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1.
Comput Math Methods Med ; 2022: 4243244, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35637847

RESUMO

To analyze the investigation of the application effects of different doses of dexmedetomidine (Dex) with combined spinal and epidural anesthesia nursing on analgesia after transurethral resection of prostate (TURP) by intelligent algorithm-based magnetic resonance imaging (MRI), MRI imaging segmentation model of mask regions with convolutional neural network (Mask R-CNN) features was proposed in the research. Besides, the segmentation effects of Mask R-CNN, U-net, and V-net algorithms were compared and analyzed. Meanwhile, a total of 184 patients receiving TURP were selected as the research objects, and they were divided into A, B, C, and D groups based on random number table method, each group including 46 cases. Patients in each group were offered different doses of Dex, and visual analogue scale (VAS) and Ramsay scores of different follow-up visit time, use of other analgesics, the incidence of postoperative cystospasm, and nursing satisfaction of patients in four groups were compared. The results demonstrated that Dice similarity coefficient (DSC) value, specificity, and positive predictive value of Mask R-CNN algorithm were 0.623 ± 0.084, 98.61%, and 69.57%, respectively, all of which were higher than those of U-net and V-net algorithms. Pain VAS scores and the incidence of cystospasm at different time periods of groups B and C were both significantly lower than those of group D (P < 0.05). Ramsay scores of groups B and C at 8 hours, 12 hours, 24 hours, and 48 hours after the operation were all remarkably higher than those in group D (P < 0.05). Besides, nursing satisfaction of groups B and C was obviously superior to that in group D, and the difference demonstrated statistical meaning (P < 0.05). The differences revealed that Dex showed excellent analgesic and sedative effects and could effectively reduce the incidence of complications after TURP, including cystospasm and nausea. In addition, it helped improve nursing satisfaction and patient prognosis.


Assuntos
Anestesia Epidural , Dexmedetomidina , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Algoritmos , Anestesia Epidural/efeitos adversos , Humanos , Hiperplasia/etiologia , Imageamento por Ressonância Magnética/métodos , Masculino , Próstata/diagnóstico por imagem , Próstata/cirurgia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos
2.
Int J Obstet Anesth ; 50: 103538, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35390734

RESUMO

BACKGROUND: The conversion of neuraxial anesthesia (NA) to general anesthesia (GA) during a cesarean section (CS) may be associated with a higher risk of neonatal morbidity by adding the undesirable effects of both these anesthesia techniques. We aimed to compare the neonatal morbidity of non-elective CS performed after conversion from NA to GA (secondary GA) vs. that after GA from the outset (primary GA). METHODS: We performed a monocentric retrospective study at the Angers University Hospital (France). All non-elective CSs performed under GA between January 2015 and December 2019 were included. The CSs were classified using a three-color coding system (green for non-urgent delivery, orange for urgent CS, and red for very urgent CS). The primary neonatal outcome was a composite of umbilical artery pH <7.10 or 5-min Apgar score <7. The crude and adjusted odds ratios (OR) for the risk of neonatal morbidity associated with secondary GA were estimated. RESULTS: We included 247 patients, of whom 101 (41.3%) had a secondary GA and 146 (58.7%) had primary GA. In the secondary GA group, 86.1% (87/101) had epidural anesthesia and 13.9% (14/101) had spinal anesthesia. Multivariate analysis showed no difference in neonatal morbidity between the two groups (adjusted odds ratio 1.18, 95% CI 0.56 to 2.51). CONCLUSIONS: Our study found insufficient evidence to identify a difference in neonatal outcomes between secondary compared with primary GA for CS, regardless of the level of emergency. However, our study is underpowered and additional studies are needed to confirm these data.


