to se utilizó mezcla oxígeno-óxido nitroso, fentanil en infusión continua según demanda del paciente, así como infusión de (VO), rectal, intramuscular e intravenosa (IV). Des- pués de la . postoperatoria con buprenorfina en aplicación pre-. PURPOSE To compare, by continuous infusion of ketamine or medetomidine Avaliação da buprenorfina pelas vias intravenosa ou intramuscular em cães. PDF | To compare, by continuous infusion of ketamine or medetomidine na dose de 1,0 mg/kg e buprenorfina na dose de 0,mg/kg ou 3 µg/kg intravenoso.

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Analgesic techniques for labour: Palacio-Abizanda 2 e I. Complejo Infusoin de Navarra. Hospital Puerta de Hierro. Analgesia controlada por el paciente. Epidural analgesia is now the method of choice for the treatment of pain in labour and delivery. However, this technique may fail and provide inadequate or null alleviation to the mother. This paper reviews the risk factors, possible causes and possible therapeutic alternatives to inadequate analgesia, whether pharmacological therapies neuroaxial, peripheral blocks or analgesic administration via intravenous or inhalational routes or non-pharmacological ones relaxation techniques, psychological or mechanical.

In all possible cases the efficacy and indications of alternative therapies based on the published literature are reviewed, especially from the point of view of evidence-based medicine.

The need is underscored of a multifactorial therapeutic approach to the pregnant woman, not just restricting ourselves to eliminating the pain of childbirth. Sin embargo, la analgesia resultante puede no ser satisfactoria Fig. La paciente presenta dolor solo en un lado. Conviene en estos casos explicar claramente a la paciente la alternativa elegida y el grado de analgesia que esperamos de ella. En este caso, hay que reforzar con volumen ej.

La incidencia de complicaciones es rara La morfina se usa raramente por sus efectos adversos maternofetales 54,55,59, El fentanilo es incapaz de aliviar por completo el dolor de las contracciones uterinas especialmente en la 2 a fase del parto incluso a dosis de 0,3 mg. Sin embargo, el fentanilo incrementa la tolerancia al dolor sin efectos adversos neuroconductuales en el neonato. Algunos fueron frecuentes en el pasado, como la escopolamina o el tiopental.

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Ambas terapias se pueden usar combinadas o secuencialmente para incrementar su efecto global. Se clasifican en 3 grupos: Permitir la movilidad y los cambios posturales se asocia a menos dolor de partoNo hay estudios definitivos sobre el tema. The McGill Pain Questionnaire: Alternatives to regional anesthesia for labor pain relief.

Reg Anesth Pain Med ; Epidural failure rate using a standardised definition. Int J Obstet Anesth ; Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: A comparison of multiport and uniport epidural catheters in laboring patients. Anesth Analg ; Prospective examination of epidural catheter insertion. Why obstetric epidurals fail: Int J Obstet Anesth; 5: A comparison between open-end single hole and closed-end three lateral holes epidural catheters.

Complications and quality of sensory blockade. The occurrence of unblocked segments during continous lumbar epidural analgesia for pain relief in labour. Br J Anaesth ; Extensive application of epidural anesthesia and analgesia in a university hospital: Reg Anesth ; Extradural anaesthesia in patients with previous lumbar spine surgery.

Faulty loss of resistance syringe. Another cause for failed epidural. A randomised controlled study. Bupernorfina sufentanil and fetal heart rate abnormalities: Single-shot intrathecal sufentanil with bupivacaine in late labour-analgesic quality and obstetric outcome.

All obese patients in labor should receive an epidural catheter? The con point of view. Anesthetic and obstetric outcome in morbidly obese parturients. Faheem M, Sarwar N.

Sliding of the skin over subcutaneous tissue is another important factor in epidural catheter migration. Can J Anaesth ; Changes in the position of epidural catheters associated with patient movement. Iwama H, Katayama T.

J Clin Anesth ; Late intravascular migration of a previously well functioning labour epidural catheter. Untravenosa J Anaesthesiol ; Failure of extradural blockade in obstetrics.

Repeat epidural analgesia and unilateral block. The dorsomedian connective tissue band in the lumbar epidural space of humans: Anatomy of the human lumbar epidural space: Rainbird A, Pfitzner J.

Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural

Restricted spread of analgesia following epidural blood patch. Case report with a review of possible complications.

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Impaired epidural analgesia after dural inttravenosa with and without subsequent blood patch.

Epidural analgesia with ropivacaine and sufentanil is associated with transient fetal heart rate changes. Minerva Anestesiol ; Van de Velde M.

Neuraxial analgesia and fetal bradycardia. Curr Opin Anaesthesiol ; Fetal bradycardia due to intrathecal opioids for labour analgesia: A randomized trial of dural puncture epidural technique compared with the standard epidural technique for labor analgesia.

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Dural puncture with a gauge Whitacre needle as part of a combined spinal-epidural technique does not improve labor epidural catheter function. Rev Esp Anestesiol Reanim ; Una alternativa eficaz a la anestesia epidural. Deaths from paracervical anesthesia used for first-trimester abortion, N Engl J Med ; Paracervical block for labor analgesia: Am J Obstet Gynecol ; A comparison of paracervical block with single-shot spinal for labour analgesia in multiparous women: J Obstet Anesth ; Biophysical composition of cervical mucus and spermigration during treatment with Conluten and Conlunett.

Acta Obstet Gynecol Scand ; A comparative study of the safety of 0. Paracervical block anesthesia in obstetrics. Fetal complications and neonatal morbidity. Pudendal block in intracenosa deliveries. Mepivacaine with and without epinephrine. The neonatal neurobehavioral effects of bupivacaine, mepivacaine, and 2-chloroprocaine used for pudendal block. Nitrous oxide for the management of labor pain: Nitrous oxide for relief of labor pain: Centre for Reviews and Dissemination.

Effects of obstetric analgesics and anesthetics on the neonate: Paediatric drugs ; 5: The effect of drugs on fetal heart rate variability. Bricker L, Lavender T. Parenteral innfusion for labor pain relief: Lack of analgesic effect of systemically administered morphine or pethidine on labour pain. Br J Obstet Gynaecol ;