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We report the anesthetic management of a parturient with Takayasu arteritis and several comorbidities scheduled for elective cesarean section with the authorization of the institutional ethics committee. A twosegment combined spinal-epidural technique was used to provide anesthesia with close control of invasive arterial pressure and the use of Norepinephrine endovenous infusion. Likewise, a literature review of the two-segment combined technique for cesarean section in pregnant women with this disease was performed. [ABSTRACT FROM AUTHOR]

Objectives: to demonstrate the effect of adrenaline infusion in relation to noradrenaline for the purpose of preventing maternal hypotension post intradural anesthesia. Methods: a total of 114 people, a sample of 46 patients, are distributed in 2 distinct group: A (noradrenaline) and B (adrenaline) at a dose of 0.02 µg/kg/ min. Mean of continuous variables was measured and Shapiro – Wilk normality test was applied. Student's T was applied for the means and Mann-Whitney U for the medians. The frequency was determined for nominal variables. Results: the age was 32 to 33 years, with a significant heartbeat in T3 and T4 for group B, p value 0.045 and 0.000. No significant changes in blood pressure or APGAR scores. Side effects are the presence of headache possibly related to the use of oxytocin. 18 and 16 patients did not present hypotension with chi square of 0.89. Total volume of crystalloids from 650 ml to 700 ml in both groups A and B. The reference cost was 0.9 bolivianos. Conclusions: adrenaline is a suggestive vasopressor, without alterations in maternal heartbeat, but with greater control than noradrenaline, and with a similar action on mean arterial pressure in both groups [ABSTRACT FROM AUTHOR]

The importance of breastfeeding with its positive impact on the wellbeing of the mother-infant pair is well established. Anesthesiologists should encourage the promotion of lactation by being willing to give reassurance during the preoperative period and preparing a plan that does not interfere with safe breastfeeding. There is concern regarding the transfer of drugs into breast milk, which may lead to inconsistent advice from many health professionals and to early discontinuation. However, evidence shows that most anesthetic drugs are safe in terms of transfer into breast milk, and hence, compatible with breastfeeding, which should be resumed after anesthesia as soon as the mother is alert and feels well enough to hold her infant, without the need to "pump and dump". This review provides pharmacokinetic information on commonly used anesthesia drugs and their passage into breast milk, to help practitioners discuss risks and benefits with the mother, emphasizing that anesthesia should not interfere with the benefits of breastfeeding. Four practical clinical scenarios are presented: pregnant women concerned about the effect of epidural analgesia on subsequent breastfeeding, spinal anesthesia for c-section and lactation, patients who will receive general anesthesia during cesarean section, and finally women who are breastfeeding and require anesthesia for elective or urgent surgery. Neuraxial anesthesia allows for better pain control and immediate skin-to-skin contact at the time of childbirth. Also, it interferes the least with the woman's ability to care for her infant. Regional techniques, opioid-sparing techniques and outpatient surgery are preferred. Drugs such as opioids and longer-acting benzodiazepines should be administered cautiously, particularly in repeat doses. [ABSTRACT FROM AUTHOR]

Introduction: Marfan syndrome is an inherited disorder that affects connective tissue. Case: We report the anesthetic management of a parturient with Marfan syndrome scheduled for an elective C-section. Successful use of a combined spinal-epidural technique was used to provide neuraxial anesthesia; however, she presented an unfavorable evolution due to maternal sepsis. Likewise, a literature review of combined spinal-epidural anesthesia for C-sections in Marfan syndrome pregnant women was performed. Conclusion: Anesthetic management of parturients affected by Marfan syndrome during the cesarean section can be challenging. Strict blood pressure control during the intraoperative period has cornerstone importance. Likewise, neuraxial techniques have a significant percentage of failure in these patients. [ABSTRACT FROM AUTHOR]

Cardiac tamponade is the accumulation of fluid within the pericardial sac, which leads to an increase in intrapericardial pressure, allowing the deterioration of the heart's ability to fill and act as a pump. Among its causes are tuberculosis, collagen disease, and cancer. In pregnancy, the signs and symptoms of cardiac tamponade can be masked by the physiological changes of pregnancy. The gold standard of detection is echocardiography. Treatment of cardiac tamponade is pericardiocentesis or surgical. The case of a 26-yearold patient is presented with: a 32.6 for week pregnancy in preterm labor, cardiac tamponade and 2-hour post-pericardiocentesis, for culminate of pregnancy. Anesthetic management is complex for both the mother and the newborn, basing on maintaining hemodynamic stability and subsequent transfer to the intensive care unit. [ABSTRACT FROM AUTHOR]