Assuntos
Anestesia Epidural , Anestesia Obstétrica , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Geral , Anestesia Obstétrica/métodos , Índice de Apgar , Cesárea/métodos , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
3.
Ann Ital Chir ; 92: 27-32, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35342098

RESUMO

AIM: Paraplegia is an infrequent although fearsome complication of anesthesia and surgical procedures, such as epidural anesthesia and thoracotomy. It may occur in both adults and children and a medullary lesion may be confirmed by magnetic resonance imaging, rather than computed tomography. The aim of this study is to describe the experience of two pediatric tertiary centers, contextualizing it with the other cases reported in literature. MATERIAL AND METHODS: We reported three pediatric cases of post-operative paraplegia in oncological patients, focusing on the potential causes and underling the possible strategies to prevent this complication. RESULTS: From our study, two principal features emerged: 1) Epidural anesthesia may expose children to a greater risk of spinal cord permanent damage due to the execution of the procedure under general anesthesia, which deprives the anesthesiologist of an important feedback about the position of the device; 2) In thoracotomy, the risk of paraplegia tends to increase along with the proximity to the costo-vertebral angle, especially if electrocautery or hemostatic materials are used. CONCLUSIONS: A prompt post-surgical neurological status routine assessment in pediatric patients undergoing epidural anesthesia or thoracotomy should be mandatory and, associated with the correct imaging study, may lead to the most appropriate therapeutic pathway and to a better prognosis. KEY WORDS: Anesthesia, Children, Epidural, Thoracotomy, Paraplegia.


Assuntos
Anestesia Epidural , Toracotomia , Adulto , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Geral/efeitos adversos , Criança , Humanos , Imageamento por Ressonância Magnética , Paraplegia/etiologia , Paraplegia/prevenção & controle , Toracotomia/efeitos adversos , Toracotomia/métodos
4.
Medicina (Kaunas) ; 58(3)2022 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-35334579

RESUMO

Background and Objectives: Vasopressors are used for treating maternal hypotension. However, the appropriate administration method and effects on newborns have not been reported. We evaluated maternal blood pressure fluctuation and neonatal findings in patients who received continuous vasopressor administration during elective cesarean sections and those who received bolus vasopressor administration upon onset of hypotension. Materials and Methods: We retrospectively analyzed the data of 220 patients scheduled for elective cesarean delivery under spinal anesthesia at Mie University Hospital between April 2017 and March 2021. The patients were classified according to the method of vasopressor administration. Maternal information, intraoperative maternal blood pressure fluctuation, and neonatal findings were examined. A multiple regression analysis was performed for the administration of postpartum neonatal respiratory support using maternal background information and other variables related to blood pressure changes as independent variables. Results: The Continuous group and the Bolus group were composed of 98 and 122 patients, respectively. No difference was observed in maternal background information between the groups. Significant changes were noted in several blood pressure parameters between both groups. As for neonatal parameters, newborns of Bolus group patients had lower pO2, 1 min and 5 min Apgar scores, and required more respiratory support than those of Continuous group patients. In the multiple regression analysis, the groups and maternal post-anesthesia diastolic blood pressure variability were considered explanatory variables. Conclusions: Maternal hypotension and the need for neonatal respiratory support associated with anesthesia administration in elective cesarean section may be improved by continuous vasopressor administration upon induction of combined spinal-epidural anesthesia.


Assuntos
Anestesia Epidural , Anestesia Obstétrica , Raquianestesia , Hipotensão , Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Feminino , Humanos , Hipotensão/tratamento farmacológico , Hipotensão/etiologia , Recém-Nascido , Gravidez , Estudos Retrospectivos
5.
J Healthc Eng ; 2022: 4752609, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35313517

