RESUMO
The primary goal of this study was to determine the median effective dose (ED50 ) of spinal chloroprocaine for labour analgesia. Thirty-eight parturients requesting neuraxial analgesia were enrolled. Doses of 1% chloroprocaine were determined by the technique of up-down sequential allocation, with an initial dose of 20 mg and steps of 2 mg. The chloroprocaine spinal dose was given as the spinal component of a combined spinal-epidural, which was then supplemented with an epidural dose of 7.5 µg sufentanil in 7 ml saline. Effective analgesia was defined as a score ≤ 10 mm within 15 min on a 100-mm visual analogue pain scale. Using the isotonic regression estimator method, the ED50 of chloroprocaine for the spinal component of a combined spinal-epidural for labour was calculated to be median (95%CI) 12.0 (9.3-17.0) mg.
Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Anestésicos Locais/administração & dosagem , Procaína/análogos & derivados , Adolescente , Adulto , Parto Obstétrico , Feminino , Humanos , Trabalho de Parto , Pessoa de Meia-Idade , Medição da Dor , Gravidez , Procaína/administração & dosagem , Adulto JovemRESUMO
This case report presents anaphylactic shock in which hyperfibrinolysis was diagnosed with Thromboelastography (TEG). A 45 year old female patient was scheduled for vacuum-assisted wound closure. At induction, she developed an anaphylactic shock that stabilized after standard treatment. TEG analysis revealed hyperfibrinolysis. Surgery was delayed and there were no signs of spontaneous bleeding. A repeat TEG analysis performed 30 minutes later showed a completely normalized coagulation pattern. Few reports have documented the association between anaphylactic shock and hyperfibrinolysis. This case illustrates the transient and short-lived nature of the phenomenon. The mechanisms and potential consequences are discussed.