Development and Validation of a Nomogram for the Failed Conversion of Labor Analgesia to Cesarean Section Anesthesia.

Purpose: The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often encounters failures. This study aimed to develop a nomogram for predicting the failure rate of this conversion. Patients and Methods: A retrospective analysis was conducted on data from the Fujian Maternity and Child Health Hospital. Pregnant women (n=214) who underwent cesarean section after receiving labor analgesia. We performed correlation heat map and Lasso regression in terms of exclusion confounding factors and screening independent variables. A nomogram was developed to predict the occurrence. Results: The developed nomogram incorporated variables such as pregnant history, weight, premature rupture of membranes (PROM), dural puncture epidural (DPE), anesthesiologist level of cesarean section (ALOCS), and Anesthesiologist level of labor analgesia (ALOLA). The model demonstrated good predictive performance, providing a practical tool for assessing the risk of failure in converting labor analgesia to cesarean section anesthesia. Conclusion: The nomogram can aid anesthesiologists in making informed decisions and optimizing patient care. By utilizing the nomogram, clinicians can estimate the probability of conversion failure based on individual patient characteristics and clinical factors.

Protocolo para el manejo anestésico del binomio materno fetal en el proyecto EXIT para neonatos con hernia diafragmática / Protocol for the anesthetic management of the maternal-fetal binomial in the EXIT project for neonates with diaphragmatic hernia

Resumen: EXIT (tratamiento ex útero intraparto). El manejo anestésico para esta cirugía es significativamente diferente del manejo anestésico de una cesárea convencional, involucra anestesia general profunda con halogenados, administración de narcóticos, relajación uterina adecuada y preservación del flujo útero placentario hacia el feto durante la anestesia y al mismo tiempo tiene el beneficio de la anestesia general para que el producto obtenga anestesia y facilite el acceso a la vía aérea del neonato antes del pinzamiento del cordón umbilical. El fin de mantener la oxigenación a través de la placenta es efectuar la maniobra de intubación sin el riesgo de hipoxia. En el Hospital Infantil de México «Federico Gómez¼ se lleva a cabo este tipo de cirugías desde junio de 2007; sin embargo, aún no se cuenta con un manejo homogéneo. Material y métodos: A través de un reporte de casos se hizo una revisión perioperatoria de las pacientes embarazadas, a las cuales se les dio manejo anestésico para cirugía EXIT en el período comprendido entre junio de 2007 y mayo de 2018. Resultados: De los 43 casos manejados, la información anestésica perioperatoria obtenida permitió homologar el manejo anestésico del binomio materno fetal para poder realizar un protocolo intrahospitalario. Conclusión: El poder realizar un protocolo para el manejo anestésico del binomio materno fetal en el proyecto EXIT permite disminuir las complicaciones y la morbimortalidad ofreciendo mejor calidad en la atención.

Abstract: The anesthetic management for this procedure is quite different from the anesthetic management of a conventional caesarean section. It includes deep general anesthesia with halogenated and narcotic administration, to get adecuate uterine relaxation and preservation of best uteroplacental flow to the fetus during anesthesia and the benefit of general anesthesia to aim the neonate show effects of of anesthetic medication by this way facilitate airway access before umbilical cord clamping. The aim to mantain placental oxigenation to neonate is avoid hypoxia risk during intubation technique. In the Hospital Infantil de Mexico «Federico Gómez¼ this procedures have been carried out since June 2007, however, there is still no homogeneous management. Material and methods: Through a case report, a perioperative files review was made of pregnant patients who were given anesthetic management for EXIT procedure in June 2007 to May 2018 period. Results: Of the 43 cases, the perioperative anesthetic information obtained allowed to standardize the anesthetic management of the maternal fetal binomial in order to perform an intrahospital protocol. Conclusion: The ability to perform a protocol for the anesthetic management of the maternal fetal binomial in the exit project allows to reduce complications and morbidity and mortality in the binomial, offering better quality of care.

