Peridural Anesthesia Research Articles

Possibilities of using nimesulide in clinical practice, features of use in dorsopathy

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a structurally diverse group of drugs with a common mechanism of action (reversible inhibition of cyclooxygenase). They are widely used due to their analgesic, antipyretic and anti-inflammatory properties; available both as prescription and over-the-counter medications; available as individual pharmaceuticals, compound painkillers. The methods of treatment of acute and chronic pain are different. For acute pain, analgesics such as nonsteroidal anti-inflammatory drugs and opiates are commonly used, sometimes in combination with regional anesthesia such as peripheral nerve blockade or peridural local anesthesia. A systematic review and meta-analysis of the efficacy and safety of nimesulide published in the sources MEDLINE/PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure. The efficacy and safety of the use of nimesulide in clinical practice is shown. In particular, in the treatment of acute musculoskeletal pain (dorsopathy of the cervical-thoracic and lumbar region), as well as migraines, due to a decrease in the release of calcitonin- gene related peptide (CGRP) and prostaglandin E2 (PGE2) from the trigeminal ganglia, while other NSAIDs have shown a lack of efficacy. Noncompliance with international guidelines, irrational use of NSAIDs among all groups of drugs is one of the leading causes of hospitalizations associated with side effects, which increases health care costs. The article presents an overview of the safety and efficacy of medicines containing nimesulide, as well as recommendations for patients and prescribers of this drug.

Venous thrombectomy in extensive cerebral venous sinus thrombosis and cerebrospinal fluid leakage after cesarean sectio under peridural anesthesia

Venous thrombectomy in extensive cerebral venous sinus thrombosis and cerebrospinal fluid leakage after cesarean sectio under peridural anesthesia

Neuraxial anesthesia in hepato-pancreatic-bilio surgery: a first western pilot study of 46 patients.

The most common anesthetic approach in hepato-pancreatic-biliary (HPB) surgery is general anesthesia (GA), but it may result in increased morbidity and mortality and peri-operative risks especially in frail patients. The aim of this study was to assess the safety and effectiveness of neuraxial anesthesia (NA) in HPB in a pilot clinical series. This analysis was conducted on 46 consecutive patients undergoing HPB surgery in an Italian Tertial referral center. Data were prospectively collected and retrospectively analyzed. continuous spinal anesthesia (CSA), combined spino-epidural anesthesia (CSEA) and peridural anesthesia (PA) were used in major and minor hepatectomies and bilio-pancreatic surgery instead of GA. NA was evaluated by analyzing the surgical and anesthesiological short-term outcomes. 46 patients were considered eligible for the study between February 2018 and May 2020. The average age was 69.07 (± 9.95) years. 22 were males and 24 were females. According to the ASA score, 19 (41.30%) patients had ASA II, 22 (47.83%) had ASA III and 5 (10.87%) had ASA IV. 22 (47.83%) patients underwent CSA, 20 (43.48%) CSEA and 4 (8.69%) PA. We performed 8 major and 19 minor hepatectomies, 7 bilio-digestive derivations, 5 Whipple procedures, 4 iatrogenic biliary duct injuries, 2 splenopancreatectomies and 1 hepatic cyst fenestration. Clavien-Dindo ≥ 3 was observed in 3 patients. The conversion rate to endotracheal intubation occurring in 3 of 46 (6.52%) patients. After surgery, no local or pulmonary complications and delirium were reported in our series. The present study demonstrates that NA is a safe and feasible option in selected patients, if performed in referral centers by well-trained anaesthesiologists and surgeons.

Trial of Labor after Three or More Previous Cesarean Sections: Systematic Review and Meta-Analysis of Observational Studies.

To assess the success rate and prevalence of maternal or neonatal complications in women undergoing a trial of labor after three or more (≥3) previous cesarean sections (CSs). A systematic literature review and meta-analysis was conducted from inception to May 2022 in Medline, Scopus, ENBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials and Reviews. Items detailing success rate and complications in women with a history of≥3 previous CSs were considered. Selected articles were evaluated for quality, heterogeneity, and publication bias. A pooled prevalence or odds ratio was calculated. Twelve articles were included for a total of 540 women with a history of≥3 CSs, accounting for the 2% (CI 95% 1-4%) of the whole cohort of trial of labor. Our findings show a 0.67 (CI 95% 0.53-0.78) rate of successful vaginal delivery. A higher success rate was observed in women having a history of a prior vaginal delivery (0.90, CI 95% 0.77-0.96) and when prostaglandins, peridural anesthesia or oxytocin were allowed (respectively 0.73, CI 95% 0.62-0.83, 0,73, CI 95% 0.57-0.85 and 0.73, CI 95% 0.64-0.81). Uterine rupture rate was 0.01 (CI 95% 0.00-0.01). No cases of fetal asphyxia or maternal or neonatal death were registered. The success rate and low frequency of severe complications observed seem to support a trial of labor in selected patients desiring a natural birth. However, a potential underestimation of serious maternal and neonatal complications should be considered in the decision-making process.

