço:From the Department of Anesthesiology, Duke University Hospital, Durham, North Carolina.
[Ti] Título:Inadvertent Perioperative Hypothermia Induced by Spinal Anesthesia for Cesarean Delivery Might Be More Significant Than We Think: Are We Doing Enough to Warm Our Parturients?
[So] Source:Anesth Analg;126(1):7-9, 2018 01.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Raquianestesia
Hipotermia
[Mh] Termos MeSH secundário: Anestesia Obstétrica
Cesárea
Feminino
Seres Humanos
Gravidez
[Pt] Tipo de publicação:EDITORIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; COMMENT
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002604


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[PMID]:28904717
[Au] Autor:Doghmi N; Meskine A; Benakroute A; Bensghir M; Baite A; Haimeur C
[Ad] Endereço:Service d'Anesthésie-Réanimation, Hôpital Militaire Med V, Rabat, Maroc.
[Ti] Título:Aseptic meningitis following a bupivacaine spinal anesthesia.
[So] Source:Pan Afr Med J;27:192, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:eng
[Ab] Resumo:Spinal anesthesia complicated by meningitis is rare. The diagnosis is difficult and the clinical signs are unspecific. There is a subgroup called aseptic meningitis of a different mechanism (hypersensitive reaction and irritation of the meninges), which must be identified for appropriate care. We report the case of aseptic meningitis resulting from bupivacaine use complicating spinal anesthesia. She is 31 years old and was admitted to the intensive care unit for meningitis following a Caesarean delivery. 10 hours after the procedure, she was found to have severe headache, neck stiffness and was found restless. She lost consciousness; she was treated by attending physicians. A CT scan have been performed and was found normal. 24 hours after intubation, the patient woke up. The clinical and biological valuations were normal, allowing for the elimination of the other causes of meningitis.
[Mh] Termos MeSH primário: Anestesia Obstétrica/efeitos adversos
Raquianestesia/efeitos adversos
Bupivacaína/efeitos adversos
Meningite Asséptica/induzido quimicamente
[Mh] Termos MeSH secundário: Adulto
Anestesia Obstétrica/métodos
Raquianestesia/métodos
Anestésicos Locais/administração & dosagem
Anestésicos Locais/efeitos adversos
Bupivacaína/administração & dosagem
Cesárea/métodos
Feminino
Seres Humanos
Gravidez
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Local); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.27.192.9327


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[PMID]:28795968
[Au] Autor:Xu Z; Xu T; Zhao P; Ma R; Zhang M; Zheng J
[Ad] Endereço:From the *Department of Anesthesiology, the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and †Department of Anesthesiology & Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
[Ti] Título:Differential Roles of the Right and Left Toe Perfusion Index in Predicting the Incidence of Postspinal Hypotension During Cesarean Delivery.
[So] Source:Anesth Analg;125(5):1560-1566, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Aortocaval compression by the gravid uterus, low baseline vasomotor tone, and spinal anesthesia-related sympathetic blockade contribute to spinal anesthesia-induced hypotension during cesarean delivery. The finger perfusion index (PI) can predict spinal hypotension by reflecting baseline vasomotor tone, but cannot directly reflect aortocaval compression by the gravid uterus. This study aimed to examine whether baseline toe PIs predict the incidence of maternal hypotension and reflect aortocaval compression by the gravid uterus during cesarean delivery under spinal anesthesia. METHODS: One hundred parturients undergoing elective cesarean delivery were enrolled. The relationship between baseline toe PI and the incidence of hypotension after induction of spinal anesthesia was quantified using area under the receiver operator curves, and results compared for the right and left toe PIs. RESULTS: The area under the receiver operator curves for left and right toe baseline PIs were 0.81 (95% confidence interval, 0.71-0.88) and 0.76 (95% confidence interval, 0.66-0.84), respectively. After induction of spinal anesthesia, the toe PIs did not change in parturients with hypotension, but increased significantly among those who did not develop hypotension. CONCLUSIONS: Our study demonstrated that baseline toe PIs were inversely associated with the incidence of postspinal hypotension during cesarean delivery. Continuous monitoring of toe PIs during induction of spinal anesthesia might help to predict the development of postspinal hypotension and reflect the aortocaval compression by the gravid uterus.
[Mh] Termos MeSH primário: Anestesia Obstétrica
Raquianestesia
Pressão Sanguínea
Cesárea
Hipotensão/etiologia
Monitorização Intraoperatória/métodos
Dedos do Pé/irrigação sanguínea
[Mh] Termos MeSH secundário: Adulto
Anestesia Obstétrica/efeitos adversos
Raquianestesia/efeitos adversos
Área Sob a Curva
Cesárea/efeitos adversos
Procedimentos Cirúrgicos Eletivos
Feminino
Seres Humanos
Hipotensão/diagnóstico
Hipotensão/fisiopatologia
Modelos Logísticos
Análise Multivariada
Valor Preditivo dos Testes
Gravidez
Curva ROC
Fluxo Sanguíneo Regional
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002393


