RESUMO
Abstract Tuberous sclerosis (TSC) is a rare disease with multi-systemic involvement, predominantly neurological. Little evidence exists about the anesthetic management of patients with this disorder, particularly in pregnant women. This article discusses a case of a patient with TSC admitted to our hospital for the delivery of a twin gestation. Twenty-four hours after surgery, the patient presented left-side facial-brachial hypoesthesia and headache. A brain CT revealed a right frontal cortical bleeding tumor, which was diagnosed as glioblastoma multiforme. The patient was discharged 15 days after admission and a neurosurgical approach was suggested.
Resumen La esclerosis tuberosa es una enfermedad poco frecuente asociada con compromiso multisistémico, principalmente neurológico. Es poca la evidencia sobre el manejo anestésico de los pacientes con este trastorno, en particular las mujeres embarazadas. En este artículo presentamos el caso de una paciente con esclerosis tuberosa ingresada en nuestro hospital para el parto de una gestación gemelar. Veinticuatro horas después de la cirugía, la paciente presentó hipoestesia facial y braquial izquierda y cefalea. La tomografía cerebral mostró un tumor cortical sangrante en el lóbulo frontal derecho, diagnosticado como glioblastoma multiforme. La paciente fue dada de alta 15 días después de su ingreso y, con recomendación de manejo por neurocirugía.
Assuntos
Humanos , Feminino , Gravidez , Cesárea , Glioblastoma , Cefaleia , Anestesia Epidural , Anestésicos , Neurocirurgia , Esclerose Tuberosa , Encéfalo , Doenças Raras , Parto , Hemorragia , Hospitais , Hipestesia , Neoplasias , Doenças do Sistema NervosoRESUMO
BACKGROUND: Recent investigations have showed that cesarean section (CS) might be a cause of chronic pain, with a consequent decrease in quality of life. METHODS: Prospective observational study in a Spanish tertiary hospital. Main outcome measure was to assess early neuropathic characteristics of pain (DN2 score ≥3) one week after CS as a potential risk factor for post-cesarean section chronic pain (PCSCP) at three months. Secondary outcome was to identify other risk factors. Six hundred ten consecutive consenting patients undergoing CS were interviewed preoperatively, at discharge from recovery room and 24 hours postoperatively. Telephone follow-up interviews were conducted one week, three months and twelve months following surgery. RESULTS: We analyzed 597 consecutive patients. The incidence of PCSCP at three and twelve postoperative months were 6.2% and 1% respectively. Subjects with NRS score superior to five on movement one week after CS presented higher incidence of PCSCP (NRS superior to five: 19 [52.2%]; NRS equal or lower to five: 172 [30.9%]; P=0.009). On multivariate analysis neuropathic pain one week after CS was associated with a higher risk of PCSCP (AOR=1.63 [95% CI: 1.26-2.11; P<0.001]). Other identified risk factors for PCSCP were: uterine exteriorization during CS (AOR=3.89 [95% CI: 1.25-12.10; P=0.019]) and a lower gestational age (AOR=0.87 [95% CI: 0.78-0.96; P=0.008]). CONCLUSIONS: Incidence of PCSCP at three and twelve postoperative months was low, 6.2% and 1% respectively. Early neuropathic characteristics of pain after one week measured by neuropathic pain questionnaire, consisting of two questions (DN2)≥3/7 could be used to identify patients at risk for chronic post-surgical pain and develop preventive strategies.
Assuntos
Dor Crônica , Cesárea , Dor Crônica/epidemiologia , Feminino , Humanos , Dor Pós-Operatória/epidemiologia , Gravidez , Estudos Prospectivos , Qualidade de VidaRESUMO
No disponible
Assuntos
Humanos , Cuidados Paliativos/tendências , Cuidados Paliativos na Terminalidade da Vida/tendências , Direito a Morrer , Atitude Frente a Morte , Eutanásia , Eutanásia Passiva , Suicídio AssistidoRESUMO
Después de iniciar una analgesia neuroaxial para el dolor del trabajo de parto, hay muchas técnicas que pueden utilizarse para el mantenimiento de la misma. Los métodos usados para este mantenimiento de la analgesia, se pueden clasificar en dos grandes grupos: técnicas de top up y técnicas que previenen la recurrencia del dolor. El dolor del parto es algo dinámico, personal y cambiante, así que los anestesiólogos, debemos hacer lo posible por llegar a una analgesia a la medida de cada parturienta, para facilitar que el nacimiento sea una experiencia memorable y agradable. La tecnología médica ha evolucionado para permitirnos posiblemente atender mejor estos requerimientos y llegar a proporcionar a las mujeres un parto sin dolor, seguro y más natural. Los nuevos sistemas de administración de analgesia en el parto permiten individualizar los regímenes a medida. Los bolos programados intermitentes reducen el consumo de anestésico local y la incidencia de dolor irruptivo. Se necesitan más estudios para ver si la incidencia de parto instrumental se confirma que disminuye y en qué cuantía. Los costes de estas tecnologías quedarían justificados si se confirma la mejora de resultados obstétricos y analgésicos (AU)
After initiating a neuraxial analgesia for labor pain, there are a few techniques that can be used for its maintenance. The methods used for the maintenance of analgesia, can be classified into two major groups: "top up" techniques and techniques to prevent recurrence of pain (to prevent breakthrough pain). Labor pain is dynamic and can be variable during labour so that anesthesiologists should be able to reach a tailored analgesia and every woman in labor, to facilitate a memorable and pleasant birth experience. Medical technology has evolved to allow us these goals and requirements and provide women a painless, safe and more natural childbirth. New management labor analgesia systems, allow individualized regimens. Programmed intermittent boluses reduce local anesthetic consumption and the incidence of breakthrough pain. Further studies are needed to definitively demonstrate that the incidence of instrumental delivery is confirmed to be decreased and by how much. The costs of these technologies would be justified if confirmed improved obstetric and analgesics (AU)
Assuntos
Humanos , Feminino , Gravidez , Analgesia Obstétrica/métodos , Pulsoterapia/métodos , Parto Obstétrico/métodos , Anestésicos/administração & dosagemRESUMO
El abordaje anestésico de una paciente obstétrica con patología hematológica requiere la elaboración de un plan que incluya los problemas obstétricos, los hematológicos y los anestésicos. Los cambios fisiológicos, en la cuantificación y funcionalidad de factores, hacen de la parturienta una paciente con una tendencia a la hipercoagulabilidad. En esta revisión se abordarán de forma somera las implicaciones anestésicas de pacientes con hemoglobinopatías, con déficits de factores de coagulación y se discutirán las implicaciones que puede haber en las pacientes anticoaguladas o antiagregadas, al hilo de las recomendaciones de las guías de práctica clínica y recomendaciones de las distintas asociaciones (europea o norteamericana) (AU)
The anesthetic approach of an obstetric patient with hematologic requires the development of an anaesthetic and obstetric plan before labour. Physiological changes in the quantification and functionality of factors make the mother one patient with a tendency to hypercoagulability. In this review we will focus on the anesthetic implications of patients with hemoglobinopathies, patients with coagulation factors deficits we´ll discuss its anaesthetic implications. Particular issues regarding to anticoagulated or with antiplatelet drugs pregnant women will be discussed, in accordance with the recommendations of the clinical practice guidelines and recommendations of the various associations (European or American) (AU)