Analyses of requirements for curriculum development for the training of anesthesiologists in the delivery room-A nationwide survey

HintergrundDie anästhesiologische Tätigkeit in der Kreißsaalumgebung impliziert die Besonderheiten der 200 %-Letalität, die beschreibt, dass Notfallsituationen Mutter und Kind betreffen können. Ein Umstand, der die Notwendigkeit einer besonderen Sorgfalt in der Mitarbeiterausbildung und -auswahl eindrücklich unterstreicht. Gleichwohl existiert derzeit keine detaillierte Beschreibung der notwendigen Kompetenzen in dieser Arbeitsumgebung. Die vorliegende Studie soll die Ausbildungssituation in der anästhesiologischen Weiterbildung beschreiben und im Hinblick auf die Notwendigkeit eines Curriculums analysieren.MethodikIn einer multizentrischen Beobachtungsstudie wurden Ärzt:innen in Weiterbildung (AiW) und ausbildende Fachärzt:innen (FÄ) nach Methoden der Einarbeitung, Feedbackgabe, übernommenen Tätigkeiten und Bedarf eines Curriculums befragt. Teilnehmende wurden über die Mitgliedsdatenbank der DGAI angeschrieben und konnten onlinebasiert den 11 Items umfassenden Fragebogen beantworten.ErgebnisseInsgesamt wurden 495 Fragebogen (FÄ 329;166 AiW) abgeschlossen. Fachärzt:innen und AiW machen unterschiedliche Angaben zur Durchführung von Abschlussgesprächen (59,6 % vs. 10 %) und der Unterstützung durch ein Curriculum (76,3 % vs. 15,7 %). Unabhängig vom Weiterbildungsjahr werden von AiW Kaiserschnitte unter Supervisionsstufe „Rufweite“ durchgeführt. Die Periduralanästhesie (PDA) ist während der Einarbeitung die am seltensten durchgeführte Maßnahme. Beide Gruppen schätzen den Nutzen bzw. den Wert einer Beschreibung von Lernzielen und der Verfügbarkeit eines Curriculums als hoch ein.SchlussfolgerungDie Unterstützung der Einarbeitung wird von FÄ und AiW teilweise unterschiedlich beantwortet. Einzelne seltene durchgeführte Maßnahmen, wie die PDA, bedürfen künftig einer gesonderten Aufmerksamkeit. Die Beschreibung von Lernzielen und die Curriculumsentwicklung werden ausdrücklich gewünscht.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00101-022-01172-1) enthält den Fragebogen zur Arbeit.

Subdural hematoma and pneumocephalus after neuraxial anesthesia : Clarification of postdural puncture headache after obstetric peridural anesthesia

Subdural hematoma and pneumocephalus after neuraxial anesthesia : Clarification of postdural puncture headache after obstetric peridural anesthesia

Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic.

