Extensive extradural pneumorrhachis related to obstetric analgesia.

Iatrogenic extradural pneumorrhachis is a rare clinical entity, but anesthesiologists should be aware of this possibility when using the air technique for the identification of epidural space. Although in most published cases extradural pneumorrhachis is asymptomatic, relevant neurological consequences have been described, such as meningeal irritation, radicular pain, unilateral lower extremity weakness, cauda equina syndrome, paraplegia, and tetraplegia.We describe a very extensive extradural pneumorrachis (T9-S1), related to obstetric analgesia, in a patient with severe and atypical perineal pain after forceps-assisted delivery. Our aim is to synthesize and organize the available scientific evidence, analyzing preventive measures and summarizing the most appropriate diagnostic, follow-up and therapeutic techniques for symptomatic conditions, among which high concentrations of inspired oxygen, hyperbaric oxygen therapy and percutaneous or surgical decompression have been described.

Uso de indometacina y antibioterapia para el manejo de cérvix corto asintomático / Use of indomethacin and antibiotherapy for the management of asymptomatic short cervix

El cérvix corto es un factor de riesgo para el parto pretérmino con etiopatogenia variada y tratamiento aún por dilucidar. Se piensa que la indometacina y la antibioterapia podrían ser útiles en su manejo, lo que ayudaría a disminuir la morbimortalidad asociada al parto pretérmino. Dada la controversia existente se ha realizado una búsqueda bibliografía en las principales bases de datos sobre su uso y beneficio. El uso de indometacina podría evitar los casos de parto pretérmino en edades gestacionales extremas según los últimos estudios, con una tasa de efectos secundarios baja. Mientras tanto, la antibioterapia sería beneficiosa al intervenir en la resolución de la infección o inflamación estéril intraamniótica y del sludge. Sin embargo, el tratamiento de cérvix corto persiste en revisión y discusión, al igual que el uso o no de la amniocentesis para el estudio del líquido amniótico en estos casos. El consenso en cuanto a su manejo está dificultado por la gran variedad de actuaciones que se realizan en la práctica basadas en la experiencia clínica. Esto impide el establecimiento de una serie de pautas concretas de asistencia.(AU)

Short cervix is a risk factor for preterm delivery with varied aetiopathogenesis and its treatment is still to be specified. It is thought that indomethacin and antibiotherapy could be useful in its management, which would help reduce the morbidity and mortality associated with preterm delivery. Given the existing controversy, a literature search about its use and benefit was conducted in the main databases. The use of indomethacin could prevent cases of preterm birth at extreme gestational ages according to recent studies, with a low rate of side effects. Meanwhile antibiotherapy would be beneficial in intervening in the resolution of infection or sterile intraamniotic inflammation and sludge. However, the treatment of short cervix remains under review and discussion, as does the use or otherwise of amniocentesis to study the amniotic fluid in these cases. Consensus on its management is hampered by the great variety of actions that are carried out in practice based on clinical experience. This prevents the establishment of a series of specific care guidelines.(AU)

¿Han cambiado los conceptos de analgesia obstétrica en los últimos 100 años? / Have the concepts of obstetric analgesia changed in the last 100 years?

Objetivos: Comparar los conceptos y métodos de analgesia obstétrica actual con los existentes hace 100 años, cuando se publicaron por primera vez Anesthesia & Analgesia (1922) y British Journal of Anaesthesia (1923), que son las dos primeras revistas de anestesia publicadas de forma independiente.Material y métodos: Identificamos y analizamos todos los artículos relacionados con la analgesia obstétrica publicados en estas revistas durante los años 1922 y 1923, y los comparamos con la práctica clínica actual. También buscamos en estos números referencias indirectas a la atención prestada a la analgesia obstétrica en las reuniones científicas de la época.Resultados: En el primer número de Anesthesia & Analgesia que aparece en agosto de 1922, 3 de los 8 artículos publicados están relacionados exclusivamente con la anestesia y analgesia obstétrica, y entre 1922 y 1923 encontramos un alto número de artículos y referencias. El análisis de estos artículos publicados hace un siglo permite objetivar el interés de la época por los resultados, la comparación entre los diferentes métodos anestésicos, la seguridad y la divulgación del conocimiento científico. Son habituales las referencias a la mortalidad, a las complicaciones, al confort y la satisfacción de la paciente, a la influencia de la analgesia obstétrica en la duración del parto, así como al ahorro de tiempo y de gases anestésicos. Resulta obvio que la metodología de investigación actual no puede compararse con la de hace 100 años. Pero existen numerosos aspectos científicos que sentaron algunas de las bases de la investigación actual en obstetricia, entre los que destacan la recogida de amplias series de pacientes durante largos periodos de tiempo, la mención expresa a la publicación de resultados tanto favorables como desfavorables...(AU)

