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Meningite após técnica combinada para analgesia de parto: relato de caso
Vásquez, Carlos Escobar;Pereira, Raquel da Rocha;Tomita, Tomio;Bedin, Antonio;Castro, Renato Almeida Couto de;
Revista Brasileira de Anestesiologia , 2002, DOI: 10.1590/S0034-70942002000300008
Abstract: backgraund and objectives: meningitis is a serious complication, although rare in regional anesthesia. this report aimed at presenting a case which evolved to meningitis after combined labor spinal-epidural analgesia. case report: laboring patient, 25 years old, second gestation and previous c-section. combined labor spinal-epidural analgesia was induced with double-puncture. twenty-four hours later she presented with headache at rest, fever and mild chills, which regressed with symptomatic medication. headache worsened in the 5th day. there were vomiting and neck pain in the 10th day. symptoms became more severe in the 13th day. lumbar puncture was performed. clinical history and csf analysis were compatible with bacterial meningitis. conclusions: combined labor spinal-epidural analgesia is very close to being the ideal technique. care must be taken with the sterile technique to induce spinal blockade. the reported complication has occurred without an apparent technique failure and is inherent to technique?s risk-benefit ratio.
Meningite após técnica combinada para analgesia de parto: relato de caso  [cached]
Oliveira Amaury Sanchez,C?rtes Carlos Alberto Figueiredo
Revista Brasileira de Anestesiologia , 2002,
Abstract:
Analgesia combinada vs analgesia peridural para trabajo de parto  [cached]
Juan Pablo Aristizábal,Wilson Vargas,Maribel Arrieta
Revista Colombiana de Anestesiología , 2005,
Abstract: Introducción: Las ventajas de la analgesia epidural-espinal incluyen una identificación confiable del espacio subaracnoideo, requerimiento de poco fármaco, disminución de toxicidad sistemica y analgesia de instauración rápida. En este estudio se comparan las técnicas peridural y epidural-espinal. Materiales y Métodos: Se incluyeron 200 pacientes en un periodo de 12 meses. Los criterios de inclusión fueron mujeres en trabajo de parto con dilatación mayor o igual a 5 cm sin patologías asociadas. Se evalúo la respuesta analgésica a los 5 y 15 minutos, la respuesta hemodinamica, bloqueo motor, efectos adversos y respuesta fetal. La técnica peridural se realizo con bupivacaina al 0.065% y la técnica epidural-espinal con fentanyl 25mcg intratecales sin anestésico local. Resultados : Cada grupo incluyó 100 pacientes (peridural o analgesia A y epidural-espinal o analgesia B). La percepción de dolor fue similar en ambos grupos a los 5 minutos (p value = 0.291), a los 15 minutos fue menor con analgesia epidural-espinal (p value = 0.008). No hubo cambios hemodinamicos ni bloqueo motor ni diferencia fetal en ambos grupos. Se encontró una incidencia de prurito con la técnica epidural-espinal de 36%. Conclusión: La analgesia epidural-espinal con opioides intratecales produce mayor disminución en la percepción del dolor a los 15 minutos comparado con la peridural, sin presentar cambios hemodinamicos ni bloqueo motor y sin alteración en el recién nacido, con una incidencia de 36% de prurito. Backround: The advantage of epidural-spinal analgesia technique include better subaracnoid space identification, less drug requirements, less sistemic toxicity, and rapid analgesic effect. In this study we compare peridural and peridural-spinal tecnique. Methods: The study included 200 patients during a period of 12 months. The inclusion criteria were women during labour with dilatation of 5cm or more without any associated pathology. The study evaluate analgesic response at 5 and 15 minutes, hemodinamic response, motor block, adverse effects and fetal response. The peridural tecnique was done with bupivacaina 0.065% and the peridural-spinal tecnique with fentanyl 25mcg intrathecal without local anesthetic. Results: Each group included 100 patients (peridural or group A and peridural-spinal or group B). Pain perception was similar between both groups at 5 minutes (p value = 0.291), at 15 minutes peridural-spinal tecnique produced less pain perception (p value = 0.008). There wasn′t any hemodinamic, motor, or fetal change. There was a 36% prurito incidence with peridural-spinal anal
