Impact of Labor Epidural Analgesia on Maternal Satisfaction and Childbirth Expectations in a Tertiary Care Center in Portugal: A Prospective Study.

INTRODUCTION: In the current century, increasing importance has been given to the opinions, expectations and experiences of women using healthcare services. The fulfillment of expectations is determined by satisfaction. This study aims to analyze both expectations and satisfaction during childbirth regarding labor epidural analgesia among parturients, with a focus on myths. MATERIAL AND METHODS: A prospective observational study was conducted in parturients at the Centro Hospitalar Universitário Lisboa Norte - Santa Maria Hospital in Lisbon, Portugal, applying a questionnaire to 317 random women. SPSS v22.0 was used for data analysis. RESULTS: Three hundred questionnaires were returned, from women with a mean age of 31. Among the respondents, 46.3% had a college degree and 64% were employed, 46% were primiparas and only 14% had a previous anesthesiology appointment for childbirth purposes. The overall degree of satisfaction surrounding the birth experience was good/excellent for 87% of women. Labor epidural analgesia was performed on 96% of all patients, with an excellent/good outcome for 82.1% and a higher than expected results for 40.7% of them. Regarding the myths, 52.5% believed that epidural analgesia imposes a dose limit and 58.9% that it often causes permanent back pain. The level of education was significantly associated with some myths (p < 0.05), since women with a higher level of education do not believe most of them. DISCUSSION: This study supports the need for an evaluation of the current information that women have about labor epidural analgesia/childbirth. Women's individual needs can be met by multidisciplinary teams including Anesthesiology specialists. CONCLUSION: Maternal satisfaction with childbirth and analgesia is a complex and dynamic process that includes and is not limited to the relief of pain.

Introdução: As opiniões, expectativas e experiências das mulheres que utilizam os serviços de saúde têm vindo a alcançar crescente importância. O cumprimento das expectativas é determinado pela satisfação. Este estudo tem como objetivo analisar as expectativas e satisfação das mulheres durante o trabalho de parto em relação à analgesia epidural, com foco principal nos mitos. Material e Métodos: Foi realizado um estudo observacional e prospetivo em grávidas do Centro Hospitalar Universitário Lisboa Norte - Santa Maria Hospital, em Lisboa, Portugal, através da aplicação aleatória de um questionário a 317 mulheres. Foi utilizado o programa SPSS v.22 para análise estatística. Resultados: Foram obtidos 300 questionários, provenientes de mulheres com idade média de 31 anos. Entre as grávidas que responderam ao questionário, 46,3% possuíam diploma universitário e 64% estavam empregadas. Apenas 14% tiveram consulta prévia de Anestesiologia. O grau de satisfação em torno da experiência do parto foi bom/excelente para 87% das mulheres. A analgesia epidural foi realizada em 96% das grávidas, tendo 82,1% considerado a analgesia excelente e 40,7% avaliado como superior ao esperado. Em relação aos mitos, 52,5% acreditam que a técnica epidural apresenta uma dose limite e 58,9% consideram que a técnica acarreta dor permanente nas costas. O nível de escolaridade mostrou-se significativamente associado a alguns mitos (p < 0,05), uma vez que as mulheres com maior grau de escolaridade não acreditam na maioria destes. Discussão: Este estudo demonstra a necessidade da avaliação da informação que as mulheres possuem sobre a analgesia do trabalho de parto. As necessidades individuais devem ser geridas por equipas multidisciplinares que incluamanestesiologistas. Conclusão: A satisfação materna com o parto e respetiva analgesia é um processo complexo e dinâmico, que inclui e não se limita ao alívio da dor.

[Preparing For the COVID-19 Pandemic: The Perspective of a Department of Anesthesiology in a Tertiary Hospital in Portugal]. / Preparação para a Pandemia COVID-19: A Perspetiva de um Serviço de Anestesiologia de um Hospital Terciário em Portugal.

Since the detection of the first cases of COVID-19, reported by the People's Republic of China on the 31st December 2019, up to the confirmation of the first cases in Portugal, on the 2nd March, countries like Italy and Spain faced the collapse of their healthcare systems. Anticipating this possibility, the Portuguese National Health Service carried out measures to prepare for this reality. This paper describes the changes implemented in the Anesthesiology department of a tertiary hospital center in Portugal, aiming to ensure the safety of both patients and healthcare professionals. The measures implemented had to do mostly with scientific preparation and team reorganization; management of personal protective equipment; redesigning the department's clinical common areas, separation of patient circuits with creation of a designated COVID Operating Room, Post-Anesthetic Care Unit; rescheduling of elective surgery and testing all patients before anesthesia procedures and consulting other hospital departments. The reported data covers the period between the 2nd March and the 30th April of 2020. In this period, 64 cases with COVID-19 or with high clinical suspicion were approached. To date, there have been no cases of in-hospital spread to other patients or to professionals in this department. With this paper we intend to start a reflection that will end up with the optimization of strategies that allows health systems to deal better with COVID-19, keeping patients and health providers safe.