RESUMO

The change of perioperative immune function in patients with esophageal cancer is mainly caused by the joint action of surgical trauma and anesthesia. In our study, we aimed to investigate the effects of different anesthetic methods on the changes of T lymphocyte subsets and cytokines in peripheral blood of patients with esophageal cancer surgery. 50 patients with esophageal cancer were divided into the study group and the control group. Among them, the patients in the control group chose intravenous anesthesia and received self-controlled intravenous analgesia after surgery. Patients in the study group chose thoracic epidural anesthesia combined with general anesthesia, undergoing self-controlled epidural analgesia after surgery; serum interleukin-2 (IL-2) and soluble interleukin-2 receptor (sIL-2R) were measured by ELISA. Serum stress hormones GH and sIL-8 were measured by radioimmunoassay. Both groups of patients achieved significant postoperative analgesia, but the VAS score in the study group at the T2-T4 time point was lower than that in the control group. The serum GH concentration in the study group increased at T1 and reached its highest peak at T2, then decreased. The serum IL-8 concentration of the two groups showed a downward trend from T1 to T4. Thoracic epidural anesthesia combined with general anesthesia for postoperative epidural analgesia can relieve the degree of cellular immunosuppression during and after surgery. Moreover, the thoracic epidural block combined with general anesthesia for esophageal cancer surgery and epidural analgesia after surgery for patients are anesthetic and analgesic methods with clinically significant effects. Our research results have a positive effect on the promotion of postoperative rehabilitation in patients with malignant cell tumors.


Assuntos
Anestesia Epidural , Anestésicos , Neoplasias Esofágicas , Analgésicos , Anestesia Epidural/efeitos adversos , Neoplasias Esofágicas/cirurgia , Hormônios , Humanos , Imunidade , Dor Pós-Operatória/etiologia
6.
J Obstet Gynaecol Res ; 48(4): 1033-1038, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35118765

RESUMO

The clinical features of extracranial arteriovenous malformations (AVM) vary from stages I (quiescence) with few symptoms to IV (decompensation) with overt symptoms of cardiac failure. Although the maternal outcomes of pregnant women with extracranial AVM is understudied due to its rarity, previous studies suggested the difficulty in the management of recurrent hemorrhage due to AVM progression during perinatal period; thus, pregnant case of extracranial AVM complicated with cardiac failure were considered challenging. We have reported a woman of stage IV extracranial AVM in the right lower limb with a history of below-the-knee amputation, in which two pregnancies and vaginal deliveries under epidural anesthesia were managed successfully. Cardiac failure did not exacerbate throughout the gestational or postpartum periods. Ulceration gradually worsened, with no massive hemorrhage. It is ideal to assess abnormal vascularity, especially in the lower abdomen, vagina, and epidural and subdural spaces, through magnetic resonance imaging to ensure safe delivery.


Assuntos
Anestesia Epidural , Malformações Arteriovenosas , Insuficiência Cardíaca , Complicações Cardiovasculares na Gravidez , Anestesia Epidural/efeitos adversos , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/terapia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Gestantes
7.
J Laryngol Otol ; 136(3): 271-278, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35081999

RESUMO

BACKGROUND: Sensorineural hearing loss following spinal anaesthesia, epidural anaesthesia or lumbar puncture is a rare phenomenon that is thought to occur when reduced cerebrospinal fluid pressure is transmitted to the inner ear through an enlarged cochlear aqueduct. METHOD: This study presents two cases of sensorineural hearing loss following spinal anaesthesia for caesarean section as well as presenting results of a systemic review of the available literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text articles from Medline, PubMed and Embase were used, as well as associated reference lists. Risk factors associated with poorer outcomes and an approach to management of this rare condition are also discussed. RESULTS: Twenty-one cases were identified. The literature was systematically reviewed showing presentations, investigations performed, treatments offered and outcomes. CONCLUSION: Sensorineural hearing loss following spinal anaesthesia, epidural anaesthesia or lumbar puncture is a rare occurrence that requires a high degree of clinical suspicion and prompt investigation and treatment.


