Anestesia subaracnoidea para cesárea con dosis de seis miligramos de bupivacaína pesada más opioides. Estudio retrospectivo
Background: Caesarean section is one the most widely performed surgical procedure in the world. Subarachnoid anesthesia is currently the most controlled anesthetic technique for this procedure, safest to the mother and the fetus. The dose of bupivacaine administered in this technique varies signific...
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| Tipo de recurso: | tesis de maestría |
| Estado: | Versión aceptada para publicación |
| Fecha de publicación: | 2020 |
| País: | Colombia |
| Institución: | Universidad Nacional de Colombia |
| Repositorio: | Repositorio UN |
| Idioma: | español |
| OAI Identifier: | oai:repositorio.unal.edu.co:unal/75558 |
| Acceso en línea: | https://repositorio.unal.edu.co/handle/unal/75558 |
| Access Level: | acceso abierto |
| Palabra clave: | Medicina y salud Anestesia subaracnoidea; Espinal fallida; Cesárea; Dosis bajas; Bupivacaína Subarachnoid anesthesia; Failed spinal; Cesarean section; Low dose; Bupivacaine |
| Sumario: | Background: Caesarean section is one the most widely performed surgical procedure in the world. Subarachnoid anesthesia is currently the most controlled anesthetic technique for this procedure, safest to the mother and the fetus. The dose of bupivacaine administered in this technique varies significantly; low doses are considered to be less than 8 mg when co-administered with opioids. Some benefits have been suggested for low doses of bupivacaine, but their usefulness is still controversial Purpose: To establish the proportion of pregnant women in which caesarean section (operability) was performed under subarachnoid anesthesia with a dose of 6 mg of simple bupivacaine plus fentanyl (variable doses) and 100 mcg of morphine, as well as the patients who required sedation and the total patients with failed spinal anesthesia. To calculate the percentage of patients with hypotension, the used vasopressor and the doses. To determine associations between the studied variables with operability, sedation requirement and failed spinal anesthesia. Methods and design: Descriptive retrospective observational study in the period between July 1, 2018 and December 31, 2018. Records from patients in La Victoria hospital - Instituto Materno Infantil, led to caesarean section under subarachnoid anesthesia, in which doses of 6 mg of Bupivacaine with varying fentanyl was performed with the IBM SPSS Statistics 25® package. After making the descriptive analysis of each variable, they were crossed to determine associations. Results: A total of 85 records that met the inclusion criteria were obtained. No records were excluded. 81 patients (95.29%) met operability criteria; precisely, 4 (4.93%) required sedation. The total percentage of failed spinal was 9.4%. The proportion of patients who presented hypotension was 62.9%. The main vasopressor used was noreadrenaline (92.8% of cases), with a median dose of 50 mcg (Q1 = 40, Q3 = 97.5). An association was found between presenting levels of sensory block of T5 or lower with sedation requirement (OR = 0.05, p = 0.012) and failed spinal (OR = 0.09, p = 0.004). Discussion and conclusions: The rate of conversion to general anesthesia and sedation was higher than acceptable reported by some authors. The proportion of sedation requirement was lower than reported in most studies with similar low doses. Presented hypotension was high. The main vasopressor used was norepinephrine as currently recommended in literature. Presenting a level of T5 sensory block or lower was associated with a sedation requirement and failed spinal. Keywords: subarachnoid anesthesia, failed spinal, cesarean section, low dose, bupivacaine. |
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