The anaesthesiologist facing a pregnant woman with rheumatic disease is caught between a rock (th... more The anaesthesiologist facing a pregnant woman with rheumatic disease is caught between a rock (the problems of general anaesthesia, i.e., the difficult airway and/or the cardiopulmonary dysfunctions that can worsen the response to general anaesthetics or to mechanical ventilation) and a hard place (the problems of loco-regional anaesthesia, i.e., intrinsic or iatrogenic haemostatic dysfunctions, potentially causing spinal haematoma, the most threatening complication). However, the term lupus anticoagulant is a misnomer and in the absence of an underlying coagulation deficit or anticoagulant therapy, the anaesthesiologist can usually guarantee epidural analgesia for vaginal delivery to parturients affected by rheumatic diseases (so contributing to the decrease of the caesarean section rate) and, in case of a caesarean section for medical or obstetrical indications, often he can perform a loco-regional anaesthesia, which determines a substantially lower maternal mortality rate. It is very important to adopt a multidisciplinary approach comprising an antepartum team evaluation (to be performed at 36th gestational week) of the basal condition of the parturient: together, the obstetrician, the rheumatologist and the anaesthesiologist should define the type of delivery. We will also try to define the haemostatic safety criteria to be fulfilled for administration of an epidural analgesia to a parturient affected by rheumatic disease.
Maternal mortality and thromboembolic risk in pregnancy Every year, around the world over half a ... more Maternal mortality and thromboembolic risk in pregnancy Every year, around the world over half a million women die for pregnancy related com-plications. In developing countries one woman in 16 dies compared to one in 2,800 in developed countries. Prevention programs based on the right knowledge can avoid many of these deaths, even in resource poor countries. In this review will be taken into account maternal deaths in developed countries (less than 1 % of the global maternal death rate). In order to reduce maternal mortality, onemust answer the following five ques-tions: 1. How many mothers die? 2. Which kind of mother die? 3. Why mothers die? 4. Was maternal death avoidable? 5. What can be done to prevent them?
ObjectiveTo investigate whether the nature of the decision about receiving neuraxial labour analg... more ObjectiveTo investigate whether the nature of the decision about receiving neuraxial labour analgesia is associated with breastfeeding initiation success (BIS), defined as exclusive breastfeeding until discharge associated with postnatal weight loss <7% at 60 hours from birth.DesignSingle-centre community-based cohort study.SettingAn Italian baby-friendly hospital, from 1 July 2011 to 22 September 2015.ParticipantsInclusion criteria: women vaginally delivering singleton cephalic newborns and willing to breastfeed. Exclusion criteria: women who delivered in uterus-dead fetuses, were single or requested but did not receive neuraxial analgesia. Overall, 775 out of the 3628 enrolled women received neuraxial analgesia.ResultsCompared with women who tried to cope with labour pain, those who decided a priori to receive neuraxial analgesia had less BIS (planned vaginal birth: 2121/3421 (62.0%), vs 102/207 (49.3%; p<0.001; risk difference (RD), 12.7%); actual vaginal birth: 1924/2994 (...
Every year, around the world over half a million women die for pregnancy related complications. I... more Every year, around the world over half a million women die for pregnancy related complications. In developing countries one woman in 16 dies compared to one in 2,800 in developed countries. Prevention programs based on the right knowledge can avoid many of these deaths, even in resource poor countries. In this review will be taken into account maternal deaths in developed countries (less than 1% of the global maternal death rate).
European Review for Medical and Pharmacological Sciences, 2010
To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean sec... more To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean section (CS) performed by Stark method. 200 women were prospectively studied before undergoing to a Stark CS in two groups: 95 patients were assigned to a local anaesthesia by SA (first group) and 105 women to CSE anaesthesia (second group). After a pre-load of 500 ml of plasma expander in both groups, SA was performed at the L1-L2 interspace with an injection of 5 ml of levobupivacaine 0.15%, with a 5 mcg of Sufentanil. The CSE was performed by a spinal-epidural injection at the L1-L2 interspace, primarily by 4 ml of levobupivacaine 0.125% and 5 mcg of Sufentanil, then by 3-7 mL of xilocaine carbonate 0.5% plus 1 mcg/ml of Sufentanil. Successively a CS by Stark method was performed in both groups. The recorded anaesthesiologic side effects in two groups were: motor block, intraoperative discomfort, vomiting, bradycardia and hypotension. Statistical evaluation was by Z-Test referred to the ...
