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Biomedical subjects

E Guasch

Publications and source records attributed to E Guasch.

15 recordsLinked to original sources
PubMed2006

[Difficulty of epidural puncture for obstetric analgesia: risk factors].

INTRODUCTION: Predicting technical difficulties in performing an epidural block can affect the anesthesiologist's choice of technique or decisions about who should carry it out. Our aim was to determine patient characteristics associated with difficulty in performing an epidural block for obstetric analgesia. MATERIAL AND METHODS: We designed a prospective observational study in 540 pregnant women who requested epidural analgesia for obstetric labor. Patient characteristics (age, weight, height), anatomical features (body constitution, visible and/or palpable spinal apophyses, structural anomalies), technical features (number of attempts, repositioning of the needle), anesthesiologist's experience (resident or staff), block success, time taken to accomplish the procedure, and obstetrical variables (parity, gestational age, cervical dilatation). RESULTS: The factor that best correlates with puncture difficulty in the obstetric patient is the presence of visible or palpable spinal apophyses and palpation prior to carrying out the block. Factors like weight, body constitution, or anesthesiologist's experience seem to influence the rate of success or failure of the epidural block for obstetric analgesia, although to a lesser degree. CONCLUSIONS: The most important factor for predicting success of an epidural block for obstetric analgesia in our practice is the presence of palpable spinal apophyses.

Adolescent↗
PubMed2005

[Comparison of 4 anesthetic techniques for in vitro fertilization].

UNLABELLED: Little is known of the effect on oocytes of anesthesia administered during retrieval. The main objective of this study was to compare the prolactin and stress hormone responses to surgical stimulus under 4 anesthetic techniques and to determine whether there is an effect of technique on the number and quality of oocytes retrieved. METHODS: We designed a clinical trial to determine the plasma and follicular levels of prolactin and cortisol in patients in an assisted reproduction program. The patients were randomized to 3 anesthetic groups: general anesthesia, spinal anesthesia, or sedation with alfentanil and midazolam plus paracervical block. Patients were consecutively assigned to the fourth group to receive sedation with remifentanil plus paracervical block. RESULTS: We studied 90 patients. The patients receiving general anesthesia had the greatest increase in prolactin by the end of the procedure. Follicular cortisol increased in the paracervical block group in which remifentanil was used for sedation. The only significant difference between groups was seen for the rate of gestation of 0% in the group receiving sedation with alfentanil and midazolam before a paracervical block. Adverse effects were few with all the techniques. All patients reported a high degree of satisfaction. CONCLUSIONS: Plasma increases in prolactin and hormonal responses to follicular puncture were fully attenuated by spinal anesthesia and partially attenuated by the techniques requiring sedation. None of the anesthetic techniques proved harmful to oocytes or embryos. Nor was the effectiveness of the in vitro fertilization technique affected by any of the anesthetic techniques studied.

Adult↗
PubMed2005

[Randomized controlled trial comparing a low dose to a conventional dose of hyperbaric bupivacaine for scheduled cesarean section].

INTRODUCTION: Spinal anesthesia is the technique most often applied in cases of scheduled cesarean section. Many authors have tried decreasing the local anesthetic dose by adding opioids to achieve adequate analgesia with greater hemodynamic stability, although the ideal dose remains to be established. Our aim was to analyze hemodynamic stability and quality of analgesia with 2 different regimens for administering spinal hyperbaric bupivacaine. METHODS: We designed a controlled, double-blind trial comparing 2 doses of spinal hyperbaric bupivacaine with fentanyl in 42 patients undergoing elective cesarean section randomized to 2 groups to receive either the low dose or the conventional one. One group received an 11 mg dose of bupivacaine and the other group received a 6.5 mg dose, combined with 20 microg of fentanyl in both cases. RESULTS: The hemodynamic profile and the level of maximum sensory block obtained were similar in the two groups. The motor block was less intense in patients receiving the lower dose and it was necessary to convert 2 patients (10%) to general anesthesia in that group. CONCLUSIONS: Spinal anesthesia with low doses of bupivacaine and fentanyl provides acceptable intraoperative conditions for a high percentage of patients undergoing cesarean section, with a similar incidence of hypotension. The low dose generates a less intense intraoperative motor blockade with similar spread of the sensory block. The low dose was not efficacious for 10% of the patients who received it.

Adult↗
PubMed1996

[Amniotic fluid embolism: review].

The amniotic fluid embolism, is a very uncommon syndrome but because of its severity and high mortality, it is interesting to study and to get a deep knowledge of its etiopathogenia and physiopathology. In this article, we revise the actually purposed pathogenic mechanisms, specially the humoral mechanisms in front of mechanical, as it was defended a few years ago. The diagnostic of this syndrome, is an interesting question, because it is not only pathology, actually it trends to immunologic diagnosis. The amniotic fluid embolism, interests to anesthesiologist and its differences in cardiopulmonary resuscitation in the pregnant woman too. All these data are discussed in our article, as much as treatment, that is based upon haemodinamics and cardiopulmonary resuscitation.

Amniotic Fluid↗
PubMed1990

[Cardiac hypertrophy associated with subaortic obstruction induced by adrenocorticotropic hormone treatment].

A 7 months-old child affected of West syndrome presented a cardiac hypertrophy with subaortic obstruction induced by adrenocorticotropic hormone treatment. The administration of this hormone may induce a Cushing syndrome; at high doses has chronotropic and inotropic positive effects and may produce arterial hypertension and cardiac hypertrophy. We pointed out the importance of the echocardiography-Doppler in the diagnosis and follow-up of the cardiac hypertrophy with subaortic obstruction as well as the reversibility of the cardiac involvement when the drug is suppressed.

Adrenocorticotropic Hormone↗