Epidural analgesia involves the technique of choice for pain relief of labor. Adverse neurological effects have been reported, one of which is called Horner syndrome, its evolution is usually benign, it does not require specific management, except clinical monitoring for the probable spread of local anesthetic cephalic. Most of the existing literature cases are isolated, in our paper we present a series of 3 clinical cases and reviewed its pathogenesis and management in the obstetric patient. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Regional anesthesia provides excellent anesthesia and analgesia in obstetric patients, but has potential for complications such as post-dural puncture headache and permanent or transient nerve damage. This study aimed to describe the incidence of post-dural puncture headache and nerve damage in the obstetric population of auniversity hospital that was submitted to neuraxial blockades, comparing with the world literature, and identify risk factors. Materials and methods: A retrospective cohort was performed including data collected in the records of post-anesthetic consults conducted during the year 2010. The main analysis was performed on the complaints of peripheral neurological deficits and headaches reported by patients, type of anesthesia and performed surgical procedures. A multiple regression analysis was performed to investigate the association between the onset of lower limb paresthesias and the length of stay of these patients in the gynecological position and other variables. Results: A total of 2399 pregnant patients who had undergone neuraxial blockade were evaluated. Neurologic complications that occurred in these patients were divided into lower limb paresthesias (0.3%), transient radicular irritation (0.1%), and post-dural puncture headache (3%). The patients who stayed more than 60 min in gynecological position showed an odds ratio of evolution with lower limb paresthesias of 1.75 and patients who stayed more than 120 min showed an odds ratio of 2.1, but without statistical significance. Conclusions: Patients submitted to neuraxial blockades and placed in gynecological position were more likely to evolve with lower limb paresthesias related to duration of this position. [ABSTRACT FROM AUTHOR]

The literature related with the anesthetic management of emergent C section is limited, for which reasonwe proposed the systematic evaluation of the existing literature on anesthetic management of obstetric patients undergoing emergency cesarean section in order to define the most appropriate interventions based on evidence. A systematic review of the literature was undertaken in MEDLINE, 1966 to December 2010, Cochrane Collaboration registry of clinical trials, Cochrane systematic review database, and LILACS. The study selection process was undertaken independently by two researcher-reviewers, who identified controlled clinical trials and cohort studies of anaesthetic management in emergency C-section. The data were extracted, reviewed and subjected to quality evaluation in duplicate fashion. In total, 2,297, 36, 221were examined, respectively, and of those 16 potentially relevant papers, 9 clinical trials and 7 observational studies were included in the study. A heterogeneity analysis was done using I2, with a result of 52%, and for this reason no meta-analysiswas conducted. Conclusions: The anaesthetist plays a critical part in mother-and-child care, prioritization of the C-section urgency, peridural anaesthesia extension with 2% lidocaine plus adjuvants (fentanyl plus fresh adrenaline), the use of vasopressors (phenylephrine, ephedrine) for the aggressive management of hypotension, the use of oxygen supplementation and the adequate management of general anaesthesia when indicated, contributing to a favourable impact on the outcome for both the mother and the baby. Long-term neonatal outcomes are not influenced by the type of anaesthesia given to the mother. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean section under general anesthesia is recommended in achondroplastic pregnant patients; however, the use of conductive techniques has been recently reported, with acceptable results. Objective: To describe the anesthesia management in an achondroplastic patient scheduled for C-section under combined spinal-epidural anesthesia. Methods and results: We present the case of a first pregnancy in a patient with achondroplasia, height 110cm and 37 weeks of gestation. The patient underwent cesarean section under ultrasound-guided conductive anesthesia, using a titrated mixture of local anesthetic and opiate, with good results for the mother and child. Conclusions: Conductive anesthesia is an option in C-section in patients with achondroplasia. Although there are no clear recommendations to guide a safe access to the neuroaxis or to administer anesthetic agents at this level, ultrasound and the titrated administration of neuraxial drugs (epidural, epidural-spinal and continuous spinal) for improved safety and efficacy of the technique in this type of patients may be considered. [ABSTRACT FROM AUTHOR]

The addition of opioids to bupivacaine for spinal anesthesia has been shown to improve quality of anesthesia by the action of fentanyl, and extend postoperative analgesia by the effect of morphine. Side effects, particularly respiratory depression, have prevented their widespread use. Studies are not consistent regarding the incidence of respiratory depression due to the variety of definitions of this complication and the doses of opioids used. Low dose regimens currently used do not produce further respiratory depression than parenteral opioids. The high levels of progesterone, a potent respiratory stimulant, makes safe the use of neuroaxial opioids in scenarios such as obstetrical anesthesia or analgesia, hence their use should not be overlooked. [ABSTRACT FROM AUTHOR]