Assuntos
Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Perda Auditiva Neurossensorial/etiologia , Punção Espinal/efeitos adversos , Adulto , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Gravidez
8.
J Vet Med Sci ; 84(3): 457-464, 2022 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-35067493

RESUMO

This prospective clinical trial evaluated the effects of epidural anesthesia (EA) placed at the lumbosacral compared to the L5-L6 junction in dogs undergoing hindlimb orthopedic surgery. In all, 98 dogs were randomly assigned to receive injection at either L7-S1 (LS group) or L5-L6 (LL group) at the same local anesthetic regimen (1 mg/kg bupivacaine 0.5% and 0.1 mg/kg morphine 1%). Fentanyl (1 µg/kg) was the intraoperative rescue analgesia (iRA) administered if mean arterial pressure increased by 30% above pre-stimulation value. Procedural failure, iRA, hypotension, motor block resolution, and postoperative side effects were recorded. There were 7/47 (15%) epidural procedural failures in the LS group and 8/51 (16%) (P=1.00) in the LL group; iRA was administered in 21/40 (52%) LS group dogs and in 13/43 (30%) LL group dogs, respectively (P=0.047). The incidence of hypotension was 10/40 (25%) and 16/43 (37%) in the LS group and the LL group, respectively (P=0.25). Proprioceptive residual deficit at 8 hr after EA was recorded in 3/26 (12%) in group LS dogs and in 13/26 (50%) group LL dogs, respectively (P=0.01). The proprioceptive residual deficit at 24 hr in one dog (LL group) resolved within 36 hr. No episodes of postoperative urinary retention, pruritus or neurological damage were recorded. The L5-L6 EA decreased significantly iRA but delays the proprioceptive recovery time. Further studies are needed to determine whether a lower bupivacaine dose reduces the duration of the residual block retaining the same incidence of iRA.


Assuntos
Anestesia Epidural , Doenças do Cão , Procedimentos Ortopédicos , Analgésicos Opioides , Anestesia Epidural/efeitos adversos , Anestesia Epidural/veterinária , Anestésicos Locais/farmacologia , Animais , Bupivacaína/farmacologia , Doenças do Cão/cirurgia , Cães , Membro Posterior/cirurgia , Morfina/farmacologia , Morfina/uso terapêutico , Procedimentos Ortopédicos/veterinária , Dor Pós-Operatória/veterinária
11.
J Clin Anesth ; 77: 110573, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34883414

RESUMO

STUDY OBJECTIVES: To describe the anesthetic management and outcomes of placenta accreta spectrum (PAS) cases at our institution over a 19 year period and to compare outcomes associated with the lumbar combined spinal epidural (CSE) technique versus the double catheter technique (lumbar CSE with thoracic epidural catheter). DESIGN: Retrospective cohort study. SETTING: Labor and delivery unit at a tertiary care center. PATIENTS: 113 female patients who had histologically confirmed PAS on the final pathology report after cesarean delivery or cesarean hysterectomy. INTERVENTION: Neuraxial anesthesia, including CSE and the double catheter technique, and general anesthesia for PAS cases (including scheduled and unscheduled cases and those known or unknown as PAS preoperatively). MEASUREMENTS: The medical records were reviewed for demographic information, intraoperative management, anesthetic technique, and outcomes. We describe anesthetic management and outcomes of cases classified as scheduled vs. unscheduled and known vs. unknown PAS. We also compare the CSE and double catheter techniques with the primary outcome being conversion to general anesthesia (GA). MAIN RESULTS: We included 113 cases: 60 (53.1%) scheduled/known cases, 12 (10.6%), scheduled/unknown cases, 22 (19.5%) unscheduled/known, and 19 (16.8%) unscheduled/unknown cases. All scheduled cases except two were started with a neuraxial technique. General anesthesia (GA) was used to start 18/41 (44%) of unscheduled cases. The double catheter technique (n = 35) was associated with a lower GA conversion rate (5.7% vs. 29.7%, P = 0.036) compared to the CSE technique (n = 37). CONCLUSIONS: Neuraxial anesthesia is the most commonly used technique for PAS cases in our practice. The double catheter technique was associated with lower GA conversion rates compared to the CSE technique in our cohort.


