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3.
Rev Esp Anestesiol Reanim (Engl Ed) ; 67(3): 167-175, 2020 Mar.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32085919

RESUMEN

The number of caesarean sections performed worldwide is increasing, and with it, the need for the optimal analgesia strategies. Deficient postoperative analgesia increases the need for opioids, delays recovery, and is associated with chronic pain and postpartum depression. It is essential to find good postoperative pain control strategies that facilitate early mobility, early recovery, and early hospital discharge with minimal side effects on the mother and infant. Multimodal analgesia based on neuroaxial anaesthesia with morphine in combination with non-opioids such as non-steroidal anti-inflammatory drugs and paracetamol, gives the best post-caesarean analgesia outcome, and allows anaesthesiologists to reserve opioids, corticoids, gabapentin, magnesium or ketamine for situations where neuroaxial anaesthesia cannot be performed, for high-risk patients, or when pain is difficult to control. Peripheral nerve block techniques can also be added, such as transverse abdominis plane block, erector spinae block, or continuous wound infiltration.


Asunto(s)
Analgesia Obstétrica/métodos , Analgésicos Opioides/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Cesárea , Morfina/administración & dosificación , Dolor Postoperatorio/terapia , Acetaminofén/administración & dosificación , Analgésicos no Narcóticos/administración & dosificación , Analgésicos Opioides/efectos adversos , Anestesia Epidural/métodos , Anestesia Obstétrica/métodos , Anestesia Raquidea/métodos , Dolor Crónico/terapia , Clonidina/administración & dosificación , Epinefrina/administración & dosificación , Femenino , Humanos , Morfina/efectos adversos , Neostigmina/administración & dosificación , Bloqueo Nervioso/métodos , Embarazo
5.
Rev Esp Anestesiol Reanim (Engl Ed) ; 66(9): 459-466, 2019 Nov.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31582277

RESUMEN

INTRODUCTION: Quality improvement in health care entails the design of reliable processes which prevent and mitigate medical errors. Checklists are cognitive tools which reduce such errors. The primary objective of this study was to design an anesthetic checklist in Pediatrics to be implemented in our hospital. METHODS: Delphi technique was used, with 3 rounds of questionnaire surveys: a generic questionnaire to obtain dimensions and items; and 2 specific ones to score individual items and obtain an overall rating for the checklist (median), and to measure the level of consensus (relative interquartile range) and internal reliability (Wilcoxon signed-rank test). RESULTS: Final version of the checklist obtained a high overall score (Med 9) with a very high consensus (RIR 5%). Internal consensus was reached on all items (RIR ≤ 30%). Wilcoxon signed-rank test found no statistically significant differences, demonstrating reliability or consistency of responses between consecutive rounds. CONCLUSION: The Anesthetic checklist in Pediatrics has been methodically designed for implementation and use in our hospital.


Asunto(s)
Anestesia/normas , Lista de Verificación/normas , Errores Médicos/prevención & control , Pediatría/normas , Mejoramiento de la Calidad , Lista de Verificación/métodos , Consenso , Técnica Delphi , Retroalimentación , Encuestas de Atención de la Salud/normas , Humanos , Seguridad del Paciente , Calidad de la Atención de Salud , Reproducibilidad de los Resultados , Estadísticas no Paramétricas , Encuestas y Cuestionarios/normas
6.
Rev Esp Anestesiol Reanim ; 63(5): 301-4, 2016 May.
Artículo en Español | MEDLINE | ID: mdl-26277650

RESUMEN

Pial arteriovenous fistula is a rare intracranial congenital malformation (0.1-1: 100,000). It has a high blood flow between one or more pial arteries and drains into the venous circulation. It is usually diagnosed during the childhood by triggering an intracranial hypertension and/or congestive heart failure due to left-right systemic shunt. It is a rare malformation with a complex pathophysiology. The perioperative anaesthetic management is not well established. We present a 6-month-old infant diagnosed with pial arteriovenous fistula with hypertension and congestive heart failure due to left-right shunt. He required a craniotomy and clipping of vascular malformation. Anaesthetic considerations in patients with this condition are a great challenge. It must be performed by multidisciplinary teams with experience in paediatrics. The maintenance of blood volume during the intraoperative course is very important. Excessive fluid therapy can precipitate a congestive heart failure or intracranial hypertension, and a lower fluid therapy may cause a tissue hypoxia due to the bleeding.


Asunto(s)
Fístula Arteriovenosa/cirugía , Fluidoterapia , Insuficiencia Cardíaca/cirugía , Fístula Arteriovenosa/diagnóstico , Angiografía Cerebral , Craneotomía , Humanos , Lactante , Masculino
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