Objectives: To compare current obstetric analgesia concepts and methods with those existing 100 years ago, when Anesthesia & Analgesia (1922) and British Journal of Anaesthesia (1923), the first two independently published anesthesia journals, were first published.Methods: We identified and analyzed all articles related to obstetric analgesia published in these journals during the years 1922 and 1923 and compared them with current clinical practice. We also searched these issues for indirect references to the attention given to obstetric analgesia at scientific meetings of the time.Results: In the first issue of Anesthesia & Analgesia, appearing in August 1922, 3 of the 8 articles published are related exclusively to obstetric anesthesia and analgesia, and between 1922 and 1923 we found a high number of articles and references. The analysis of these articles published a century ago allows us to objectify the interest of the time in the results, the comparison between different anesthetic methods, safety and the dissemination of scientific knowledge. References to mortality, complications, patient comfort and satisfaction, the influence of obstetric analgesia on the duration of labor, as well as savings in time and anesthetic gases are common.It is obvious that today's research methodology cannot be compared with that of 100 years ago. But there are many scientific aspects that laid some of the foundations of current research in obstetrics, including the collection of large series of patients over long periods of time, the express mention of the publication of both favorable and unfavorable results, the references not only to cost but also to cost-effectiveness, as well as the use of specific parameters to measure not only results but also patient satisfaction.Conclusions: It is evident that over the years the outcomes in the practice of anesthesiology have improved, but also that many concepts remain the same 100 years later...(AU)

Rotura prematura de membranas en gestante afecta de mastocitosis cutánea / Premature rupture of membranes in pregnant women with cutaneous mastocytosis

La mastocitosis es una enfermedad poco frecuente, caracterizada por la proliferación de mastocitos. Los síntomas aparecen tras la exposición a factores desencadenantes, que generan una liberación de mediadores inflamatorios, pudiendo dar lugar a reacciones alérgicas e incluso a reacciones anafilácticas. Existen dos formas de presentación, la cutánea y la sistémica. Su relación con la gestación es poco conocida y hace plantearse aspectos sobre la seguridad tanto materna como fetal. Durante la gestación, esta entidad puede mejorar, empeorar o mantenerse estable y se ha relacionado con la amenaza de parto pretérmino, mientras que durante el parto es esencial el control del dolor y evitar aquellos fármacos que puedan desencadenar un brote. Además, los cambios hormonales acontecidos durante la gestación, parto y puerperio pueden favorecer la aparición de reacciones anafilácticas. Presentamos el caso de una gestante de 34 semanas de amenorrea, afecta de mastocitosis cutánea, que ingresó en nuestro servicio por rotura prematura de membranas, con lo que tuvimos que plantearnos cuál era el protocolo de actuación más adecuado a la patología que presentaba la paciente.

Mastocytosis is an uncommon disease characterized by the proliferation of mast cells. Symptoms appear after exposure to triggering factors resulting in mast cell mediator release, which can lead to anaphylactic reactions. There are two forms of presentation, cutaneous and systemic mastocytosis. There is limited information on the impact of this disorder on pregnancy and questions may arise about maternal and foetal safety. During pregnancy, this disease can improve, worsen, or remain stable and even be associated with preterm delivery. During labour pain control is important and drugs that can trigger an episode should be avoided. Furthermore, the hormonal changes that occur during pregnancy, childbirth and puerperium can lead to anaphylactic reactions. We present a pregnant woman at 34 weeks of amenorrhoea, affected by cutaneous mastocytosis, admitted in our hospital due to premature rupture of membranes. We had to consider the most appropriate protocol for our patient's pathology.

Síndrome de burnout en una unidad de gestión clínica de obstetricia y ginecología / Burnout syndrome in an obstetrics and gynaecology management unit

Objetivo. Conocer la prevalencia del síndrome de burnout entre los integrantes de una UGC de Obstetricia y Ginecología. Material y método. Estudio transversal anónimo utilizando un cuestionario sociodemográfico y la versión española del Maslach Burnout Inventory. Resultados. La encuesta fue contestada por 21 médicos, 11 matronas, 14 DUE, 22 auxiliares de clínica, 2 administrativas y 1 celador, lo que supone una tasa de respuesta del 43,2% Los valores medios fueron de 20,1 puntos para el agotamiento emocional, 7,6 puntos para la despersonalización y 42,1 puntos para la realización personal. Se encontraron valores más elevados de agotamiento emocional y despersonalización en el colectivo de médicos en relación con las demás categorías profesionales. Conclusiones. Consideramos preocupante que el 33,8% de los integrantes del estudio presente cifras elevadas de agotamiento emocional y que este sea alto en el 52,3% de los médicos especialistas. Valores elevados de satisfacción profesional hacen que solo en el 2,8% coincidan puntuaciones altas de las 3 subescalas(AU)