Assuntos
Anestesia Epidural , Anestésicos , Placenta Acreta , Anestesia Epidural/efeitos adversos , Cateteres , Feminino , Humanos , Histerectomia/efeitos adversos , Placenta Acreta/cirurgia , Gravidez , Estudos Retrospectivos
12.
J Matern Fetal Neonatal Med ; 35(6): 1127-1133, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32204637

RESUMO

OBJECTIVE: To determine the effectiveness of extending epidural analgesia following epidural labor analgesia for intrapartum cesarean section, and provide a reference for clinical practice. METHODS: Data of 1254 singleton parturient who failed trial of epidural labor analgesia and underwent intrapartum cesarean section were retrospectively included. After entering the operating room, parturient were given 3 ml of 1.5% lidocaine with 1:200,000 epinephrine 15 µg as a test dose, followed by a dose of 10 ml 0.75% ropivacaine plus 5 ml of 2% lidocaine mixed solution was administered via the epidural catheter. Case data were reviewed and analyzed of cesarean section anesthesia implementation methods, results and maternal and neonatal outcomes. RESULTS: Of the 1254 parturient, 4.7% (59 of 1254) underwent general anesthesia directly, 7.1% (89 of 1254) were given combined spinal and epidural anesthesia, and the other 88.2% (1106 of 1254) underwent extending epidural anesthesia, 3.5% (39 of 1106) of them were given general anesthesia after extending epidural anesthesia failed, and 96.5% (1067 of 1106) parturient have a successful extending epidural anesthesia. Adverse reactions of extending epidural anesthesia: 6.7% (72 of 1067) parturient experienced hypotension and 12.1% (129 of 1067) of nausea and vomiting occurred. For the neonatal Apgar scores at 1 min, eleven of 1254 (0.9%) newborns were between 0 and 3 points, 107 (8.5%) newborns between 4 and 7 points, and 1136 (90.6%) newborns Apgar scores between 8 and 10 point. 24 (1.9%) newborns with Apgar scores between 4 to 7 points at 5 min transferred to the department of neonatology, and the rest 1230 (98.1%) newborns with Apgar scores 8-10 points. CONCLUSION: Extending epidural analgesia using the well-functioning epidural catheter for epidural labor analgesia might be a reliable and effective anesthetic method for intrapartum cesarean section.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Anestesia Epidural , Trabalho de Parto , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
13.
Vet Comp Orthop Traumatol ; 35(2): 81-89, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34560807

RESUMO

OBJECTIVE: The aim of this study was to retrospectively evaluate the success rate and perioperative complications of lumbosacral extradural anaesthesia in dogs undergoing total hip replacement. STUDY DESIGN: Records of dogs undergoing total hip replacement in which lumbosacral extradural anaesthesia with 0.5% levo- or bupivacaine combined with either morphine or buprenorphine were retrieved. Success rate was defined as intraoperative fentanyl consumption <1 µg/kg/h with no intravenous infusion of other analgesic drugs and no additional morphine/methadone within the first 3 hours from premedication. Prevalence of intraoperative anaesthetic and postoperative surgical complications was calculated. RESULTS: Overall, 206 dogs were included in the study. Success rate was 88.7%. Hypercapnia (75.2%), hypotension (46.1%), hypothermia (27.7%) and regurgitation (6.3%) were recorded during anaesthesia. Within 24 hours post-surgery, urinary retention (17.8%), vomiting/regurgitation/diarrhea (8.2%) and sciatic neurapraxia of the operated limb (5.8%) were recorded. Luxation of the operated hip occurred at 48 and 72 hours after surgery in two dogs and one dog respectively. One dog had cardiopulmonary arrest at 52 hours after surgery. CONCLUSION: While hypercapnia, hypotension and hypothermia might develop intraoperatively, the high success rate and the relatively low prevalence of postoperative surgical complications directly associated with lumbosacral extradural anaesthesia justify its use in dogs undergoing total hip replacement.