Desde os primeiros casos de COVID-19 reportados pela República Popular da China, a 31 de dezembro de 2019, até à confirmação dos primeiros casos em Portugal, a 2 de março, países como Itália e Espanha depararam-se com o colapso dos seus sistemas de saúde. Antevendo essa possibilidade, o Serviço Nacional de Saúde preparou-se para enfrentar esta nova realidade. Neste documento descreve-se especificamente a preparação do serviço de Anestesiologia de um centro hospitalar terciário português, por forma a garantir a segurança dos seus doentes e profissionais de saúde. As medidas implementadas incidiram na preparação científica e reorganização das equipas; gestão do equipamento de proteção individual; reorganização dos espaços comuns do serviço; separação dos fluxos de doentes com a criação do Bloco Operatório e Unidade de Cuidados Pós-Anestésicos COVID; reprogramação da cirurgia eletiva; rastreio de todos os doentes propostos a procedimentos anestésicos e consultoria a outros serviços. Os dados apresentados compreendem a atividade desenvolvida entre 2 de março e 30 de abril de 2020. Nesse período foram abordados 64 casos com COVID-19 ou com elevada suspeita clínica, sendo que até à data não foram registados casos de contágio intra-hospitalar de outros doentes ou de profissionais neste serviço. Com este trabalho pretende-se iniciar uma reflexão que culmine numa futura otimização de estratégias que permitam aos serviços de saúde lidar com a COVID-19, mantendo a segurança dos outros doentes e dos profissionais de saúde.

Erector spinae plane block and altered hemostasis: is it a safe option? -a case series.

BACKGRUOND: We described 5 cases of uneventful administration of the erector spinae plane (ESP) block to patients with altered hemostasis. CASE: Five patients were admitted to the intensive care unit with altered hemostasis, defined by the activated partial thromboplastin time ratio or internatinal normalized ratio exceeding 1.5 times the normal value; platelet count equal to or below 80000/µl; or use of anticoagulation therapy. A multimodal analgesic regimen was used for all patients, which proved unsatisfactory and limited successful ventilator weaning, until the administration of the ESP block. Effective analgesia was observed in all patients, with at least 70% reduction in numeric pain scale scores and 83% reduction in opioid consumption, which enabled successful ventilator weaning. No neurologic or hemorrhagic complications were recorded during daily surveillance over 5 days. CONCLUSIONS: The ESP block may be a suitable regional analgesia technique for patients with altered hemostasis. Further studies are needed to support this finding.

[A new method of ostial revascularization of digestive and renal arteries in complex obstructive aortic pathology]. / Um novo método de revascularização ostial das artérias digestivas em patologia aórtica obstrutiva complexa.

A new method of revascularization of digestive and renal arteries is reported in this paper, accomplished through the intra-aortic or ostial root, in a 53-year old woman, with the diagnosis of thrombotic occlusion of the terminal aorta associated to a protuberant and calcified lesion of the supraceliac aorta ("coral reef"). The procedure consisted in the implantation of a bifurcated prosthesis from the descending thoracic aorta to both common iliac arteries, through the diaphragm, followed by a longitudinal aortotomy aimed at the removal of the "coral reef" lesion and revascularization of renal, mesenteric and celiac arteries, by means of additional prosthesis placed between the bypass graft and the ostia of these arteries. The left renal artery was reattached to the bypass graft. Visceral ischemic times were short. The post operative course was uneventfull. Two months later, an angio-CT disclosed the complex procedure of revascularization working in excellent condition. The advantages of this new method of revascularization of abdominal visceral arteries in complex obstructive aortic pathology are analysed and discussed.

[The controversial use of dopamine in major vascular surgery]. / O uso controverso da dopamina em cirurgia vascular "major".

Major vascular surgery patients are at great risk of renal failure. Several pharmacological and non pharmacological strategies have been developed to prevent renal failure in those patients. Renal doses of dopamine were used, based on its beneficial effects on renal function, in animals and healthy individuals. However, major vascular surgery patients are often critically ill, with diverse pathophysiological conditions and they cannot be easily compared to healthy individuals. There are, nowadays, enough scientific evidence demonstrating that renal doses of dopamine do not play a significant protective role of renal function in these critically ill patients.