Objective. To determine the prevalence of the Burnout Syndrome among the members of an Obstetrics and Gynaecology Unit. Material and methods. Cross-sectional study using an anonymous questionnaire and socio-Spanish version of the Maslach Burnout Inventory. Results. The survey was answered by 21 doctors, 11 matrons, 14 DUE, 22 nurses, 2 administrative officers and 1 watchman, with a response rate of 43.2%. Average values were 20.1 points for the emotional exhaustion, depersonalization 7.6 points to 42.1 points and for personal fulfilment. We found higher values of emotional exhaustion and depersonalization in the group of doctors in relation to other professional groups. Conclusion. We believe that 33.8% is an alarmingly high level of emotional exhaustion in the members of the present study, and this level is even higher in medical specialists (52.3%). Only the 2.8% of the professionals had high values in the three sub-scales(AU)

[Burnout syndrome in an obstetrics and gynaecology management unit]. / Síndrome de burnout en una unidad de gestión clínica de obstetricia y ginecología.

OBJECTIVE: To determine the prevalence of the Burnout Syndrome among the members of an Obstetrics and Gynaecology Unit. MATERIAL AND METHODS: Cross-sectional study using an anonymous questionnaire and socio-Spanish version of the Maslach Burnout Inventory. RESULTS: The survey was answered by 21 doctors, 11 matrons, 14 DUE, 22 nurses, 2 administrative officers and 1 watchman, with a response rate of 43.2%. Average values were 20.1 points for the emotional exhaustion, depersonalization 7.6 points to 42.1 points and for personal fulfilment. We found higher values of emotional exhaustion and depersonalization in the group of doctors in relation to other professional groups. CONCLUSION: We believe that 33.8% is an alarmingly high level of emotional exhaustion in the members of the present study, and this level is even higher in medical specialists (52.3%). Only the 2.8% of the professionals had high values in the three sub-scales.

[Obstetric analgesia for a patient with a history of 3 previous operations on the spine]. / Analgesia obstétrica en una paciente con tres cirugías previas de columna.

A history of spinal surgery is not currently considered a contraindication for regional obstetric analgesia. However, there are highly complex cases in which choosing the best analgesic technique presents genuine problems. We report the case of a woman in labor at full-term with 4-cm dilatation of the cervix who had undergone 3 operations for scoliosis and a herniated disk treated by T5-L4 and L4-sacral arthrodesis, laminectomy, and diskectomy. No previous anesthetic plan was in place, so we chose intravenous patient-controlled analgesia for labor and vaginal delivery and spinal anesthesia for a cesarean delivery. However, general anesthesia became necessary because it was impossible to reach the dura mater. The literature was reviewed to assess alternative forms of obstetric analgesia for patients who have undergone scoliosis surgery.

[Characterization of major ambulatory surgery in a basic general hospital]. / Caracterización de la cirugia mayor ambulatoria en un hospital general básico.

BACKGROUND: Outpatient surgery initially came into being and further developed as a result of the progressive increase in the demand and in hospital expenses. Although it has afforded the possibility of lowering the cost per procedure and of improving the efficiency of the hospitals by maintaining the degrees of patient satisfaction and safety, it has also made it necessary to question the customary activity indicators. This had led us to assess the outpatient surgery units of the recently-opened Algeciras Hospital based on the customary system of payment in other countries, the Related Diagnostic Groups (RDG's). METHODS: Descriptive study regarding 3,051 surgical procedures performed on a scheduled basis in 1997 (not including the minor surgery using a local anesthetic), using as a source of information the minimum basic set of data for hospital discharge, obtaining and analyzing the RDG's. The hospital stays avoided based on the average stay of those patients admitted for the same RDG within the time period under study have been calculated. RESULTS: Major surgery performed on an outpatient basis afforded the possibility of an overall replacement percentage of 50.4% (33.3% of all of the patients who underwent surgery on a scheduled basis, that is, 4.1% of all of this Hospital's admissions), which meant an savings of 2,112 hospital stays. The most frequent RDG's having the greatest impact on stays avoided were the surgical procedures performed on the crystalline lens and the scraping or conization procedures performed for reasons other than malignant neoplasia. The readmission rate was 1.5%. CONCLUSIONS: The overall replacement rate obtained by this major outpatient surgery unit is considered to be acceptable, although it must increase within the next few years. We found differences in the spread of the processes dealt with as compared to other units in our environment, this being explainable due to the difficulties involved in starting up surgery of these characteristics.