Assuntos
Anestesia Epidural , Artroplastia de Quadril , Anestesia Epidural/efeitos adversos , Anestesia Epidural/veterinária , Anestésicos Locais , Animais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/veterinária , Bupivacaína , Cães , Estudos Retrospectivos
14.
Can J Anaesth ; 69(1): 72-85, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34494224

RESUMO

BACKGROUND: Anesthesia-related complications in obstetric patients could be catastrophic and impact the lives of both the parturient and the neonate. The objective of this study was to determine the frequency, temporal trend, and risk factors of anesthesia-related adverse events during hospitalization for delivery in Canada. METHODS: This retrospective population-based study utilized the hospitalization database of the Canadian Institute for Health Information for all parturients (gestation ≥ 20 weeks) in Canada (except Quebec) hospitalized for childbirth from April 2004 to March 2017. Complications were identified by the enhanced Canadian version of the tenth revision of the International Statistical Classification of Diseases and Related Health Problems codes. Data were summarized with descriptive statistics. Associations between hospitalizations with an anesthesia-related adverse event and patient characteristics, delivery method, and modality of anesthesia were assessed using multivariate logistic regression. RESULTS: Among 2,601,034 hospitalizations (3,194,875 interventions), 8,361 anesthesia-related adverse events occurred over a 13-year period (262 per 100,000 interventions; 95% confidence interval [CI], 256 to 267), with a significant decline over time (P < 0.001). These were two-fold and seven-fold higher per 100,000 interventions with general (488; 95% CI, 438 to 542) and general plus neuraxial (1,476; 95% CI, 1,284 to 1,689) anesthesia compared with neuraxial anesthesia alone (225; 95% CI, 219 to 230). Serious adverse events constituted 9% of all adverse events. The most common adverse event was spinal and epidural anesthesia-induced headache (6,908/8,361; 83%); the overall rate of failed or difficult intubations was low (201/8,361; 2%). Anesthesia-related events were more likely in those who had a Cesarean delivery compared with vaginal delivery (odds ratio [OR], 1.12; 95% CI, 1.06 to 1.18) and general anesthesia compared with neuraxial anesthesia (OR, 1.71; 95% CI, 1.53 to 1.93). Noteworthy associations were found between any anesthesia-related adverse events and cardiomyopathy (OR, 8.34; 95% CI, 2.59 to 26.83), eclampsia (OR, 3.11; 95% CI, 1.95 to 4.97), and obstructive sleep apnea (OR, 1.91; 95% CI, 1.66 to 2.19). CONCLUSION: The incidence of anesthesia-related adverse events in obstetric patients in Canada is low and declining. High vigilance is required in parturients undergoing Cesarean delivery, receiving general anesthesia, and those with pre-existing medical conditions.