Background: laparoscopic surgery is mainly performed in general anesthesia. Symptomatic patients infected with COVID-19 needing surgery are however at higher risk for COVID-19 complications in general anesthesia than in regional anesthesia. Even so, Covid transfection is a hazard to medical personnel during the intubation procedure and treatment drugs may be in shortage during a pandemic. Recovery and hospital stay are also shorter after laparoscopy. Laparoscopy performed in regional anesthesia may have several advantages in limiting Covid. Methods: international literature on the risk of COVID-19 complications development was searched. 3 topics concerning laparoscopic surgery were reviewed: (1) Achievements in laparoscopy; (2) Advantages of regional anesthesia compared to general anesthesia; (3) Feasibility to perform laparoscopy in regional anesthesia in COVID-19 pandemic. The authors reviewed abstracts and full-text articles concerning laparoscopic surgery, gynecology, anesthesia and COVID-19. Studies published in PubMed, Embase, Cochrane Library and found in Google Scholar before 1st FEB, 2021 were retrieved and analyzed. Results: a total of 83 studies were found, all of them written in English. 17 studies could be found in gynecology and in general surgery about laparoscopy with regional anesthesia. In Covid time only one study compared laparoscopic surgery in general anesthesia to laparotomy and another study laparotomy in general anesthesia to regional anesthesia. Laparoscopy showed no disadvantage compared to laparotomy in Covid pandemic and in another study laparotomy in general anesthesia was associated with higher mortality and more pulmonary complications. Trendelenburg position can be a threat if used by inexperienced personnel and can induce unintended anesthesia of breathing organs. On the other hand Trendelenburg position has advantages for cardiovascular and pulmonary functions. Pneumoperitoneum of low CO2 pressure is well tolerated by patients. Conclusions: elective surgery should be postponed in symptomatic Covid patients. In inevitable emergency surgery intubation anesthesia in COVID-19 pandemic is as far as possible to be avoided. In COVID-19 pandemic, regional anesthesia is the preferred choice. The optimum may be the combination of laparoscopic surgery with regional anesthesia. Reducing the pneumoperitoneum is a good compromise for the comfort of patients and surgeons. A special case is gynecology, which needs to be performed in Trendelenburg position to free pelvic organs.

Ein deutsch-deutsches Schicksal: Heinz Ruppert – ein in Vergessenheit geratener Pionier der Periduralanästhesie und der letzte Schiffsarzt der PAMIR

In the fall of 1957 there was amomentous ship disaster, during which the four-masted barque PAMIR sank in the Hurricane Carrie northwest of the Azores and 80crew members were killed. Among the crew members killed was the ship's doctor Dr. med. Heinz Ruppert, aspecialist in anesthesiology, gynecology and obstetrics from the University Women's Hospital of the Charité in East Berlin. Since he was also aspecialist in anaesthesiology he was primarily responsible for the anaesthesiological care of patients at the University Women's Hospital at the Charité. As an avid supporter of neuraxial conduction anaesthesia techniques, he primarily worked on this topic scientifically and tried to establish peridural anaesthesia in obstetrics. In 1954 he was able to habilitate at the Charité with athesis on this subject and was appointed as lecturer. His scientific oeuvre has so far not been appreciated, areason to remember this forgotten German protagonist of gynecological obstetric anaesthesia.

Peridural Anesthesia and Cancer-Related Survival after Surgery for Pancreatic Cancer—A Retrospective Cohort Study

Background: In patients with prostatic and breast cancer the application of peridural anesthesia (PDA) showed a beneficial effect on prognosis. This was explained by reduced requirements for general anesthetics and perioperative opioids as well as a lower perioperative stress level. The impact of PDA in patients with more aggressive types of cancer has not been completely elucidated. Here, we analyzed the prognostic influence of PDA on overall survival after surgery as primary in patients that underwent radical resection of pancreatic adenocarcinoma. Methods: Records of 98 consecutive patients were reviewed. In 70 of these cases PDA was applied. Patient characteristics such as demographics, TNM stage, and operative data were retrospectively collected from medical records and analyzed. Survival data were analyzed by Cox’s proportional hazard regression model. Results: Overall, no significant prognostic influence of PDA on recurrence or overall survival (p = 0.762, Hazard Ratio [HR] 0.884, 95% confidence interval [CI] 0.398–1.961) was found. However, there was a trend towards a longer overall survival (p = 0.069, HR 0.394, 95% CI 0.144–1.078) associated with PDA in a subgroup of patients with better differentiation of pancreatic adenocarcinoma. Conclusion: The observation of longer survival associated with PDA in our subgroup of patients with better-differentiated pancreatic carcinomas is in line with previous reports on various other less aggressive tumor entities. Our results indicate that PDA might improve the oncological outcome of patients with pancreatic adenocarcinoma.

Placenta Accreta: Management by Peridural Anesthesia

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Sensory Stimulation of Oxytocin Release Is Associated With Stress Management and Maternal Care.

