ABSTRACT
Introducción: En los últimos años se han introducido nuevas modalidades de mantenimiento de analgesia epidural (AE). Objetivo: El objetivo de este estudio es comparar diferentes modalidades de mantenimiento de AE para parto relacionando el tiempo de expulsivo y dilatación, bloqueo motor e instrumentación del parto (fórceps, ventosa o cesárea). Material y métodos: Se incluyeron pacientes ingresadas para trabajo de parto en el Hospital Universitario Nuestra Señora de Candelaria entre enero de 2013 y diciembre de 2015. Se determinaron como variables independientes las modalidades de mantenimiento de AE, perfusión continua (PC), perfusión continua más analgesia controlada por la paciente (PCA) (PC+PCA) y bolos intermitentes más analgesia controlada por la paciente (BI+PCA). Resultados: No encontramos diferencias en el tiempo de expulsivo ni dilatación entre las 3 modalidades. Existen diferencias en la instrumentación (p>0,05) siendo el porcentaje de partos no instrumentados en BI+PCA del 66% frente al 60% en PC y 65% en PC+PCA. El porcentaje de cesáreas fue del 23% en PC, y del 17% en PC+PCA y BI+PCA. La PC aumenta un 27% la posibilidad de parto instrumentado respecto a BI+PCA, no existiendo diferencia entre PC+PCA y BI+PCA. El bloqueo motor a los 60 y 90min alcanza menores valores con BI+PCA con una media de 0 y rango de 0-1, frente a PC+PCA 0 (0-4). La satisfacción con PC+PCA va de 2-10 y con BI+PCA 0-10. Conclusión: Se puede decir que BI+PCA se asocia a una mayor frecuencia de partos no instrumentados. La posibilidad de parto instrumentado aumenta con PC frente a BI+PCA. Se observa menor bloqueo motor con BI+PCA que con PC+PCA. No se manifiestan diferencias en tiempo de dilatación, de expulsivo, ni satisfacción de las pacientes
Introduction: In recent years new modalities of epidural analgesia maintenance (EA) have been introduced. Objective: The objective of this study is to compare different modalities of EA maintenance for childbirth relating the time of expulsive and dilatation, motor blockade and delivery instrumentation (caesarean section, sucker, forceps, eutocic delivery or non-instrumented delivery). Material and methods: Patients admitted for labor in the University Hospital Nuestra Señora de Candelaria between January 2013 and December 2015 were included. Independent modalities of EA, continuous infusion (CI), continuous infusion plus analgesia patient controlled epidural analgesia were determined as independent variables (CI+PCEA) and intermittent programmed epidural boluses plus patient controlled epidural analgesia (PIEB+PCEA). Results: There are no differences in expulsive time or dilation. There is a difference in the type of instrumentation, caesarean section, sucker, forceps, eutocic delivery or non-instrumented delivery (P>.05), with the percentage of eutocic deliveries in PIEB+PCEA of 66 versus 60 in CI and 65 in CI+PCEA. The percentage of caesarean sections was 23 in CI, in CI+PCEA and PIEB+PCEA of 17. CI increases by 27% the possibility of instrumented deliveries respect to PIEB+PCEA, there is no difference between CI+PCEA and PIEB+PCEA. The motor blockade at 60 and 90minutes reaches lower values with PIEB+PCEA with an average of 0 and a range of 0-1, compared to CI+PCEA 0 (0-4). Satisfaction with CI+PCEA ranges from 2-10 and with PIEB+PCEA 0-10. Conclusion: It is possible to say that PIEB+PCEA is associated with higher frequency of non-instrumented deliveries. The possibility of instrumented deliveries increases with CI versus PIEB+PCEA. There is less motor block with PIEB+PCEA than with CI+PCEA. There are no differences in time of dilatation, expulsion, or patient satisfaction
Subject(s)
Humans , Female , Pregnancy , Adult , Analgesia, Epidural/methods , Delivery, Obstetric/methods , Labor Pain/drug therapy , Analgesia, Obstetrical/methods , Analgesics/administration & dosage , Analgesia, Patient-Controlled/methods , Pulse Therapy, Drug/methodsABSTRACT