RéSUMé: CONTEXTE: Les complications liées à l'anesthésie chez les patientes obstétricales pourraient être catastrophiques et avoir un impact tant sur la vie de la parturiente que sur celle du nouveau-né. L'objectif de cette étude était de déterminer la fréquence, la tendance temporelle et les facteurs de risque d'événements indésirables liés à l'anesthésie pendant l'hospitalisation pour accouchement au Canada. MéTHODE: Cette étude rétrospective basée sur la population a utilisé la base de données sur les hospitalisations de l'Institut canadien d'information sur la santé pour analyser les dossiers de toutes les parturientes (≥ 20 semaines de gestation) au Canada (à l'exception du Québec) hospitalisées pour accouchement entre les mois d'avril 2004 et mars 2017. Les complications ont été identifiées en suivant la version canadienne améliorée de la dixième révision des codes de la Classification statistique internationale des maladies et des problèmes de santé connexes. Les données ont été résumées à l'aide de statistiques descriptives. Les associations entre les hospitalisations comportant un événement indésirable lié à l'anesthésie et les caractéristiques de la patiente, la méthode d'accouchement et les modalités anesthésiques ont été évaluées à l'aide d'une régression logistique multivariée. RéSULTATS: Parmi les 2 601 034 hospitalisations (3 194 875 interventions), 8361 événements indésirables liés à l'anesthésie se sont produits sur une période de 13 ans (262 par 100 000 interventions; intervalle de confiance [IC] à 95 %, 256 à 267), avec une baisse significative au fil du temps (P < 0,001). Celles-ci étaient deux et sept fois plus élevées par 100 000 interventions avec une anesthésie générale (488; IC 95 %, 438 à 542) et avec une anesthésie générale plus neuraxiale (1476; IC 95 %, 1284 à 1689), respectivement, par rapport à une anesthésie neuraxiale seule (225; IC 95 %, 219 à 230). Les événements indésirables graves constituaient 9 % de tous les événements indésirables. L'événement indésirable le plus fréquent était les céphalées consécutives à l'anesthésie rachidienne et péridurale (6908/8361; 83 %); le taux global d'échecs d'intubation ou d'intubations difficiles était faible (201/8361; 2 %). Les événements liés à l'anesthésie étaient plus probables chez les parturientes ayant subi un accouchement par césarienne par rapport à un accouchement vaginal (rapport de cotes [RC], 1,12; IC 95 %, 1,06 à 1,18) et une anesthésie générale par rapport à une anesthésie neuraxiale (RC, 1,71; IC 95 %, 1,53 à 1,93). Des associations remarquables ont été notées entre tout événement indésirable lié à l'anesthésie et la cardiomyopathie (RC, 8,34; IC 95 %, 2,59 à 26,83), l'éclampsie (RC, 3,11; IC 95 %, 1,95 à 4,97) et l'apnée obstructive du sommeil (RC, 1,91; IC 95 %, 1,66 à 2,19). CONCLUSION: Au Canada, l'incidence d'événements indésirables liés à l'anesthésie chez les patientes obstétricales est faible et en baisse. Une vigilance élevée est de mise lors de la prise en charge de parturientes accouchant par césarienne, recevant une anesthésie générale et pour celles souffrant de conditions médicales préexistantes.


Assuntos
Anestesia Epidural , Anestesia Obstétrica , Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Canadá/epidemiologia , Cesárea/métodos , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
17.
Int J Obstet Anesth ; 49: 103241, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34906428

RESUMO

Cerebrospinal fluid-cutaneous fistula is a rare complication associated with neuraxial procedures. Here, we describe a case of fistula formation related to combined spinal-epidural anaesthesia for elective caesarean delivery, where the epidural catheter was removed only two hours later. The clear fluid leaking persistently from the site of the skin puncture associated with the epidural insertion site was confirmed to be cerebrospinal fluid with an increased beta-trace protein, and the fistula was closed with skin sutures. Subsequently, the patient presented with neurological signs and symptoms consistent with meningitis and was treated empirically with intravenous antibiotics. Cerebrospinal fluid-cutaneous fistula formation with secondary meningitis is an exceptionally rare event in obstetric anaesthesia.


Assuntos
Anestesia Epidural , Raquianestesia , Fístula Cutânea , Meningite , Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Fístula Cutânea/etiologia , Fístula Cutânea/terapia , Feminino , Humanos , Meningite/complicações , Gravidez
19.
Rev Colomb Obstet Ginecol ; 72(3): 258-270, 2021 09 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34851569

RESUMO

Objective: To describe the clinical characteristics and the frequency of maternal, fetal and neonatal complications in accordance with the neuraxial anesthesia (NA) technique in women with twin-totwin transfusion syndrome (TTTS) treated with laser photocoagulation. Materials and Methods: Descriptive retrospective cohort study of pregnant patients with TTTS treated with laser photocoagulation under NA at Fundación Valle del Lili, Cali (Colombia), between 2013-2017. Patients with Quintero stage V TTTS were excluded. The protocol was approved by the institutional ethics committee. Results: Of the participants, 32 met the inclusion and exclusion criteria. The study population consisted of young, multiparous women. Urgent interventions were performed in 87.5% of cases; 43.7% were Quintero stage III and epidural anesthesia was used in 56.2% of the women. Maternal hemodynamic variables were similar, in accordance with the timing of surgery and the neuraxial technique used. Sustained hypotension occurred in 65.6% of the pregnant women and 9.3% developed pulmonary edema. Pre-term delivery occurred in 65.6% of the patients and 18.7% had premature rupture of membranes. There were 14 fetal demises and five neonatal deaths. There were no cases of maternal mortality. Conclusions: In patients with TTTS requiring laser photocoagulation, the use of epidural, spinal or combined anesthesia is likely associated with similar maternal hemodynamic variables at the time of surgery. Practitioners providing care to these pregnant women must be aware of the frequent occurrence of maternal, fetal and neonatal complications. Prospective studies to assess the safety and effectiveness of the different neuraxial anesthesia techniques in patients with TTTS are required.