It has been shown that various types of stress initiate different physiological and neuroendocrine disorders. Oxytocin (OT) is mainly produced in the supraoptic nucleus (SON) and paraventricular nucleus (PVN) of the hypothalamus. Hypothalamic OT has antistress effects and attenuates the hypothalamic–pituitary–adrenal (HPA) axis. One mechanism behind the antistress effects of OT is mediated through the inhibition from GABAA receptors on corticotropin-releasing factor (CRF) expression at the PVN. Various manual therapies such as acupuncture, transcutaneous electrical nerve stimulation (TENS), and massage initiate the stimulation of somatosensory neurons of the body. It is well-known that TENS simulates OT expression, while it inhibits CRF expression at the PVN following chronic stress loading in rodents. Upregulation of OT expression at the hypothalamus is activated by the somatosensory stimulation, which is mediated via the spinothalamic pathway (the connection between the spinal cord and hypothalamus). Thus, somatosensory stimulation is beneficial in treating stress-associated symptoms. Hypothalamic OT is associated with the social behaviors, including maternal care and affiliation. Childhood neglect and/or child abuse are severely responsible for deleterious long-term effects on the cognitive/social activity and behavioral development. At parturition, a profound amount of OT is released into the systemic circulation in response to vaginal and cervical stimulation caused by the body of fetus, which induces the onset of maternal behavior. Peridural anesthesia effectively impairs the sensitivity to vaginal and cervical stimulation at parturition. OT levels in cerebrospinal fluid is significantly reduced following peridural anesthesia. The vaginal delivery mothers had significantly more OT pulses than the caesarian section (CS) mothers. Due to low levels of endogenous OT, maternal behavior could be interrupted by epidural anesthesia and CS at parturition because of the reduction of the usual sensory input from the genitalia.

Diagnosis and treatment of destructive forms of acute pancreatitis

Purpose of the study. The study of the diagnosis and treatment of destructive forms of acute pancreatitis and the identification of possible ways to optimize them.
 Materials and methods. Destructive forms of acute pancreatitis were found in 16,8%. The algorithm for treating acute destructive pancreatitis consisted in artificial ventilation of the lungs, adequate infusion therapy, peridural anesthesia, setting up a nasoenteric probe, stimulating the bowels, correcting hemodynamics, intraand extracorporal detoxification, antisecretory, anti-bacterial, hepatoprotective, cerebroprotective, antioxidant therapy, directed immune correction, use of anti-enzyme drugs, suppression of the release of mediators inflammation, external secretory activity of the pancreas. Medical video laparoscopy and puncture interventions under the control of ultrasound were used as the first stage of surgical treatment. The indications for traditional surgical interventions are large areas of aseptic destruction, unlimited infected pancreatic necrosis, infection of necrotic areas with complete cell sequestration, abscesses with large sequesters, abdominal phlegmon, signs of progressive multiple organ failure and the development of arousal hemorrhage, perforation of cystic formations in the abdominal cavity, perforation of a hollow organ, purulent peritonitis.
 Results. The developed therapeutic tactics allowed, in destructive forms of acute pancreatitis, to achieve a reduction in overall mortality to 23,4%.
 Conclusion. Diagnostic and treatment tactics for destructive forms of acute pancreatitis should be standardized depending on the timing, severity of the disease, localization and prevalence of the destructive process, systemic and local complications.

A Novel Skin Marking Technique for Excess Skin Resection by Fleur-de-lis Abdominoplasty

Introduction: Fleur-de-lis abdominoplasty is used in vertical and horizontal correction of excess skin. However, determining how much skin to resect can be challenging. In this paper we describe a high-precision skin marking technique for this purpose. Patients and methods: Between April 2012 and June 2016, 24 patients of both sexes were submitted to fleur-de-lis abdominoplasty under peridural anesthesia and sedation, without liposuction, by the same surgeon. Results: The average age was 44 years (range: 23-61). The mean duration of surgery was 144 min (range: 120-160). All scars were adequately aligned. Conclusion: The technique was found to be safe and easy to perform and reproduce. Moreover, high precision helps avoid sinuous and tense scars. Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome associated with intracranial hypotension

Reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES) are both rare disorders. The pathophysiology of both diseases is not yet fully understood. We report the unique case of a 19-year-old comatose woman who was brought to the ER after a series of generalized tonic-clonic seizures 6days post peridural anesthesia for cesarean section. Vital signs and initial laboratory testing including urine analysis and drug screening were unremarkable. Initial cranial CT scan showed an acute small subdural hematoma (17mm length×6mm width×30mm height), cerebral edema with slit ventricles, and slight cerebellar tonsillar herniation as signs of intracranial hypotension. CT angiography depicted narrowing of the proximal intracranial vessels consistent with RCVS. MR imaging was also suggestive of both intracranial hypotension and RCVS and showed, in addition, vasogenic edema consistent with PRES. An extensive CSF leakage involving T1 to L2/L3 was confirmed by spinal MRI. The patient underwent conservative therapy for intracranial hypotension (e.g., head-down position) as well as epidural blood patch, which led to regression of the clinical symptoms within a few days. Follow-up MRI showed complete resolution of all radiological changes. In summary, our patient developed clinical and neuroradiological signs of intracranial hypotension and a combination of PRES and RCVS associated with a CSF leakage caused by peridural anesthesia; by treating the intracranial hypotension, the other syndromes resolved. From a clinical point of view, it is important to look for CSF leakage as a treatable possible cause of PRES and/or RCVS triggered by intracranial hypotension as in our patient postpartum. Moreover, it is vital to obtain a good history as, in cases of suspected CSF leakage with classic postural headache, a recent spinal/cranial procedure is typically present.

