RESUMEN
BACKGROUND: The purpose of this international survey was to describe the current practices and techniques of labor analgesia in the Czech Republic (CZE) and Slovakia (SVK). METHODS: All Czech and Slovak departments that provide obstetric anesthesia were invited to participate in a one-month (November 2015) prospective study that monitored in detail all peripartum anesthetic procedures delivered by anesthesiologists. Participating centers recorded all data on-line in the CLADE-IS database (Masaryk University, CZE). RESULTS: The response rate was 71% (70 of 95 departments in CZE, 35 of 54 centers in SVK). Participating centers represented 87.7% of all births in CZE and 66.4% of all births in SVK during the study period. Analgesia for labor, administered by anesthesiologists, was recorded in 12.5% of deliveries (CZE 12.1%, SVK 13.4%). Epidural analgesia was used in most of the cases (CZE 97.2%, SVK 99.1%) whereas spinal (CZE 1.4%, SVK 0.9%) or combined spinal-epidural (CZE 0.5%, SVK 0.0%) and intravenous remifentanil analgesia (CZE 2.4%, SVK 0.0%) were used infrequently. One fifth of the labors with analgesia administered by anesthesiologists (CZE 20.2%, SVK 20.5%) terminated in cesarean section. CONCLUSIONS: Although labor analgesia was available in all Czech and Slovak obstetric centers, only a small proportion of parturients received an effective method of labor pain relief (regional or intravenous analgesia).
Asunto(s)
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Epidural/efectos adversos , Analgesia Obstétrica/efectos adversos , Femenino , Humanos , Embarazo , Estudios Prospectivos , Eslovaquia , Encuestas y CuestionariosRESUMEN
BACKGROUND: In a previous study we compared rocuronium and suxamethonium for rapid-sequence induction of general anaesthesia for caesarean section and found no difference in maternal outcome. There was however, a significant difference in Apgar scores. As this was a secondary outcome, we extended the study to explore this finding on a larger sample. METHODS: We included 488 parturients of whom 240 were women from the original study. Women were randomly assigned to receive either rocuronium 1mg/kg (ROC n=245) or suxamethonium 1mg/kg (SUX n=243) after propofol 2mg/kg. Anaesthesia was maintained with up to 50% nitrous oxide and up to one minimum alveolar concentration of sevoflurane until the umbilical cord was clamped. We compared neonatal outcome using Apgar scores and umbilical cord blood gases. RESULTS: Data were analysed for 525 newborns (ROC n=263vs. SUX n=262). There was a statistically significant difference in the proportion of Apgar scores <7 at 1min (ROC 17.5% vs. SUX 10.3%, P=0.023) but no difference at 5min (ROC 8% vs. SUX 4.2%, P=0.1) or 10min (ROC 3.0% vs. SUX 1.9%, P=0.58). There was no difference between groups in other measured outcomes. CONCLUSION: The use of rocuronium was associated with lower Apgar scores at 1min compared with suxamethonium. The clinical significance of this is unclear and warrants further investigation.
Asunto(s)
Androstanoles/farmacología , Anestesia General/métodos , Anestesia Obstétrica/métodos , Puntaje de Apgar , Succinilcolina/farmacología , Adulto , Cesárea , Femenino , Humanos , Recién Nacido , Embarazo , RocuronioRESUMEN
AIM OF THE STUDY: To evaluate the influence of warmed infusions on the mothers and newborns well-being after C-section. DESIGN: Prospective randomized study. SETTING: Dept. of Anaesthesiology, Resuscitation and Intensive Care Medicine, Dept. of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry Palacký University and University Hospital Olomouc. METHODS: Prospective randomized study including 29 pregnant women between 38th and 42nd week of pregnancy, that were indicated to elective caesarian section (SC) and from all of which the fetal distress was excluded. The women were randomized into four groups according to the temperature of applied infusion solution - colloids and afterwards crystalloids (pre-heated and non pre-heated), and according to the type of anaesthesia (general or SAB). These values were monitored in perioperative period: body temperature, differences of hemoglobin and hematocrit levels, tremor and pain level after the operation. In newborns the acid-base balance parameters and Apgar score were monitored. RESULTS: The study is still going on, however up to now some of the results suggest that usage of pre-heated infusion solutions is effective both for mother and child in increasing of their comfort in the perioperative period. In the group of actively heated mothers we have noticed: lower perioperative blood loss - differences in haemoglobin levels were 8 g/l compared to 15 g/l in the group of non heated mothers. The umbilical cord blood of the newborns whose mothers were not actively heated and were operated in subarachnoid anaesthesia had the lowest pO2 (0.9 kPa). The lowest level of umbilical cord blood lactate was noticed in the group of newborns whose mothers underwent the surgery under general anaesthesia and were actively heated. CONCLUSION: Up to now results suggest that the heating of mothers during the SC lowers the loss of body temperature, blood loss, and perception of pain by the mother. In combination with general anaesthesia it increases pO2 and lowers the levels of lactate in umbilical arteria in the newborns.