Objetivo: describir las características clínicas y la frecuencia de complicaciones maternas, fetales y neonatales, según técnica de anestesia neuroaxial (AN) en mujeres con síndrome de transfusión feto-fetal (STFF) tratadas con fotocoagulación láser (FL). Materiales y métodos: estudio de cohorte retrospectiva descriptivo. Se incluyeron gestantes con STFF tratadas con FL y AN en la Fundación Valle del Lili, Cali (Colombia) entre 2013-2017. Se excluyeron pacientes con STFF estadio-V de Quintero. Se usó estadística descriptiva. El protocolo fue aprobado por el Comité de Ética de la institución. Resultados: 32 participantes cumplieron con los criterios de inclusión y de exclusión. La población estuvo constituida por mujeres jóvenes, multíparas. En el 87,5% de los casos se realizó intervención de urgencia. El 43,7% presentaba el estadio-III de Quintero y en el 56,2 % de las gestantes se utilizó anestesia epidural. Las variables hemodinámicas maternas exhibieron un comportamiento similar, acorde al momento de la cirugía y la técnica neuoraxial implementada. El 65,6 % de las gestantes presentó hipotensión sostenida y el 9,3 % desarrolló edema pulmonar. El 65,6 % de las pacientes experimentó parto pretérmino y el 18,7 % ruptura prematura de membranas. Se registraron 14 muertes fetales y cinco neonatales. No se registraron casos de mortalidad materna. Conclusiones: en pacientes con STFF que requieren FL, el uso de la anestesia epidural, espinal o combinada probablemente se asocia con un comportamiento similar al de las variables hemodinámicas maternas, durante los momentos de la cirugía. Los profesionales que brindan atención a estas gestantes deben estar alerta ante la frecuente aparición de complicaciones maternas, fetales y neonatales. Se requieren estudios prospectivos que evalúen la seguridad y la efectividad de las diferentes técnicas de anestesia neuroaxial en pacientes con STFF.


Assuntos
Anestesia Epidural , Transfusão Feto-Fetal , Anestesia Epidural/efeitos adversos , Feminino , Transfusão Feto-Fetal/cirurgia , Fetoscopia/efeitos adversos , Idade Gestacional , Humanos , Fotocoagulação a Laser , Lasers , Gravidez , Gravidez de Gêmeos , Estudos Prospectivos , Estudos Retrospectivos
20.
Anesthesiol Clin ; 39(4): 727-742, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34776106

RESUMO

Pharmacologic thromboprophylaxis from venous thromboembolism (VTE) and thrombocytopenia in pregnancy results in conditions that may preclude the use of neuraxial anesthesia due to a perceived risk of spinal/epidural hematoma. Spinal epidural hematoma is a recognized complication in patients who are hypocoagulable and may lead patients to undergo general anesthesia for delivery or other procedures, which carries numerous complications in obstetric care. A robust understanding of maternal physiologic changes in coagulation status, review of consensus statements, and safety bundles may help to maximize the use of neuraxial anesthesia in obstetric patients who might otherwise be denied these anesthetic techniques.


Assuntos
Anestesia Epidural , Anestesia Obstétrica , Raquianestesia , Hematoma Epidural Espinal , Trombocitopenia , Tromboembolia Venosa , Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Anticoagulantes/efeitos adversos , Feminino , Hematoma Epidural Espinal/prevenção & controle , Humanos , Gravidez , Trombocitopenia/induzido quimicamente , Trombocitopenia/complicações , Tromboembolia Venosa/prevenção & controle
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