scholarly journals Impact of anesttesia method on foetus condition

Author(s):  
A. M. Morozov ◽  
A. N. Pichugova ◽  
E. M. Askerov ◽  
S. V. Zhukov ◽  
Yu. E. Minakova ◽  
...  

Topicality. Currently, intrapartum fetal health care is aimed at an adequate choice of anesthetic aid used during delivery to minimize the negative impact. Despite the wide range of currently existing anesthetics, the choice of anesthetic drug is limited by its negative effect not only on the fetus, but also on the contractile activity of the uterus, which significantly reduces the number of anesthetics used in obstetric practice.The purpose of this study is to analyze domestic and foreign literature in order to study the effect of anesthesia on the condition of the fetus. Material and methods. In the course of this study, an analysis of modern Russian and foreign literary sources, as well as the latest scientific works in the field of methods of general and regional anesthesia in the field of obstetrics and gynecology, was carried out.Results. Almost all drugs used for general anesthesia in obstetric practice can have a negative effect on the fetus. Neuroaxial pain relief methods are leading in obstetric practice, but their use is associated with complications that can lead to an adverse outcome not only from the mother, but also from the fetus. One such complication is the risk of arterial hypotension. It is interesting that comparative studies of general and regional anesthesia methods during operative delivery differ in the results obtained. Regarding the issue of anesthesia of natural births, the information of the Congress of the American Society of Anesthesiologists (lecture C.A. Wong (Chicago) “Neuroaxial Labor Analgesia and Prognancy Outcome: Factand Fiction”) remains relevant, according to which neuroaxial anesthesia methods do not affect the condition of the fetus, provided that the mother has stable hemodynamics.Conclusion. Due to the appearance and release of neuroaxial pain relief methods, completely unreasonably little attention is paid to the issues of general anesthesia of pregnant women, while according to the results of a study of scientific literary sources, it was revealed that this method of pain relief in obstetric practice is accompanied by the most direct and mediated effects on the fetus. Neuroaxial pain relief methods have practically no effect on the condition of the fetus, provided that the mother has stable hemodynamics.

2006 ◽  
Vol 104 (2) ◽  
pp. 228-234 ◽  
Author(s):  
Sanjay M. Bhananker ◽  
Karen L. Posner ◽  
Frederick W. Cheney ◽  
Robert A. Caplan ◽  
Lorri A. Lee ◽  
...  

Background To assess the patterns of injury and liability associated with monitored anesthesia care (MAC) compared with general and regional anesthesia, the authors reviewed closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1990. Methods All surgical anesthesia claims associated with MAC (n = 121) were compared with those associated with general (n = 1,519) and regional (n = 312) anesthesia. A detailed analysis of MAC claims was performed to identify causative mechanisms and liability patterns. Results MAC claims involved older and sicker patients compared with general anesthesia claims (P < 0.025), often undergoing elective eye surgery (21%) or facial plastic surgery (26%). More than 40% of claims associated with MAC involved death or permanent brain damage, similar to general anesthesia claims. In contrast, the proportion of regional anesthesia claims with death or permanent brain damage was less (P < 0.01). Respiratory depression, after absolute or relative overdose of sedative or opioid drugs, was the most common (21%, n = 25) specific damaging mechanism in MAC claims. Nearly half of these claims were judged as preventable by better monitoring, including capnography, improved vigilance, or audible alarms. On-the-patient operating room fires, from the use of electrocautery, in the presence of supplemental oxygen during facial surgery, resulted in burn injuries in 20 MAC claims (17%). Conclusion Oversedation leading to respiratory depression was an important mechanism of patient injuries during MAC. Appropriate use of monitoring, vigilance, and early resuscitation could have prevented many of these injuries. Awareness and avoidance of the fire triad (oxidizer, fuel, and ignition source) is essential to prevent on-the-patient fires.


2003 ◽  
Vol 31 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Sandra H. Johnson

Scholarship has intrinsic value, of course; but when good scholarship can stimulate change for the better in an area as fundamental to human dignity as health care and the relief of suffering, there is a special satisfaction. This has been our experience since 1996, when the first of now four special issues of this journal focused on legal, regulatory, ethical, professional, and financial issues in medical treatment for pain.With the generous and steadfast support of the Mayday Fund, the American Society of Law, Medicine & Ethics (ASLME) has generated a significant body of scholarship published in the Journal of Law, Medicine & Ethics (JLME). This research has proven absolutely essential in changing public policy to support better care for those who suffer pain.Over these years, the Mayday Project at ASLME has tackled many of the real and perceived barriers to effective pain relief. In pain management, both real and perceived obstacles can have a powerful negative effect.


2019 ◽  
Vol 11 (2) ◽  
pp. 5
Author(s):  
Marcos Salmerón Martín ◽  
Pedro Torres Mosquera

Dada la preocupación creciente respecto al efecto de los anestésicos empleados en anestesia general en el neurodesarrollo de la población pediátrica; toma mayor importancia la Anestesia Locorregional en dicha población. Pero, ¿Qué sabemos sobre la dosificación en esta población de los anestésicos locales?. Debido a dicha incertidumbre y a lo poco publicado al respecto la ESRA (European Society of Regional Anesthesia) y la ASRA (American Society of Regional Anesthesia) han decido reunirse para establecer una serie de recomendaciones sobre la dosificación de anestésicos locales y adyuvantes en anestesia locorregional en la población pediátrica. Dicho documento lo hemos resumido, de forma esquemática y con ayuda de tablas, con el fin de facilitar su comprensión y tenerlo a la disposición de todo aquel interesado en este campo. ABSTRACT  ESRA/ASRA recommendations in local anesthetics and adjuvants in the pediatric population Growing concern regarding the effect of anesthetics used in general anesthesia in the neurodevelopment of the pediatric population; Loco-regional Anesthesia in this population takes greater importance. But, what do you know about the dosage of local anesthetics in this population? Due to this uncertainty and the little published about it, the ESRA (European Society of Regional Anesthesia) and the ASRA (American Society of Regional Anesthesia) have decided to meet to establish recommendations about the dosage of local anesthetics and adjuvants in loco-regional anesthesia in the pediatric population. This document has been summarized, in a schematic way with tables, to facilitate understanding. In this way, its content is available to all those interested.