INTRODUCTION: In recent years new modalities of epidural analgesia maintenance (EA) have been introduced. OBJECTIVE: The objective of this study is to compare different modalities of EA maintenance for childbirth relating the time of expulsive and dilatation, motor blockade and delivery instrumentation (caesarean section, sucker, forceps, eutocic delivery or non-instrumented delivery). MATERIAL AND METHODS: Patients admitted for labor in the University Hospital Nuestra Señora de Candelaria between January 2013 and December 2015 were included. Independent modalities of EA, continuous infusion (CI), continuous infusion plus analgesia patient controlled epidural analgesia were determined as independent variables (CI+PCEA) and intermittent programmed epidural boluses plus patient controlled epidural analgesia (PIEB+PCEA). RESULTS: There are no differences in expulsive time or dilation. There is a difference in the type of instrumentation, caesarean section, sucker, forceps, eutocic delivery or non-instrumented delivery (P>.05), with the percentage of eutocic deliveries in PIEB+PCEA of 66 versus 60 in CI and 65 in CI+PCEA. The percentage of caesarean sections was 23 in CI, in CI+PCEA and PIEB+PCEA of 17. CI increases by 27% the possibility of instrumented deliveries respect to PIEB+PCEA, there is no difference between CI+PCEA and PIEB+PCEA. The motor blockade at 60 and 90minutes reaches lower values with PIEB+PCEA with an average of 0 and a range of 0-1, compared to CI+PCEA 0 (0-4). Satisfaction with CI+PCEA ranges from 2-10 and with PIEB+PCEA 0-10. CONCLUSION: It is possible to say that PIEB+PCEA is associated with higher frequency of non-instrumented deliveries. The possibility of instrumented deliveries increases with CI versus PIEB+PCEA. There is less motor block with PIEB+PCEA than with CI+PCEA. There are no differences in time of dilatation, expulsion, or patient satisfaction.
Subject(s)
Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Delivery, Obstetric/methods , Labor Pain/drug therapy , Adult , Analgesia, Patient-Controlled/methods , Anesthesia, Epidural/methods , Cesarean Section , Delivery, Obstetric/instrumentation , Episiotomy/adverse effects , Female , Humans , Obstetrical Forceps , Pain, Postoperative/drug therapy , Patient Satisfaction , Pregnancy , Retrospective Studies , Time Factors , Vacuum Extraction, ObstetricalABSTRACT
BACKGROUND AND OBJECTIVE: Tumor extension is the factor that usually determines the choice of radiotherapy or surgery for head and neck cancers. The choice of surgery carries with it certain specific risks that must be assessed jointly by the maxillofacial surgeon and the anesthetist so that they can agree on the best course of action to choose. We aimed to identify risk factors for complications after major head and neck surgery. PATIENTS AND METHODS: Retrospective descriptive analysis of data for patients who underwent oncologic head and neck surgery with graft reconstruction. The main candidate predictors gathered from records were age, sex, ASA physical status classification, time under anesthesia, and intra- and postoperative events. The main dependent variables were records of early and delayed complications, time until extubation, and related mortality. RESULTS: We identified 61 interventions in 56 patients (mean duration of surgery, 9 hours). Early complications developed in 57.4% while they were in the critical care area. Age > or =60 years was associated with longer hospital stays. Short-term mortality was higher in current smokers (P= .01). Survival was significantly higher in patients classified ASA 1 or 2 in comparison with those classified as ASA 3 or 4, in whom long-term mortality was higher (P < .05). CONCLUSIONS: The incidence of postoperative complications was associated with comorbidity and risk behaviors found in this type of patient. We feel that a multidisciplinary medical team should assess the surgical and postoperative care of these patients.
