RESUMEN
OBJECTIVE: To evaluate the medium-term effect of epidural analgesia (EA) on the possible onset of postpartum urinary incontinence (PUI). METHODS: We performed a single-centre, retrospective case-control study. At 8-week postpartum, we recruited a cohort of women who had term singleton pregnancy and foetus in cephalic presentation, and divided in six groups: (1) vaginal delivery without episiotomy, without EA; (2) vaginal delivery without episiotomy, with EA; (3) vaginal delivery with episiotomy, without EA; (4) vaginal delivery with episiotomy, with EA; (5) emergency caesarean section without previous EA during labour and (6) emergency caesarean section with previous EA during labour. For each woman, we recorded age, Body Mass Index (BMI) and the result of the following questionnaire for urinary incontinence: International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory-6 (UDI-6). Subsequently, we compared group 1 versus group 2, group 3 versus group 4 and group 5 versus group 6. RESULTS: We did not evidence any significant difference for age, BMI and incontinence scores between groups 1 and 2, 3 and 4, and 5 and 6. CONCLUSIONS: EA did not affect the onset of PUI in medium-term, regardless the mode of delivery.
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Analgesia Epidural/efectos adversos , Trastornos Puerperales/etiología , Incontinencia Urinaria/etiología , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Approximately 28% of the patients with cystic fibrosis are affected by cholelythiasis. More than 40% of them have a symptomatic disease, which would mandate cholecystectomy. AIM: The aim of this study was to review surgical and respiratory outcomes and quality of life scores of cystic fibrosis patients undergoing laparoscopic cholecystectomy for symptomatic cholelythiasis to verify the hypothesis that cholecystectomy is a low-risk operation by laparoscopy, not affecting unfavorably respiratory function and quality of life. PATIENTS AND METHODS: Study group was consisted of 9 patients with a mean age of 24.8±8.1 years (range, 15 to 38 y), 2 male and 7 female patients, with cystic fibrosis and symptomatic cholelithiasis. Three patients also presented common bile duct stones. All the patients underwent perioperative Positive End-Expiratory Pressure mask sessions and aggressive antibiotic regimens. At the middle of the antibiotics regimen period, a standard laparoscopic cholecystectomy was performed. In the 3 cases with common duct lithiasis, the so-called "rendezvous" technique was carried out. Preoperatively, intraoperatively, and postoperatively, respiratory function was strictly monitored by the evaluation of SO2 and of the forced expiratory volume in 1 second (FEV1). Preoperatively and 6 months after laparoscopic cholecystectomy the Gastro Intestinal Quality of Life Index was evaluated on all patients. RESULTS: All the operations were completed laparoscopically. No mortality was observed. The intraoperative mean SO2 was 89.0%±5.6% (range, 80% to 95%), versus 82.8%±8.5% (range, 66% to 91%) at the extubation (P=0.006). Intraoperative respiratory functions were stable in 6 patients. In 3 patients, a severe bronchospasm occurred determining marked desaturation. Preoperative mean FEV1 was 70.5%±7.0% (range, 55% to 75%) versus 61.8%±13.2% (range, 39% to 80%) 48 hours after the operation (P=0.132). The 3 patients, who experienced intraoperatively severe bronchospasm, reported a 48 hours postoperative FEV1 under 60%. All the patients showed disappearance of postprandial colicky pain and vomiting. Preoperative mean total Gastro Intestinal Quality of Life Index score was 105.2±13.6 versus 117.8±10 at 6-month follow-up (P=0.015). CONCLUSIONS: On the basis of a proper surgical timing and adequate preoperative physiokinesis therapy, laparoscopic cholecystectomy is a safe and indicated procedure in patients with cystic fibrosis and symptomatic cholelithiasis and it is able to significantly improve the quality of life. Quality of life of these patients it not worsened while symptoms and risks of biliary gallstones are removed.
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Colecistectomía Laparoscópica/métodos , Colelitiasis/cirugía , Fibrosis Quística/complicaciones , Calidad de Vida , Adolescente , Adulto , Colelitiasis/complicaciones , Colelitiasis/psicología , Fibrosis Quística/fisiopatología , Fibrosis Quística/psicología , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado/fisiología , Humanos , Masculino , Periodo Posoperatorio , Recuperación de la Función , Pruebas de Función Respiratoria , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Exposure to anesthetics in the health environment may entail a health risk for patients and operating room personnel. Knowing the effects of anesthetic agents on genetic material could be a valuable basic support for anesthesia care providers to improve treatment performance, increase patient safety and reduce the risks for patients and staff in the operating room. AREAS COVERED: Relevant literature was identified using MEDLINE, CINAHL® and Cochrane Library databases. Over 200 abstracts for articles published from 1980 to 2010 were examined. Original articles were reviewed and relevant citations from these articles were also considered. EXPERT OPINION: Despite some conflicting results, the current available data indicate that exposure to anesthetics, especially nitrous oxide and halogenated agents, is associated with general and genotoxic risks, whereas intravenous agents, such as propofol and its metabolites are not associated with genotoxic effects. Moreover, given that different anesthetic drugs are used in combination it is, thus, very difficult to understand whether the observed effects or absence of effects are due to an individual agent action or linked to a synergy action of different anesthetics involved. Further clinical and experimental evidence is warranted.