European review for medical and pharmacological sciences, 2010
AIM To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean... more AIM To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean section (CS) performed by Stark method. MATERIAL AND METHODS 200 women were prospectively studied before undergoing to a Stark CS in two groups: 95 patients were assigned to a local anaesthesia by SA (first group) and 105 women to CSE anaesthesia (second group). After a pre-load of 500 ml of plasma expander in both groups, SA was performed at the L1-L2 interspace with an injection of 5 ml of levobupivacaine 0.15%, with a 5 mcg of Sufentanil. The CSE was performed by a spinal-epidural injection at the L1-L2 interspace, primarily by 4 ml of levobupivacaine 0.125% and 5 mcg of Sufentanil, then by 3-7 mL of xilocaine carbonate 0.5% plus 1 mcg/ml of Sufentanil. Successively a CS by Stark method was performed in both groups. The recorded anaesthesiologic side effects in two groups were: motor block, intraoperative discomfort, vomiting, bradycardia and hypotension. Statistical evaluation was b...
Believed to be due to unbalance between cerebrospinal fluid (CSF) production rate and its loss th... more Believed to be due to unbalance between cerebrospinal fluid (CSF) production rate and its loss through the spinal dural puncture hole, post-dural puncture headache (PDPH) is often considered as a physiological syndrome, usually reversible without pathological sequelae after dural hole's closure. The clinical case here presented (incapacitating headache associated with diagnostic dural puncture in a leukaemic young female patient who underwent bone marrow transplantation) shows potentially fatal pathological sequelae following prolonged headache (untreated, due to the severe postransplant immunodeficiency and coagulopathy). The observed RMI lesions suggest interesting conclusions about the clinical indications and correct timing of autologous epidural blood patch (EBP). We also suggest the ways to preventing rebound intracranial hypertension following autologous epidural blood patch in patients suffering from incapacitating and prolonged headache.
Methods: T1 was used in our practice between 2004 and 2005, according to Moore (1) with 20 ml rop... more Methods: T1 was used in our practice between 2004 and 2005, according to Moore (1) with 20 ml ropivacaine 0.75%. T2 has been used since 2006, and is performed with a 1.5 cm 25 G needle inserted along the posterior border of the sternocleidomastoid muscle, midway between the mastoid and clavicle. The needle is inserted perpendicular to the skin for all its length, avoiding muscular puncture without looking for paresthesia or bony contact. Ropivacaine 0.75%, 10 ml, is injected over 5 min under clinical-instrumental monitoring. This block is systematically combined with subcutaneous infiltration of incision line (ropivacaine 0.75%, 10 ml) and supplemented with intraoperative topicalization (lidocaine 2%,3 ml), if necessary. Data concerning Patients and Physicians satisfaction such as perioperative complications were collected and compared using t-tests and Chi-square test.
Ringrazio gli organizzatori e, in particolare, il dr Domenico Gioffrè e la dr.ssa Adriana Paolicc... more Ringrazio gli organizzatori e, in particolare, il dr Domenico Gioffrè e la dr.ssa Adriana Paolicchi, per il gradito e inatteso invito a questo VII Convegno Nazionale sul Dolore. Dato che non sono un " luminare della medicina " e dato che il tema che mi è stato affidato è piuttosto " scottante " , ho l'obbligo di una breve presentazione. Da quasi 11 anni ho avuto la fortuna di essere responsabile di un gruppo di anestesisti che si occupa di analgesia in travaglio in un'azienda che la pratica istituzionalmente, in forma gratuita da 25 anni e da ben 22 anni dispone di una guardia anestesiologica attiva h 24 a ciò dedicata. Da 5 anni ho avuto anche la fortuna di essere coinvolto, attualmente con il ruolo di responsabile, in un progetto di accreditamento come Ospedale amico del Bambino, accreditamento che abbiamo ottenuto dall'UNICEF Italia per 2 volte (2010 e 2103). Da questa duplice responsabilità nasce la " particolare coloritura " che caratte...