Subject(s)
Carcinoma/surgery , Head and Neck Neoplasms/surgery , Postoperative Complications/epidemiology , Aged , Alcohol Drinking/epidemiology , Cardiovascular Diseases/epidemiology , Comorbidity , Cross Infection/mortality , Female , Humans , Kaplan-Meier Estimate , Male , Malnutrition/epidemiology , Middle Aged , Neoplasm Staging , Pneumonia/mortality , Postoperative Complications/mortality , Retrospective Studies , Risk Factors , Smoking/epidemiologyABSTRACT
Objetivo: En los cánceres de cabeza y cuello la extensión del tumor es el parámetro que generalmente determina la elección de la radioterapia o la cirugía como alternativa terapéutica. Esta última opción conlleva unos riesgos específicos que deben ser evaluados conjuntamente por el cirujano maxilofacial y el anestesiólogo para optimizar dicha elección. El objetivo de esta trabajo fue identificar la existencia de factores de riesgo en las complicaciones postoperatorias en cirugía mayor de cabeza y cuello. Pacientes y métodos: Estudio observacional descriptivo retrospectivo en pacientes sometidos a cirugía oncológica maxilofacial más reconstrucción con injertos. Como variables principales predictoras se emplearon: edad, sexo, ASA, tiempo de anestesia e incidencias intra y postoperatorias y como variables principales dependientes: indicadores de complicaciones precoces, tardías y tiempo hasta extubación, así como la mortalidad asociada. Resultados: Sesenta y un intervenciones en 56 pacientes con un tiempo promedio de 9 horas de cirugía. Un 57,4% presentaron complicaciones precoces en la unidad de reanimación y 39% complicaciones tardías. Una edad >= 60 años se asoció a mayor duración de estancia hospitalaria. Los fumadores activos presentaron una mayor mortalidad a corto plazo (p = 0,01). Los pacientes con estado físico ASA I-II tuvieron una supervivencia significativamente mayor que los pacientes ASA III-IV, teniendo estos últimos una mayor mortalidad a largo plazo (p < 0,05). Conclusiones: La variabilidad en la incidencia de complicaciones postquirúrgicas asociadas a la comorbilidad y conductas de riesgo que presentan este tipo de pacientes, hace necesaria, a nuestro juicio, una evaluación por el equipo médico multidisciplinar involucrado en la cirugía y posteriores cuidados(AU)
Background and objective: Tumor extension is the factor that usually determines the choice of radiotherapy or surgery for head and neck cancers. The choice of surgery carries with it certain specific risks that must be assessed jointly by the maxillofacial surgeon and the anesthetist so that they can agree on the best course of action to choose. We aimed to identify risk factors for complications after major head and neck surgery. Patients and methods: Retrospective descriptive analysis of data for patients who underwent oncologic head and neck surgery with graft reconstruction. The main candidate predictors gathered from records were age, sex, ASA physical status classification, time under anesthesia, and intra- and postoperative events. The main dependent variables were records of early and delayed complications, time until extubation, and related mortality. Results: We identified 61 interventions in 56 patients (mean duration of surgery, 9 hours). Early complications developed in 57.4% while they were in the critical care area. Age >=60 years was associated with longer hospital stays. Short-term mortality was higher in current smokers (P = .01). Survival was significantly higher in patients classified ASA 1 or 2 in comparison with those classified as ASA 3 or 4, in whom long-term mortality was higher (P < .05). Conclusions: The incidence of postoperative complications was associated with comorbidity and risk behaviors found in this type of patient. We feel that a multidisciplinary medical team should assess the surgical and postoperative care of these patients(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Risk Factors , Postoperative Complications/drug therapy , Postoperative Complications/prevention & control , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/surgery , Oral Surgical Procedures/methods , Comorbidity , Head and Neck Neoplasms/physiopathology , Surgery, Oral/methods , Surgery, Oral , Retrospective Studies , Fluid Therapy , Cardiopulmonary Resuscitation/trendsABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Tracheotomy/methods , Bronchoscopy/methods , Bronchoscopes , Intubation/instrumentation , Intubation, Intratracheal , Bronchoscopy/trends , Aortic Aneurysm/surgerySubject(s)
Bronchoscopy/methods , Laryngeal Masks , Tracheotomy/methods , Aged , Aortic Aneurysm, Abdominal/surgery , Equipment Design , Fiber Optic Technology , Humans , Laparotomy , Male , Postoperative Complications/surgery , Respiratory Aspiration/prevention & control , Respiratory Distress Syndrome/surgeryABSTRACT
We describe a 52-year-old patient with rheumatoid arthritis, interventricular communication and pulmonary stenosis. After an accidental fall she was scheduled for total hip replacement. The main objective of anesthetic management was to preserve pulmonary blood circulation at arterial pressures that would assure adequate tissue perfusion. Other objectives were to maintain hydration to prevent decreases in hematocrit levels, avoid systemic embolization and allow for antibiotic prophylaxis.