2016 ◽  
Vol 10 (4-5) ◽  
pp. 77-83
Author(s):  
Zoltán Kovács

A wide range of empirical experiences shows that the performance of Hungarian producer organizations (aka TÉSZ) significantly falls behind the activity observed in the developed Western European countries. Regarding this issue, the present study examines how moral hazard - as one of the possible reasons - influences the producers’ activities in cooperative organizations. Information for the research was collected with the help of a questionnaire survey among the members of PaprikaKert TÉSZ Ltd. A statistical path model has been developed for the research, which assumed that - in addition to a direct effect - moral hazard also affects collaborative activity by eroding trust. The statistical model has been tested both in member-member and members-management relations. The experiences from the survey clearly show that moral hazard exists in the producer organization. According to my results, though its measure cannot be regarded numerically considerable, its negative effect on cooperative activity can be proved with statistical examinations. Its effect can be divided into two aspects: besides a direct effect, an indirect one can also be detected, which means that moral hazard is able to reduce producers’ willingness to cooperate by eroding trust. Moreover, our results have clearly pointed out that moral hazard has a negative impact on member-member and members-management relations to varying degrees and through different mechanisms. In addition to the above tests, the empirical testing of another model called Sholtes trust model has been carried out, too. The validating was successful, so the model - which attributes trust to the faith in the partner’s loyalty and capability - is basically acceptable. The argument says that high-level trust can be observed among partners only when faith both in loyalty and capability is strong enough. The research, however, revealed that the above-mentioned two factors determine it in a different way: regarding trust between members, the faith in capability is more important; while trust towards the management is more determined by faith in loyalty. JEL code: Q12, Q13


Author(s):  
John J. Friel

Committee E-04 on Metallography of the American Society for Testing and Materials (ASTM) conducted an interlaboratory round robin test program on quantitative energy dispersive spectroscopy (EDS). The test program was designed to produce data on which to base a precision and bias statement for quantitative analysis by EDS. Nine laboratories were sent specimens of two well characterized materials, a type 308 stainless steel, and a complex mechanical alloy from Inco Alloys International, Inconel® MA 6000. The stainless steel was chosen as an example of a straightforward analysis with no special problems. The mechanical alloy was selected because elements were present in a wide range of concentrations; K, L, and M lines were involved; and Ta was severely overlapped with W. The test aimed to establish limits of precision that could be routinely achieved by capable laboratories operating under real world conditions. The participants were first allowed to use their own best procedures, but later were instructed to repeat the analysis using specified conditions: 20 kV accelerating voltage, 200s live time, ∼25% dead time and ∼40° takeoff angle. They were also asked to run a standardless analysis.


1990 ◽  
Vol 64 (04) ◽  
pp. 497-500 ◽  
Author(s):  
Martin H Prins ◽  
Jack Hirsh

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.


2020 ◽  
Vol 25 (4) ◽  
pp. 287-294
Author(s):  
S. I. Kutukova ◽  
N. P. Beliak ◽  
G. A. Raskin ◽  
M. S. Mukhina ◽  
Yu. V. Ivaskova ◽  
...  

Relevance. Prognostic value of PD-L1 expression in oral cavity squamous cell carcinoma (OCSCC) and its effect on survival is still controversial. It should be to determine the prognostic role of PD-L1 expression on tumor and immune cells of OCSCC and assess their effect on overall survival (OS) and progression-free survival (PFS).Materials and methods. A prospective study included 145 patients, first diagnosed with OCSCC. PD-L1 expression on tumor and immune cells, infiltrating tumor and its microenvironment, was assessed in all tumor samples by IHC, CPS was calculated. Cut-off values were determined by ROC analysis for identification of PD-L1 expression effect on OS and PFS.Results. Most patients with oral mucosa squamous cell carcinoma showed positive expression of PD-L1 on tumor (77.2%) and immune cells (92.4%). The median PD-L1 expression on tumor cells was 13.5% [1.0-40.0], the median PD-L1 expression on immune cells was 5.0% [1.0-11.0], and the median CPS – 18.0 [3.0-7.8]. Univariate and multivariate analyses revealed a significant negative effect of PD-L1 expression on immune cells ≤ 7% on OS (HR 0.66; 95% CI 0.45-0.93; p = 0.0498); PD-L1 expression in tumor cells ≤ 15% (HR 0.65; 95% CI 0.43-0.98; p = 0.0416) and CPS ≤ 21 (HR 0.62; 95% CI 0.44-0.92; p = 0.0183) for PFS. PD-L1 expression in tumor cells ≤ 6% (HR 0.71; 95% CI 0.47-1.08; p = 0.1096) and CPS ≤ 7 (RR 0.67; 95% CI 0.44-1.01; p = 0.0575) had a confident tendency to negative impact on OS.Conclusion. Positive PD-L1 expression in tumor and immune cells as well as CPS are effective additional factors in the prognosis of the disease course, OS and PFS in patients with OCSCC.


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