Analgesia combinada vs analgesia peridural para trabajo de parto
Aristizábal,Juan Pablo; Vargas,Wilson; Arrieta,Maribel;
Revista Colombiana de Anestesiología , 2005,
Abstract: backround: the advantage of epidural-spinal analgesia technique include better subaracnoid space identification, less drug requirements, less sistemic toxicity, and rapid analgesic effect. in this study we compare peridural and peridural-spinal tecnique. methods: the study included 200 patients during a period of 12 months. the inclusion criteria were women during labour with dilatation of 5cm or more without any associated pathology. the study evaluate analgesic response at 5 and 15 minutes, hemodinamic response, motor block, adverse effects and fetal response. the peridural tecnique was done with bupivacaina 0.065% and the peridural-spinal tecnique with fentanyl 25mcg intrathecal without local anesthetic. results: each group included 100 patients (peridural or group a and peridural-spinal or group b). pain perception was similar between both groups at 5 minutes (p value = 0.291), at 15 minutes peridural-spinal tecnique produced less pain perception (p value = 0.008). there wasn′t any hemodinamic, motor, or fetal change. there was a 36% prurito incidence with peridural-spinal analgesia. conclusion: peridural-spinal tecnique with intrathecal opioids produce less pain perception at 15 minutes compared with peridural tecnique, without any hemodinamic, motor or fetal effects, with a 36% pruritus incidence.
Tendencias y avances actuales en anestesia obstétrica: La técnica combinada espinal-epidural para analgesia ambulatoria en trabajo de parto  [cached]
Kuczkowski Krsysztof
Revista Colombiana de Anestesiología , 2006,
Abstract: La técnica combinada espinal-epidural para analgesia del trabajo de parto (CSEA por sus iniciales en Inglés), ha alcanzado amplia popularidad en anestesia obstétrica en todo el mundo. El inicio de la analgesia es rápido y confiable y la satisfacción materna es alta. Aún cuando existe todavía alguna preocupación sobre la punción dural, la técnica CSEA ofrece muchas ventajas a la parturienta. La búsqueda permanente de una analgesia balanceada del trabajo de parto, que proporcione alivio del dolor de las contracciones conservando la función motora, ha llevado al desarrollo de la analgesia del trabajo de parto ambulatoria. La técnica CSEA utilizando opioides subaracnoideos (con o sin anestésicos locales) ocasiona mínimo bloqueo motor y es especialmente útil en la analgesia ambulatoria del trabajo de parto que permite que la paciente camine. El propósito de este artículo es revisar la información clínica disponible y aportar algunas recomendaciones relacionadas con la aplicación de la técnica CSEA para la analgesia ambulatoria del trabajo de parto. The combined spinal-epidural labor analgesia technique (CSEA) has attained wide spread popularity in obstetric anesthesia worldwide. The onset of analgesia is rapid and reliable, and maternal satisfaction is high. While there still remains some concern about dural puncture, the CSEA technique offers many advantages to the parturient. Continuous search for a balanced labor analgesia, which provides relief of pain of contractions while preserving motor function, has led to the development of the ambulatory labor analgesia. The CSEA performed with subarachnoid opioids (with or without local anesthetics) causes minimal motor block and is particularly applicable to ambulatory labor analgesia. The purpose of this paper is to review the available clinical data and provide recommendation for the application of the CSEA technique for ambulatory labor analgesia.
Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua
C?rtes, Carlos Alberto de Figueiredo;Sanchez, Candido Amaral;Oliveira, Amaury Sanchez;Sanchez, Fernando Martinez;
Revista Brasileira de Anestesiologia , 2007, DOI: 10.1590/S0034-70942007000100005
Abstract: background and objectives: pain relief during labor is a permanent concern, aiming at the maternal well being, decreasing the stress secondary to pain, and reducing its consequences on the fetus. several analgesia techniques can be used during labor. the aim of this study was to compare continuous and combined epidural analgesia, both of them using 0.25% bupivacaine with 50% enantiomeric excess and fentanyl. methods: forty pregnant women, in labor, with cervical dilation between 4 and 5 cm, were randomly divided in two groups. group i received continuous epidural anesthesia. group ii received combined anesthesia. the following parameters were evaluated: anthropometric measurements, gestational age, cervical dilation, length of time between the blockade and absence of pain according to the visual analogic scale, ability to walk, length of time between analgesia and complete cervical dilation, duration of the expulsive phase, maternal hemodynamic parameters, and vitality of the newborn. possible complications, such as respiratory depression, maternal hypotension, pruritus, nausea, and vomiting were also evaluated. the student t test was used to compare the means and the chi-square test was used to compare the number of pregnancies and type of labor. results: there were no statistically significant differences between both groups regarding the length of time between the beginning of analgesia and complete cervical dilation, as well as regarding the duration of the expulsive phase, incidence of cesarean section related to the analgesia, maternal hemodynamic parameters, and vitality of the newborn. conclusions: both techniques are effective and safe for labor analgesia, although the combined technique provided fast and immediate pain relief. clinical studies with a larger number of patients are necessary to evaluate the differences in the incidence of cesarean sections.
Analgesia de parto em paciente portadora de deficiência de proteína S: relato de caso
Stocche Renato Mestriner,Garcia Luis Vicente,Reis Marlene Paulino dos,Klamt Jyrson Guilherme
Revista Brasileira de Anestesiologia , 2004,
Abstract: JUSTIFICATIVA E OBJETIVOS: Na deficiência de proteína S, uma glicoproteína com atividade anticoagulante, o risco de eventos tromboembólicos está aumentado. O objetivo deste relato é abordar o manuseio anestésico em paciente obstétrica portadora desta deficiência. RELATO DO CASO: Paciente com deficiência de proteína S, com 25 semanas de gesta o, apresentou os seguintes resultados de exames: INR = 0,9, TTPA = 32 s (controle 25,6), proteína S = 35% (normal = 70% a 130%). Nos dois últimos trimestres de gravidez, fez uso de até 12000 U de heparina, cada 8 horas. Com 38 semanas, foi internada em trabalho de parto. Decorridas 8 horas da interrup o da heparina, já com TTPA 25,8 s (controle 27,8 s), realizou-se anestesia peridural injetando-se 6 ml de bupivacaína a 0,2% e fentanil (20 μg), seguido de infus o contínua. O tempo de infus o foi de 5 horas com dose total de 40 mg de bupivacaína. N o houve intercorrências e, 1 hora após a retirada do cateter, foi reiniciada heparina, por via subcutanea, 10.000 UI, a cada 12 horas. A m e e o recém-nascido evoluíram bem, recebendo alta no terceiro dia do pós-parto. CONCLUS ES: Grávidas com deficiência de proteína S devem receber anticoagulantes com o objetivo de manter o TTPA 2 vezes o valor controle. A heparina, por n o atravessar a barreira placentária, é o anticoagulante de elei o em obstetrícia. O bloqueio pode ser realizado respeitando um tempo mínimo entre 4 a 6 horas entre a última dose de heparina e a realiza o da pun o lombar, desde que os exames apresentem parametros de normalidade. Entretanto, nestes casos, a analgesia peridural pode auxiliar na profilaxia de eventos tromboembólicos.
Analgesia de parto em paciente com tetralogia de Fallot n?o corrigida: relato de caso
Mendes, Florentino Fernandes;Farias, Carlos Alberto T;Segabinazzi, Daniel;
Revista Brasileira de Anestesiologia , 2005, DOI: 10.1590/S0034-70942005000100012
Abstract: background and objectives: although tetralogy of fallot is the most common cyanotic congenital heart disease, national publications correlating this condition with anesthetic practice are scarce. this report aimed at presenting a case of labor epidural analgesia in a patient with uncorrected tetralogy of fallot diagnosed during gestation. case report: patient 26 years old, 1.54 m, 56 kg, 32 weeks and 5 days of gestational age, who had been diagnosed with tetralogy of fallot during gestation. patient was admitted in labour. after obstetric evaluation and decision for natural birth, epidural analgesia was performed with 0.125% bupivacaine associated to 100μg fentanyl through a catheter. patient gave birth 1 hour and 30 minutes after the procedure. the newborn weighed 1485 grams and had an apgar score of 6 and 8 at one and five minutes, respectively. patient remained stable, with no hemodynamic or ecg changes. conclusions: selecting the appropriate anesthetic technique is extremely important when managing patients with uncorrected tetralogy of fallot. favorable uterine dynamics and cervical conditions, particularly in patients with no history of syncope, are critical findings for adequate labour analgesia indication.