Risk factors for emergency caesarean section in planned vaginal breech delivery.

To identify risk factors for emergency caesarean section in women attempting a vaginal breech delivery at term. Data from 1092 breech deliveries performed between 1998 and 2013 at a Swiss cantonal hospital were extracted from an electronic database. Of the 866 women with a singleton, full term pregnancy, 464 planned a vaginal breech delivery. Fifty-seven percent (265/464) were successful in delivering vaginally. Multivariate regression analyses of risk factors were performed, and neonatal and maternal complications were compared. Risk factors for failed vaginal delivery were peridural anaesthesia (OR 2.05; 95% CI 1.09-3.84; p=0.025), nulliparity (OR 2.82; 95% CI 1.87-4.25; p<0.001), high birth weight (OR 1.17; 95% CI 1.04-1.30; p=0.006) and induction of labour (OR 1.56; 95% CI 1.003-2.44; p=0.048). Maternal age, height and weight; gestational age; or newborn length and head circumference were not associated with an unplanned caesarean section. The rate of successful vaginal delivery in the low risk sub-group (multiparous women without induction of labour) was 58-83%, depending on birth weight category. The likelihood of success for the high risk sub-group (nulliparous women with induction of labour) fell below a third at neonatal birth weights >3250g. Complication rates were low in the cohort. Use of peridural anaesthesia, nulliparity, high birth weight and induction of labour were risk factors for unsuccessful vaginal breech delivery requiring an unplanned caesarean section. Awareness of these risk factors is useful when counselling women who are considering a vaginal breech delivery.

A New Proposal for Management of Severe Frostbite in the Austere Environment

Despite advances in outdoor clothing and medical management of frostbite, individuals still experience catastrophic amputations. This is a particular risk for those in austere environments, due to resource limitations and delayed definitive treatment. The emerging best therapies for severe frostbite are thrombolytics and iloprost. However, they must be started within 24 hours after rewarming for recombinant tissue plasminogen activator (rt-PA) and within 48 hours for iloprost. Evacuation of individuals experiencing frostbite from remote environments within 24 to 48 hours is often impossible. To date, use of these agents has been confined to hospitals, thus depriving most individuals in the austere environment of the best treatment. We propose that thrombolytics and iloprost be considered for field treatment to maximize chances for recovery and reduce amputations. Given the small but potentially serious risk of complications, rt-PA should only be used for grade 4 frostbite where amputation is inevitable, and within 24 hours of rewarming. Prostacyclin has less risk and can be used for grades 2 to 4 frostbite within 48 hours of rewarming. Until more field experience is reported with these agents, their use should probably be restricted to experienced physicians. Other modalities, such as local nerve blocks and improving oxygenation at high altitude may also be considered. We submit that it remains possible to improve frostbite outcomes despite delayed evacuation using resource-limited treatment strategies. We present 2 cases of frostbite treated with rt-PA at K2 basecamp to illustrate feasibility and important considerations.

Risk factors associated with prolonged postoperative ileus after elective colon resection.

There is a coordinated inhibition of motility of the colon after its surgical manipulation that contributes to the accumulation of fluids and gas, in turn characterized by nausea,vomiting, pain, abdominal distension, and constipation. Motility is recovered in the majority of patients within the first 72 hours. A delay in its resolution is known as prolonged postoperative ileus. To study the preoperative, intraoperative, and postoperative risk factors for developing prolonged ileus in patients that underwent elective colon resection.Materials and methods: The association between 25 perioperative variables and the presentation of prolonged ileus was analyzed in 85 patients that underwent colon resection at Hospital Christus Muguerza Alta Especialidad within the time frame of 2011 and 2014. Postoperative ileus occurred in 22.3% of the patients. The statistically significant predictors of ileus were obesity (OR 1.119, P=.048) and admission to the intensive care unit (OR3.571, P=.050). The use of peridural anesthesia during the surgical act was found to be a protective factor (OR 0.363, P=.050). The presence of these risk factors can alert the physician to the need for a closer follow-up in patients at high risk for postoperative ileus, and the use of peridural anesthesiacan possibly lower the incidence of ileus.

