Jorge Rubio

Paciente embarazada con enfermedad cardiaca: manejo periparto basado en la estratificación del riesgo: serie de casos 2005-2009

RESUMEN Objetivo Reportamos nuestra experiencia en el manejo de una serie de pacientes obstetricas con enfermedad cardiaca de diferentes etiologias, utilizando una estrategia de estratificacion del riesgo, para elaborar un plan de manejo periparto en el que esta incluido el manejo anestesico. Metodos Serie de casos. Revision retrospectiva de 37 pacientes embarazadas con diagnostico de enfermedad cardiaca de diferentes etiologias, ingresadas a la Unidad de Alta Dependencia Obstetrica de la Clinica del Prado, de Medellin, Colombia entre 2005 y 2009. Resultados Del total de 37 pacientes, 15 presentaron enfermedad cardiaca congenita; 13, enfermedad cardiaca valvular; 5, cardiomiopatia periparto, y las 4 restantes, trastornos del ritmo y enfermedad isquemica. Se estratifico el riesgo segun la clasificacion de lesiones anatomicas y el riesgo de eventos cardiacos basados en el CARPREG. Se identificaron ocho pacientes en el grupo de alto riesgo y el resto, en riesgo intermedio y bajo. La mayor parte de las pacientes fueron manejadas con tecnicas anestesicas conductivas (89,2 %). La decision de cesarea (35 %) se dio por indicacion obstetrica. Se presentaron complicaciones maternas de origen cardiovascular en el 10,8 % de los casos. No se presentaron muertes maternas. Conclusion La implementacion de un protocolo de estratificacion del riesgo de muerte y de la aparicion de complicaciones cardiovasculares en la paciente embarazada con cardiopatia le permite al anestesiologo hacer parte integral del grupo interdisciplinario de manejo y, asi, tener impacto en la obtencion de un mejor resultado materno y perinatal en este grupo de pacientes.

Effects of Thermal Protection in Patients Undergoing Body Contouring Procedures: A Controlled Clinical Trial

Background: Hypothermia is common in many plastic surgery procedures, but few measures to prevent its occurrence are taken. Objectives: This study evaluated the effect of hypothermia in patients undergoing plastic surgery procedures and the effect of utilizing simple and inexpensive measures to prevent patient hypothermia during surgery. Methods: A randomized controlled clinical trial was performed among 3 groups of patients who underwent body contouring surgery for longer than 3.5 hours. In group 1, no protective measures were taken to prevent hypothermia; in group 2, maneuvers were applied intraoperatively for the duration of the entire surgical procedure; and in group 3, measures were taken preoperatively and intraoperatively. The results were quantified and analyzed through a bivariate analysis, including degree of hypothermia, anesthesia recovery time, time spent in the recovery area, intensity of pain, cold perception, response to opioids, and nausea. Results: There were 122 patients included in the study: 43 in group 1, 39 in group 2, and 40 in group 3. All patients in group 1 had a higher degree of hypothermia, longer recovery time from anesthesia, longer overall recovery time, increased pain, increased feeling of cold, and more nausea. These patients also required a greater amount of opioids compared with the patients in groups 2 and 3. Many of the results were statistically significant. Conclusions: The adoption of simple and inexpensive measures before and during plastic surgery can prevent patient hypothermia during the procedures, leading to a shorter anesthesia recovery time and avoiding the undesirable effects associated with hypothermia. In addition, these measures may have significant economic savings. Level of Evidence: 2: Figure. No Caption available.