RESUMO
INTRODUCTION: Epidural labor analgesia may decrease the risk of postpartum depression (PPD). METHODS: In a secondary analysis of a prospective study, the association between epidural utilization and PPD was evaluated using a Fisher's exact test. PPD was defined as an Edinburgh Postnatal Depression score of ≥ 10 at 6-8 weeks postpartum. RESULTS: 20% (13/65) of women meet criteria for PDD. 24% (n=12/50) of women who received epidural labor analgesia developed PPD, compared to 6.7% (n=1/15) of women who did not receive epidural labor analgesia (P = 0.27). CONCLUSIONS: Labor epidural analgesia did not reduce the risk of postpartum depression.
RESUMO
Two men developed severe tetanus after the 2010 Haitian earthquake. They were admitted to the United States Naval Ship Comfort, a hospital ship sent to provide humanitarian relief. Severe masseter and intercostal muscle spasm impaired airway access and ventilation. Propofol and sevoflurane relieved the tetany, allowing airway control and ventilation without intubation or neuromuscular blocking drugs during wound debridement. Presynaptic impairment of inhibitory neurotransmitter release by tetanospasmin toxin is countered by enhancement of spinal cord postsynaptic inhibitory receptor activity by general anesthetics. Avoidance of tracheal intubation and mechanical ventilation during anesthesia may be desirable in the settings of limited resources in which tetanus usually presents.