The anaesthesiologist facing a pregnant woman with rheumatic disease is caught between a rock (th... more The anaesthesiologist facing a pregnant woman with rheumatic disease is caught between a rock (the problems of general anaesthesia, i.e., the difficult airway and/or the cardiopulmonary dysfunctions that can worsen the response to general anaesthetics or to mechanical ventilation) and a hard place (the problems of loco-regional anaesthesia, i.e., intrinsic or iatrogenic haemostatic dysfunctions, potentially causing spinal haematoma, the most threatening complication). However, the term lupus anticoagulant is a misnomer and in the absence of an underlying coagulation deficit or anticoagulant therapy, the anaesthesiologist can usually guarantee epidural analgesia for vaginal delivery to parturients affected by rheumatic diseases (so contributing to the decrease of the caesarean section rate) and, in case of a caesarean section for medical or obstetrical indications, often he can perform a loco-regional anaesthesia, which determines a substantially lower maternal mortality rate. It is very important to adopt a multidisciplinary approach comprising an antepartum team evaluation (to be performed at 36th gestational week) of the basal condition of the parturient: together, the obstetrician, the rheumatologist and the anaesthesiologist should define the type of delivery. We will also try to define the haemostatic safety criteria to be fulfilled for administration of an epidural analgesia to a parturient affected by rheumatic disease.
Maternal mortality and thromboembolic risk in pregnancy Every year, around the world over half a ... more Maternal mortality and thromboembolic risk in pregnancy Every year, around the world over half a million women die for pregnancy related com-plications. In developing countries one woman in 16 dies compared to one in 2,800 in developed countries. Prevention programs based on the right knowledge can avoid many of these deaths, even in resource poor countries. In this review will be taken into account maternal deaths in developed countries (less than 1 % of the global maternal death rate). In order to reduce maternal mortality, onemust answer the following five ques-tions: 1. How many mothers die? 2. Which kind of mother die? 3. Why mothers die? 4. Was maternal death avoidable? 5. What can be done to prevent them?
ObjectiveTo investigate whether the nature of the decision about receiving neuraxial labour analg... more ObjectiveTo investigate whether the nature of the decision about receiving neuraxial labour analgesia is associated with breastfeeding initiation success (BIS), defined as exclusive breastfeeding until discharge associated with postnatal weight loss <7% at 60 hours from birth.DesignSingle-centre community-based cohort study.SettingAn Italian baby-friendly hospital, from 1 July 2011 to 22 September 2015.ParticipantsInclusion criteria: women vaginally delivering singleton cephalic newborns and willing to breastfeed. Exclusion criteria: women who delivered in uterus-dead fetuses, were single or requested but did not receive neuraxial analgesia. Overall, 775 out of the 3628 enrolled women received neuraxial analgesia.ResultsCompared with women who tried to cope with labour pain, those who decided a priori to receive neuraxial analgesia had less BIS (planned vaginal birth: 2121/3421 (62.0%), vs 102/207 (49.3%; p<0.001; risk difference (RD), 12.7%); actual vaginal birth: 1924/2994 (...
Every year, around the world over half a million women die for pregnancy related complications. I... more Every year, around the world over half a million women die for pregnancy related complications. In developing countries one woman in 16 dies compared to one in 2,800 in developed countries. Prevention programs based on the right knowledge can avoid many of these deaths, even in resource poor countries. In this review will be taken into account maternal deaths in developed countries (less than 1% of the global maternal death rate).
European Review for Medical and Pharmacological Sciences, 2010
To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean sec... more To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean section (CS) performed by Stark method. 200 women were prospectively studied before undergoing to a Stark CS in two groups: 95 patients were assigned to a local anaesthesia by SA (first group) and 105 women to CSE anaesthesia (second group). After a pre-load of 500 ml of plasma expander in both groups, SA was performed at the L1-L2 interspace with an injection of 5 ml of levobupivacaine 0.15%, with a 5 mcg of Sufentanil. The CSE was performed by a spinal-epidural injection at the L1-L2 interspace, primarily by 4 ml of levobupivacaine 0.125% and 5 mcg of Sufentanil, then by 3-7 mL of xilocaine carbonate 0.5% plus 1 mcg/ml of Sufentanil. Successively a CS by Stark method was performed in both groups. The recorded anaesthesiologic side effects in two groups were: motor block, intraoperative discomfort, vomiting, bradycardia and hypotension. Statistical evaluation was by Z-Test referred to the ...
