RESUMEN
Although cardiac arrest in pregnancy is rare, it is important that all individuals involved in the acute care of pregnant women are suitably trained, because the outcome for both mother and fetus can be affected by the management of the arrest. Perimortem caesarean delivery was first described in 715 BC. Initially the procedure was performed principally for religious or political reasons. Although the potential for fetal survival was proposed, it was rarely successful, probably because the delivery was delayed until maternal death was established. However, in recent decades, case reports have suggested improved maternal as well as fetal survival if perimortem caesarean section was performed rapidly once maternal arrest has occurred. While evidence for this is largely based on case reports, the physiological advantages including removing inferior caval obstruction, and hence improving venous return to the heart, reducing oxygen requirement and improving chest compliance appear compelling. Factors that reduce errors and minimise the delay in performance of caesarean delivery are discussed, in particular the importance of training, organizational factors within a hospital and the use of prompts during an arrest. While evidence is limited, it is probable that both maternal and fetal survival are improved with early delivery by perimortem caesarean delivery. More importantly, no evidence was found from case report reviews that either maternal or fetal survival was worsened. Perimortem caesarean delivery therefore remains a key consideration in the management of maternal arrest from the mid second trimester.
Asunto(s)
Cesárea , Paro Cardíaco , Muerte Materna , Complicaciones Cardiovasculares del Embarazo , Reanimación Cardiopulmonar , Femenino , Paro Cardíaco/epidemiología , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/epidemiologíaRESUMEN
OBJECTIVE: To determine the stability of individual differences in non-nutritive 'junk' palatable food (PF) intake in rats; assess the relationship of these differences to binge-eating characteristics and susceptibility to obesity; and evaluate the practicality of using these differences to model binge-eating and obesity. DESIGN: Binge-eating prone (BEP) and resistant (BER) groups were identified. Differential responses to stress, hunger, macronutrient-varied PFs, a diet-induced obesity (DIO) regimen and daily vs intermittent access to a PF+chow diet, were assessed. SUBJECTS: One hundred and twenty female Sprague-Dawley rats. MEASUREMENTS: Reliability of intake patterns within rats; food intake and body weight after various challenges over acute (1, 2, 4 h), 24-h and 2-week periods. RESULTS: Although BEP and BER rats did not differ in amount of chow consumed, BEPs consumed >50% more intermittent PF than BERs (P<0.001) and consistently so (alpha=0.86). BEPs suppressed chow but not PF intake when stressed, and ate as much when sated as when hungry. Conversely, BERs were more affected by stress and ate less PF, not chow, when stressed and were normally hyperphagic to energy deficit. BEP overeating generalized to other PFs varying in sucrose, fat and nutrition content. Half the rats in each group proved to be obesity prone after a no-choice high fat diet (DIO diet) but a continuous diet of PF+chow normalized the BEPs high drive for PF. CONCLUSION: Greater intermittent intake of PF predicts binge-eating independent of susceptibility to weight gain. Daily fat consumption in a nutritious source (DIO-diet; analogous to a fatty meal) promoted overeating and weight gain but limiting fat to daily non-nutritive food (PF+chow; analogous to a snack with a low fat meal), did not. The data offer an animal model of lean and obese binge-eating, and obesity with and without binge-eating that can be used to identify the unique physiology of these groups and henceforth suggest more specifically targeted treatments for binge-eating and obesity.
Asunto(s)
Bulimia , Obesidad/etiología , Estrés Psicológico/complicaciones , Animales , Modelos Animales de Enfermedad , Femenino , Abastecimiento de Alimentos , Predisposición Genética a la Enfermedad , Hambre/fisiología , Motivación , Ratas , Ratas Sprague-DawleyRESUMEN
A 19-yr-old woman developed a paraplegia with a T10 sensory level at 22 weeks' gestation. The spinal injury was caused by spontaneous bleed of a presumed arteriovenous malformation in the spinal cord. She presented for Caesarean section at term because of the breech position of her fetus. The successful use of a combined spinal epidural-regional anaesthetic is described and the risks of general and regional anaesthesia are discussed.
Asunto(s)
Anestesia Obstétrica/métodos , Paraplejía/etiología , Complicaciones del Embarazo , Hemorragia Subaracnoidea/complicaciones , Adulto , Anestesia Epidural/métodos , Anestesia Raquidea/métodos , Malformaciones Arteriovenosas/complicaciones , Femenino , Humanos , EmbarazoRESUMEN
Two hundred and seven anaesthetists in the Oxford region were sent a questionnaire asking about their peri-operative management of patients with diabetes mellitus. One hundred and seventy two valid returns were received. The results of this survey were compared with those of a similar survey conducted in 1985. A greater proportion of anaesthetists in 1993 would maintain their diabetic patients with a peri-operative blood glucose concentration of less than 10 mmol.l-1. Anaesthetists are more likely to be interventional in their management of diabetic patients than in 1985 and the methods used have changed in relative popularity. In 1993 diabetic patients undergoing major surgery were most commonly managed with separate infusions of insulin and glucose, while in 1985 the combined infusion of glucose, insulin and potassium was the most popular technique. The use of protocols in hospitals may increase the degree of uniformity of practice between anaesthetists.