Embolia amniótica durante parto normal sob analgesia: relato de caso
Meletti, José Fernando Amaral;Miranda, Reinaldo Vargas Bastos de;
Revista Brasileira de Anestesiologia , 2008, DOI: 10.1590/S0034-70942008000400010
Abstract: background and objectives: amniotic fluid embolism is a rare occurrence; it has a sudden onset and high morbidity. the objective of this report was to present a case of amniotic fluid embolism in a primipara undergoing analgesia for vaginal delivery. case report: this is a 38-year old pregnant woman with amniotic sac ruptured, cervix with 5-cm dilation, complaining of severe pain; the patient was agitated, diaphoretic, and with tachysystoly. after venipuncture, ringer's lactate with 5 iu of oxytocin was infused slowly, blood pressure (bp) 110 × 70 mmhg, heart rate (hr) 115 bpm with sinus rhythm, and spo2 98%. it was decided to use a combined technique: 2.5 mg of heavy bupivacaine and 20 μg of fentanyl were administered in the subarachnoid space and a catheter was inserted into the epidural space. twenty minutes after the institution of analgesia, the patient complained of sudden onset of severe pruritus, she was agitated, with nausea and vomiting, pale, hr 160 bpm, tachypneic, spo2 80%, and bp could not be detected. normal saline (500 ml) associated with hydrocortisone, ephedrine (50 mg), and oxygen with a face mask at 10 l.min-1 were administered. at that moment, she presented bp 60 × 30 mmhg, hr 150 bpm, and spo2 92%. since bp tended to decrease, a total of 7 mg of metaraminol were administered divided in several doses. after vaginal delivery, the patient was transferred to the icu with bp 90 × 60 mmhg, hr 110, and tachypnea. two hours later, she developed bleeding and hypotension; disseminated intravascular coagulation (dic) was diagnosed and the patient treated with crystalloid solutions, packed red blood cells and fresh frozen plasma. she was discharged from the icu in the 3rd postoperative day (po). conclusions: due to the dramatic presentation, severity, and fast installation of the symptoms, the speed and objectivity of the measures instituted to maintain vital signs are fundamental and decisive for survival of pregnant patients. we alert for the importance
Analgesia de parto em paciente portadora de deficiência de proteína S: relato de caso
Stocche, Renato Mestriner;Garcia, Luis Vicente;Reis, Marlene Paulino dos;Klamt, Jyrson Guilherme;
Revista Brasileira de Anestesiologia , 2004, DOI: 10.1590/S0034-70942004000100009
Abstract: background and objectives: deficiency in protein s, which is a glycoprotein with anticoagulant activity, increases the risk for thromboembolic events. this report aimed at addressing anesthetic management of protein s deficient obstetric patient. case report: protein s deficient patient, at 25 weeks gestation, presented the following lab results: inr = 0.9, ttpa = 32 s (control 25.6), protein s = 35% (normal = 70% to 130%). in the last three gestation quarters she has received up to 12,000 iu heparin every 8 hours. with 38 weeks, she was admitted in labor. after 8 uninterrupted heparin hours, already with ttpa of 25.8 s (control 27.8 s) epidural anesthesia was induced with 6 ml of 0.2% bupivacaine and fentanyl (20 μg), followed by continuous infusion. infusion time was 5 hours with total 40 mg bupivacaine dose. there have been no intercurrences and 1 hour after catheter removal, subcutaneous 10,000 iu heparin were restarted at 12-hour intervals. patient and neonate evolved well and were discharged 3 days later. conclusions: protein s deficient pregnant patients should receive anticoagulants to maintain ttpa twice the control value. heparin, for not crossing placental barrier, is the anticoagulant of choice in obstetrics. blockade may be induced respecting a minimum period of 4 to 6 hours between last heparin dose and lumbar puncture, provided lab tests are within normal ranges. in these cases, however, epidural analgesia may help in preventing thromboembolic events.
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