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[PMID]:28719524
[Au] Autor:Yuill G; Amroyan A; Millar S; Vardapetyan E; Habib AS; Owen MD
[Ad] Endereço:From the Department of Anaesthesia, Stepping Hill Hospital, Stockport, United Kingdom (G.Y.); Shengavit Medical Center, Yerevan, Armenia (A.A.); Royal Alexandra Hospital, Paisley, Scotland (S.M.); Kanaker-Zeytun Medical Center, Yerevan, Armenia (E.V.); Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina (A.S.H.); and Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.D.O.).
[Ti] Título:Establishing Obstetric Anesthesiology Practice Guidelines in the Republic of Armenia: A Global Health Collaboration.
[So] Source:Anesthesiology;127(2):220-226, 2017 Aug.
[Is] ISSN:1528-1175
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report's aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia. METHODS: An invited multinational team of physicians conducted six visits to Armenia between 2006 and 2015 to observe current practice and establish standards of obstetric anesthesia care. The Armenian Society of Anaesthesiologists and Intensive Care specialists collected data on the numbers of vaginal delivery, cesarean delivery, and neuraxial anesthesia use in maternity units during the period. Data were analyzed with the Fisher exact or chi-square test, as appropriate. RESULTS: Neuraxial anesthesia use for cesarean delivery increased significantly (P < 0.0001) in all 10 maternity hospitals within the capital city of Yerevan. For epidural labor analgesia, there was sustained or increased use in only two hospitals. For hospitals located outside the capital city, there was a similar increase in the use of neuraxial anesthesia for cesarean delivery that was greater in hospitals that were visited by an external team (P < 0.0001); however, use of epidural labor analgesia was not increased significantly. Over the course of the collaboration, guidelines for obstetric anesthesia were drafted and approved by the Armenian Ministry of Health. CONCLUSIONS: Collaboration between Armenian anesthesiologists and dedicated visiting physicians to update and standardize obstetric anesthesia practices led to national practice guidelines and sustained improvements in clinical care in the Republic of Armenia.
[Mh] Termos MeSH primário: Anestesia Obstétrica/métodos
Saúde Global
Cooperação Internacional
[Mh] Termos MeSH secundário: Armênia
Parto Obstétrico/métodos
Feminino
Seres Humanos
Trabalho de Parto
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170719
[St] Status:MEDLINE
[do] DOI:10.1097/ALN.0000000000001707


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[PMID]:28708666
[Au] Autor:Kantor E; Guglielminotti J; Azria E; Luton D; Laurent M; Oury JF; Mahieu-Caputo D; Ravaud P; Estellat C; PreCARE Study Group
[Ad] Endereço:From the *Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique (CIC) 1425-Epidémiologie Clinique (EC), UMR 1123, Paris, France; ‡Département d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France; §INSERM, Unité Mixte de Recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France; ‖INSERM, UMR 1153, Équipe de Recherche en épidémiologie Obstétricale Périnatale et Pédiatrique, Université Paris Descartes, Paris, France; ¶Maternité Notre Dame de Bon Secours, Groupe Hospitalier Paris Saint Joseph, Paris, France; #Service de Gynécologie-Obstétrique, Hôpital Beaujon, AP-HP, Clichy, France; **Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, AP-HP, Colombes, France; ††Service de Gynécologie-Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France; ‡‡Service de Gynécologie-Obstétrique, Hôpital Bichat, AP-HP, Paris, France; §§Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; ‖‖Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Université Paris Descartes, Paris, France; ¶¶Centre de Pharmaco-épidémiologie de l'AP-HP, Unité de Recherche Clinique des Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris France; and ##INSERM, UMR 1123 Epidémiologie Clinique et évaluation économique Appliquées aux Populations Vulnérables, Paris, France.
[Ti] Título:Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery: A French Retrospective, Multicenter, Cohort Study.
[So] Source:Anesth Analg;125(3):925-933, 2017 Sep.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Socioeconomic deprivation is associated with reduced use of antenatal resources and poor maternal outcomes with pregnancy. Research examining the association between socioeconomic deprivation and use of obstetric anesthesia care in a country providing universal health coverage is scarce. We hypothesized that in a country providing universal health coverage, France, socioeconomic deprivation is not associated with reduced use of anesthetic care during pregnancy and delivery. This study aimed to examine the association between socioeconomic deprivation and (1) completion of a mandatory preanesthetic evaluation during pregnancy and (2) use of neuraxial analgesia during labor. METHODS: Data were from a cohort of 10,419 women who delivered between 2010 and 2011 in 4 public teaching hospitals in Paris. We used a deprivation index that included 4 criteria: social isolation, poor housing condition, no work-related household income, and state-funded health care insurance. Socioeconomic deprivation was defined as a deprivation index greater than 1. Preanesthetic evaluation was considered completed if performed more than 48 hours before delivery. The association between socioeconomic deprivation and completion of the preanesthetic evaluation and use of neuraxial labor analgesia was assessed by multivariable logistic regression adjusting for education level, country of birth, and maternal and pregnancy characteristics. RESULTS: Preanesthetic evaluation was completed for 8142 of the 8624 women (94.4%) analyzed and neuraxial labor analgesia was used by 6258 of the 6834 women analyzed (91.6%). After adjustment, socioeconomic deprivation was associated with reduced probability of completed preanesthetic evaluation (adjusted odds ratio 0.88 [95% confidence interval, 0.79-0.98]; P = .027) but not use of neuraxial labor analgesia (adjusted odds ratio 0.97 [95% confidence interval, 0.87-1.07]; P = .540). CONCLUSIONS: In a country providing universal health care coverage, women who were socioeconomically deprived showed reduced completion of preanesthetic evaluation during pregnancy but not reduced use of neuraxial labor analgesia. Interventions should be targeted to socioeconomically deprived women to increase the completion of the preanesthetic evaluation.
[Mh] Termos MeSH primário: Anestesia Obstétrica/economia
Anestesia Obstétrica/utilização
Parto Obstétrico/economia
Manejo da Dor/economia
Manejo da Dor/utilização
Classe Social
[Mh] Termos MeSH secundário: Analgesia Obstétrica/economia
Analgesia Obstétrica/utilização
Estudos de Coortes
Feminino
França/epidemiologia
Seres Humanos
Gravidez
Estudos Prospectivos
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002275