Risk factors associated with prolonged postoperative ileus after elective colon resection

BackgroundThere is a coordinated inhibition of motility of the colon after its surgical manipulation that contributes to the accumulation of fluids and gas, in turn characterized by nausea, vomiting, pain, abdominal distension, and constipation. Motility is recovered in the majority of patients within the first 72hours. A delay in its resolution is known as prolonged postoperative ileus. AimsTo study the preoperative, intraoperative, and postoperative risk factors for developing prolonged ileus in patients that underwent elective colon resection. Materials and methodsThe association between 25 perioperative variables and the presentation of prolonged ileus was analyzed in 85 patients that underwent colon resection at Hospital Christus Muguerza Alta Especialidad within the time frame of 2011 and 2014. ResultsPostoperative ileus occurred in 22.3% of the patients. The statistically significant predictors of ileus were obesity (OR 1.119, P=.048) and admission to the intensive care unit (OR 3.571, P=.050). The use of peridural anesthesia during the surgical act was found to be a protective factor (OR 0.363, P=.050). ConclusionsThe presence of these risk factors can alert the physician to the need for a closer follow-up in patients at high risk for postoperative ileus, and the use of peridural anesthesia can possibly lower the incidence of ileus.

Transplacental Distribution of Lidocaine and Its Metabolite in Peridural Anesthesia Administered to Patients With Gestational Diabetes Mellitus

Neonatal effects of drugs administered to mothers before delivery depend on the quantity that crosses the placental barrier, which is determined by the pharmacokinetics of the drug in the mother, fetus, and placenta. Diabetes mellitus can alter the kinetic disposition and the metabolism of drugs. This study investigated the placental transfer of lidocaine and its metabolite monoethylglycinexylidide (MEGX) in pregnant women with gestational diabetes mellitus (GDM) submitted to peridural anesthesia. A total of 10 normal pregnant women (group 1) and 6 pregnant women with GDM (group 2) were studied, all at term. The patients received 200 mg 2% lidocaine hydrochloride by the peridural locoregional route. Maternal blood samples were collected at the time of delivery and, after placental expulsion, blood samples were collected from the intervillous space, umbilical artery, and vein for determination of lidocaine and MEGX concentrations and analysis of the placental transfer of the drug. The following respective lidocaine ratios between the maternal and the fetal compartments were obtained for groups 1 and 2: umbilical vein/maternal peripheral blood, 0.60 and 0.46; intervillous space/maternal blood, 1.01 and 0.88; umbilical artery/umbilical vein, 0.77 and 0.91; and umbilical vein/intervillous space, 0.53 and 0.51. The following MEGX ratios for groups 1 and 2 were, respectively, fetal/maternal, 0.43 and 0.97; intervillous space/maternal blood, 0.64 and 0.90; umbilical artery/umbilical vein, 1.09 and 0.99; and umbilical vein/intervillous space, 0.55 and 0.78. Gestational diabetes mellitus did not affect the transplacental transfer of lidocaine but interfered with the transfer of MEGX, acting as a mechanism facilitating the transport of the metabolite.

Síndrome neurológico transitorio y anestesia espinal-epidural combinada: ¿expresión de toxicidad por anestésico local?

Se reporta el caso de una paciente de 39 años de edad quien es llevada a histerectomía abdominal total, cistouretropexia retropúbica mas colporrafia posterior bajo anestesia espinal, realizada con bupivacaína hiperbárica al 0,5 % y uso de analgesia peridural; al momento del retiro de catéter peridural presenta sintomatología neurológica en miembros inferiores. Se diagnostica síndrome neurológico transitorio (TNS) y se realiza seguimiento hasta la desaparición de su sintomatología. Es importante entender que a pesar de la evolución benigna de esta entidad, este cuadro es de interés, ya que su verdadero impacto clínico aún está por definirse debido a que los primeros reportes en la literatura datan del año 1993 y que su incidencia presenta gran variabilidad. En este artículo se hace una revisión de la literatura actual sobre TNS, además se describen las características principales de dicha patología.