Clinical observation of low dose sufentanil in preventing shivering and pulling pain during cesarean section anesthesia / 中国生化药物杂志

Objective To investigate and analyze the clinical observation of low dose sufentanil in the prevention of shivering and traction during cesarean section. Methods 100 cases of cesarean section in our hospital from January 2015 to December 2016 were selected and randomly divided into two groups, the control group and the experimental group, with 50 patients in each group. The control group received bupivacaine anesthesia, and the experimental group received sufentanil anesthesia on the basis of sufentanil. The clinical indexes of the experimental group and the control group were compared and analyzed. Results After the corresponding anesthesia, there was no moderate or severe traction pain in the experimental group and the control group, and 29 cases of mild traction pain in the control group, with a rate of 58%. There were 7 patients with mild traction pain in the experimental group, with a rate of 14%. The probability of mild traction pain in the experimental group was significantly lower than that in the control group, with statistical difference (P<0.05). The incidence of shivering in the experimental group was 16%, significantly lower than that in the control group, with a rate of 52%, which was statistically significant (P<0.05). The adverse reaction rate of the experimental group was 12%, significantly lower than that of the control group, the probability of occurrence was 42%, which was statistically significant (P<0.05). Conclusion The application of small dose of sufentanil in anesthesia in cesarean section can reduce the occurrence probability of visceral pain in a large extent, prevention of shivering, high safety, low incidence rate of adverse reaction, with further clinical promotion and application significance.

Prevalencia de obesidad en la embarazada coordinada para cesárea / Prevalence of obesity in pregnant women coordinated for cesarean section

Introducción: El estado nutricional materno tiene un efecto determinante sobre la morbimortalidad obstétrica y perinatal. Las embarazadas obesas representan un reto para el anestesiólogo ya que habitualmente presentan otras patologías asociadas, mayor riesgo de nacimiento por cesárea y dificultades técnicas asociadas tanto con la anestesia regional como general. La Organización de las Naciones Unidas para la Agricultura y la Alimentación (FAO), la Organización Mundial de la Salud (OMS) y American College of Obstetricians and Gynecologists (ACOG) recomienda usar el índice de masa corporal (IMC) para evaluar el estado nutricional de la mujer embarazada. Material y métodos: Realizamos un estudio prospectivo, descriptivo que incluyó 893 pacientes sometidas a cesárea con anestesia raquídea en el Centro Hospitalario Pereira Rossell desde octubre de 2014 a octubre del 2015. Resultados: Se obtuvo un promedio de IMC 29.8 ± 0.2 Kg. /m2, con un mínimo y un máximo en 16.01 y 51.56 respectivamente. Con una incidencia de obesidad del 43,2%. Conclusiones: Los resultados de nuestro estudio muestran una alta prevalencia de obesidad, consideramos que estos datos pueden ser representativos de la realidad obstétrica de nuestro país ya que hasta el momento no hemos encontrado un estudio nacional en el que se determine la incidencia de obesidad en la población obstétrica.

Introduction: Maternal nutritional status has a decisive effect on obstetric and perinatal morbidity and mortality. Obese pregnant pose a challenge to the anesthesiologist because usually have other associated diseases, increased risk of caesarean delivery and technical difficulties associated with both regional and general anesthesia. The United Nations Food and Agriculture Organization (FAO), the World Health Organization (WHO) and American College of Obstetricians and Gynecologists (ACOG) recommends using body mass index (BMI) to assess the nutritional status in pregnant woman. Methods: We conducted a prospective study that included 893 patients undergoing cesarean section with spinal anesthesia in the CHPR from October 2014 to October 2015. Results: An average BMI 29.8 ± 0.2 kg / m2 was obtained, with a minimum and a maximum at 16.01 and 51.56 respectively. With an incidence of obesity of 43.2%. Conclusions: The results of our study show a high prevalence of obesity, we believe that these data may be representative of obstetric reality of our country and so far have not found a national study in which the incidence of obesity is determined in the obstetric population.