RESUMO
Caesarean section was performed under spinal anaesthesia in 55 women using a 25-gauge diamond-tipped needle and in a further 55 mothers with a 24-gauge Sprotte needle. Eight patients (14.5%) developed a headache in the former group, five of whom required a blood patch. There were no headaches reported in the Sprotte group.
Assuntos
Anestesia Obstétrica/instrumentação , Raquianestesia/instrumentação , Cesárea , Cefaleia/prevenção & controle , Agulhas , Adolescente , Adulto , Raquianestesia/efeitos adversos , Dura-Máter/lesões , Desenho de Equipamento , Feminino , Humanos , Complicações Pós-Operatórias/prevenção & controle , GravidezRESUMO
In 18 women A.S.A. physical status 1, a noninvasive thoracic electrical bioimpedance method was used to evaluate haemodynamic changes during gynaecological laparoscopy. A significant decrease in cardiac index was observed after peritoneal insufflation, from 3.2 to 2.8 L.min-1.m-2 and returned to the initial values after ten minutes of Trendelenburg's position. Elevated intra-abdominal pressure was also associated with a significant increase in mean arterial pressure (from 68 to 88 mmHg) and systemic vascular resistance index (from 1620 to 2491 dyn.s.cm-5.m-2). However, values were not restored after peritoneal exsufflation: systemic vascular resistance index values remained 30 per cent higher than that before insufflation. Decreased venous return may account for the significant decrease in cardiac output but mechanical compression does not explain the persistent elevation of systemic vascular resistance.
Assuntos
Cardiografia de Impedância , Hemodinâmica , Laparoscopia , Pletismografia de Impedância , Adulto , Anestesia por Inalação , Pressão Sanguínea , Débito Cardíaco , Feminino , Frequência Cardíaca , Humanos , Pneumoperitônio Artificial , Postura , Resistência VascularRESUMO
Au cours de 18 cÅlioscopies chez des jeunes femmes A.S.A. status physique 1, les conséquences hémodynamiques du pneumopéritoine et de la position de Trendelenburg ont été évaluées par la méthode non invasive de bioimpédance électrique thoracique. L'index cardiaque chute significativement de 3,2 à 2,8 L · min-1 · m-2 à l'insufflation intra-abdominale et retrouve ses valeurs de départ après dix minutes de Trendelenburg. La pression artérielle moyenne et les résistances vasculaires systémiques indexées sont très augmentées de 1620 à 2491 dyn · s · cm-5 · m-2 après insufflation; l'exsufflation ne permet pas un retour aux valeurs de départ: l'élevation résiduelle des RVSI est de 30 pour cent. L'obstacle au retour veineux pas compression intra-abdominale explique bien la chute du débit cardiaque, conformément aux données de la littérature. En revanche, l'augmentation des résistances vasculaires systémiques ne peut être expliquée par les seuls phénomènes mécaniques du fait de leur persistance après la levée de la compression. L'hypothèse de l'intervention d'un médiateur humoral doit done être discutée.In 18 women A.S.A. physical status 1, a noninvasive thoracic electrical bioimpedance method was used to evaluate haemodynamic changes during gynaecologycal laparoscopy. A significant decrease in cardiac index was observed after peritoneal insufflation, from 3.2 to 2.8 L · min-1 · m-2 and returned to the initial values after ten minutes of Trendelenburg's position. Elevated intra-abdominal pressure was also associated with a significant increase in mean arterial pressure (from 68 to 88 mmHg) and systemic vascular resistance index (from 1620 to 2491 dyn · s · cm-5 · m-2). However, values were not restored after peritoneal exsufflation: systemic vascular resistance index values remained 30 per cent higher than that before insufflation. Decreased venous return may account for the significant decrease in cardiac output but mechanical compression does not explain the persistent elevation of systemic vascular resistance.
RESUMO
The authors analyse Mendelson's original article on the lung disorders caused by inhalation: the clinical aspects, the etiological aspects of the pathology and above all preventive measures to be taken. These are still all of importance. The epidemiological incidence of this condition was tackled by the slant of the INSERM enquiry conducted on the anaesthetists on the one hand and by a retrospective enquiry by the University Department in Bordeaux on the other hand. Reviewing the literature shows that traditional methods of treatment have to be re-examined. These are: pulmonary lavage, treatment with corticosteroids and progress which has been made parallel with progress in respiratory resuscitation especially in severe forms of the condition. Prevention is the most important feature. Endotracheal intubation needs to be carried out when general anaesthetics are employed. The use of anti-H2 substances is increasing. All the same, the most decisive steps will be taken when more local regional anesthesia is used. This should be started in labour wards by further use of epidural analgesia.