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[PMID]:28708665
[Au] Autor:Uppal V; Retter S; Shanthanna H; Prabhakar C; McKeen DM
[Ad] Endereço:From the *Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK (Izaak Walton Killam) Health Centre, Halifax, Nova Scotia, Canada; †Department of Anesthesia, McMaster University, St Joseph's Health Care, Hamilton, Ontario, Canada; and ‡Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada.
[Ti] Título:Hyperbaric Versus Isobaric Bupivacaine for Spinal Anesthesia: Systematic Review and Meta-analysis for Adult Patients Undergoing Noncesarean Delivery Surgery.
[So] Source:Anesth Analg;125(5):1627-1637, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: It is widely believed that the choice between isobaric bupivacaine and hyperbaric bupivacaine formulations alters the block characteristics for the conduct of surgery under spinal anesthesia. The aim of this study was to systematically review the comparative evidence regarding the effectiveness and safety of the 2 formulations when used for spinal anesthesia for adult noncesarean delivery surgery. METHODS: Key electronic databases were searched for randomized controlled trials, excluding cesarean delivery surgeries under spinal anesthesia, without any language or date restrictions. The primary outcome measure for this review was the failure of spinal anesthesia. Two independent reviewers selected the studies and extracted the data. Results were expressed as relative risk (RR) or mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Seven hundred fifty-one studies were identified between 1946 and 2016. After screening, there were 16 randomized controlled clinical trials, including 724 participants, that provided data for the meta-analysis. The methodological reporting of most studies was poor, and appropriate judgment of their individual risk of bias elements was not possible. There was no difference between the 2 drugs regarding the need for conversion to general anesthesia (RR, 0.60; 95% CI, 0.08-4.41; P = .62; I = 0%), incidence of hypotension (RR, 1.15; 95% CI, 0.69-1.92; P = .58; I = 0%), nausea/vomiting (RR, 0.29; 95% CI, 0.06-1.32; P = .11; I = 7%), or onset of sensory block (MD = 1.7 minutes; 95% CI, -3.5 to 0.1; P = .07; I = 0%). The onset of motor block (MD = 4.6 minutes; 95% CI, 7.5-1.7; P = .002; I = 78%) was significantly faster with hyperbaric bupivacaine. Conversely, the duration of motor (MD = 45.2 minutes; 95% CI, 66.3-24.2; P < .001; I = 87%) and sensory (MD = 29.4 minutes; 95% CI, 15.5-43.3; P < .001; I = 73%) block was longer with isobaric bupivacaine. CONCLUSIONS: Both hyperbaric bupivacaine and isobaric bupivacaine provided effective anesthesia with no difference in the failure rate or adverse effects. The hyperbaric formulation allows for a relatively rapid motor block onset, with shorter duration of motor and sensory block. The isobaric formulation has a slower onset and provides a longer duration of both sensory and motor block. Nevertheless, the small sample size and high heterogeneity involving these outcomes suggest that all the results should be treated with caution.
[Mh] Termos MeSH primário: Anestesia Obstétrica/métodos
Raquianestesia/métodos
Anestésicos Locais/administração & dosagem
Bupivacaína/administração & dosagem
Parto Obstétrico
[Mh] Termos MeSH secundário: Anestesia Obstétrica/efeitos adversos
Raquianestesia/efeitos adversos
Anestésicos Locais/efeitos adversos
Anestésicos Locais/química
Bupivacaína/efeitos adversos
Bupivacaína/química
Distribuição de Qui-Quadrado
Parto Obstétrico/efeitos adversos
Composição de Medicamentos
Feminino
Seres Humanos
Atividade Motora/efeitos dos fármacos
Razão de Chances
Medição da Dor
Limiar da Dor/efeitos dos fármacos
Gravidez
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Anesthetics, Local); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002254


