Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Feb 2013
Review[Do anesthetic techniques influence postoperative outcomes? Part II].
The knowledge of the influence of anesthetic techniques in postoperative outcomes has opened a large field of research in recent years. In this second part, we review some of the major controversies arising from the literature on the impact of anesthetic techniques on postoperative outcomes in 6 areas: postoperative cognitive dysfunction, chronic postoperative pain, cancer recurrence, postoperative nausea/vomiting, surgical outcomes, and resources utilization. The development of protective and preventive anesthetic strategies against short and long-term postoperative complications will probably occupy an important role in our daily anesthetic practice. ⋯ The classic pattern of perioperative fluid therapy may increase postoperative complications. On the other hand, the maintenance of normoglycemia and normothermia was associated with a decreased postoperative morbidity. The high volume of surgical procedures means that the adequacy of human, organizational and technological resources have a major impact on overall costs.
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Rev Esp Anestesiol Reanim · Jan 2013
Randomized Controlled Trial Multicenter Study Comparative Study[Clinical and pharmacological study of the efficacy of carbetocin in elective caesareans compared to low and usual doses of oxytocin].
To evaluate uterine contractility, bleeding, haemodynamic performance, and side effects of different doses of oxytocin after delivery under spinal anaesthesia in caesarean section without prior labour in childbirth. We also perform a pharmacoeconomic evaluation. ⋯ With these results, we cannot recommend the routine use of carbetocin in caesarean sections, because it is accompanied by an increased incidence of side effects without any improvement in the prevention of obstetric haemorrhage. Finally, it is economically more expensive than the use of low doses of oxytocin, which may be the trend that should be considered in the future, due to the clinical outcomes, and its lower cost.
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Rev Esp Anestesiol Reanim · Jan 2013
[Impact on the implementation of patient controlled epidural analgesia for pain management during labor. A survey in a university hospital in Chile].
Analgesia for labor is a legal obligation in Chile. In our institution we implemented patient controlled analgesia for pain relief during labor. We describe the perception of the several professionals involved in the medical care of patients in labor in terms of effectiveness, usefulness, satisfaction, and safety. ⋯ Considering the study design limitations, absence of knowledge of economical impact, and the satisfaction level of patients under standard epidural analgesia, we recommend the patient controlled analgesia technique due to its good obstetric outcomes, general satisfaction and workload decrease.