European review for medical and pharmacological sciences, 2010
AIM To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean... more AIM To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean section (CS) performed by Stark method. MATERIAL AND METHODS 200 women were prospectively studied before undergoing to a Stark CS in two groups: 95 patients were assigned to a local anaesthesia by SA (first group) and 105 women to CSE anaesthesia (second group). After a pre-load of 500 ml of plasma expander in both groups, SA was performed at the L1-L2 interspace with an injection of 5 ml of levobupivacaine 0.15%, with a 5 mcg of Sufentanil. The CSE was performed by a spinal-epidural injection at the L1-L2 interspace, primarily by 4 ml of levobupivacaine 0.125% and 5 mcg of Sufentanil, then by 3-7 mL of xilocaine carbonate 0.5% plus 1 mcg/ml of Sufentanil. Successively a CS by Stark method was performed in both groups. The recorded anaesthesiologic side effects in two groups were: motor block, intraoperative discomfort, vomiting, bradycardia and hypotension. Statistical evaluation was b...
Believed to be due to unbalance between cerebrospinal fluid (CSF) production rate and its loss th... more Believed to be due to unbalance between cerebrospinal fluid (CSF) production rate and its loss through the spinal dural puncture hole, post-dural puncture headache (PDPH) is often considered as a physiological syndrome, usually reversible without pathological sequelae after dural hole's closure. The clinical case here presented (incapacitating headache associated with diagnostic dural puncture in a leukaemic young female patient who underwent bone marrow transplantation) shows potentially fatal pathological sequelae following prolonged headache (untreated, due to the severe postransplant immunodeficiency and coagulopathy). The observed RMI lesions suggest interesting conclusions about the clinical indications and correct timing of autologous epidural blood patch (EBP). We also suggest the ways to preventing rebound intracranial hypertension following autologous epidural blood patch in patients suffering from incapacitating and prolonged headache.
Methods: T1 was used in our practice between 2004 and 2005, according to Moore (1) with 20 ml rop... more Methods: T1 was used in our practice between 2004 and 2005, according to Moore (1) with 20 ml ropivacaine 0.75%. T2 has been used since 2006, and is performed with a 1.5 cm 25 G needle inserted along the posterior border of the sternocleidomastoid muscle, midway between the mastoid and clavicle. The needle is inserted perpendicular to the skin for all its length, avoiding muscular puncture without looking for paresthesia or bony contact. Ropivacaine 0.75%, 10 ml, is injected over 5 min under clinical-instrumental monitoring. This block is systematically combined with subcutaneous infiltration of incision line (ropivacaine 0.75%, 10 ml) and supplemented with intraoperative topicalization (lidocaine 2%,3 ml), if necessary. Data concerning Patients and Physicians satisfaction such as perioperative complications were collected and compared using t-tests and Chi-square test.
Ringrazio gli organizzatori e, in particolare, il dr Domenico Gioffrè e la dr.ssa Adriana Paolicc... more Ringrazio gli organizzatori e, in particolare, il dr Domenico Gioffrè e la dr.ssa Adriana Paolicchi, per il gradito e inatteso invito a questo VII Convegno Nazionale sul Dolore. Dato che non sono un " luminare della medicina " e dato che il tema che mi è stato affidato è piuttosto " scottante " , ho l'obbligo di una breve presentazione. Da quasi 11 anni ho avuto la fortuna di essere responsabile di un gruppo di anestesisti che si occupa di analgesia in travaglio in un'azienda che la pratica istituzionalmente, in forma gratuita da 25 anni e da ben 22 anni dispone di una guardia anestesiologica attiva h 24 a ciò dedicata. Da 5 anni ho avuto anche la fortuna di essere coinvolto, attualmente con il ruolo di responsabile, in un progetto di accreditamento come Ospedale amico del Bambino, accreditamento che abbiamo ottenuto dall'UNICEF Italia per 2 volte (2010 e 2103). Da questa duplice responsabilità nasce la " particolare coloritura " che caratte...
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