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[PMID]:28701185
[Au] Autor:Zheng Q; Wei P; Zhou J; Zhou H; Ji F; Tang W; Li J
[Ad] Endereço:Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, 266035, People's Republic of China.
[Ti] Título:Case report: perioperative management of caesarean section for a parturient with mitochondrial myopathy.
[So] Source:BMC Anesthesiol;17(1):94, 2017 Jul 12.
[Is] ISSN:1471-2253
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Mitochondrial myopathies represent a group of disorders caused by mitochondrial defects that disrupt energy production. Most patients have issues from infancy to early childhood. Pregnancy in women with mitochondrial myopathy is uncommon and the management for these parturients is full of challenges. CASE PRESENTATION: A 36-year-old woman with mitochondrial myopathy was scheduled for caesarean section under a combined spinal-epidural anaesthesia and multi-model analgesia. The parturient was safe and the delivery was performed safely and smoothly, but there were some complications after surgery due to the complex condition of the patient. After consultation with and treatment from multiple disciplines, both the parturient and neonate were well and discharged. CONCLUSION: It is important that patients with mitochondrial diseases are comprehensively assessed and monitored perioperatively.
[Mh] Termos MeSH primário: Anestesia Epidural
Anestesia Obstétrica
Raquianestesia
Cesárea
Miopatias Mitocondriais/complicações
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Gravidez
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170714
[St] Status:MEDLINE
[do] DOI:10.1186/s12871-017-0385-4


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[PMID]:28697113
[Au] Autor:Soon R; Tschann M; Salcedo J; Stevens K; Ahn HJ; Kaneshiro B
[Ad] Endereço:Department of Obstetrics, Gynecology & Women's Health and the Office of Biostatistics & Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
[Ti] Título:Paracervical Block for Laminaria Insertion Before Second-Trimester Abortion: A Randomized Controlled Trial.
[So] Source:Obstet Gynecol;130(2):387-392, 2017 Aug.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the efficacy of a paracervical block to decrease pain during osmotic dilator insertion before second-trimester abortion. METHODS: In this double-blind, randomized trial, 41 women undergoing Laminaria insertion before a second-trimester abortion received either a paracervical block with 18 mL 1% lidocaine and 2 mL sodium bicarbonate or a sham block. Women were between 14 and 23 6/7 weeks of gestation. The primary outcome was pain immediately after insertion of Laminaria. Women assessed their pain on a 100-mm visual analog scale. Secondary outcomes included assessment of pain at other times during the insertion procedure and overall satisfaction with pain control. To detect a 25-mm difference in pain immediately after Laminaria insertion, at an α of 0.05 and 80% power, we aimed to enroll 20 patients in each arm. RESULTS: From May 2015 to December 2015, 20 women received a paracervical block and 21 received a sham block. Groups were similar in demographics, including parity, history of surgical abortion, and number of Laminaria placed. The paracervical block reduced pain after Laminaria insertion (median scores 13 mm [interquartile range 2-39] compared with 54 mm [interquartile range 27-61], P=.01, 95% CI -47.0 to -4.0). Women who received a paracervical block also reported higher satisfaction with overall pain control throughout the entire Laminaria insertion procedure (median scores 95 mm [interquartile range 78-100] compared with 70 mm [interquartile range 44-90], P=.05, 95% CI 0.0-37.0). CONCLUSION: Paracervical block is effective at reducing the pain of Laminaria insertion. Additionally, a paracervical block increases overall patient satisfaction with pain control during Laminaria placement. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02454296.
[Mh] Termos MeSH primário: Anestesia Obstétrica/métodos
Idade Gestacional
Laminaria
[Mh] Termos MeSH secundário: Aborto Induzido/métodos
Adulto
Método Duplo-Cego
Feminino
Hawaii
Seres Humanos
Lidocaína/administração & dosagem
Medição da Dor
Satisfação do Paciente
Gravidez
Segundo Trimestre da Gravidez
Bicarbonato de Sódio/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
8MDF5V39QO (Sodium Bicarbonate); 98PI200987 (Lidocaine)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170712
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002149



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