Browsing by Author "Saraiva, Alexandra"
Now showing 1 - 2 of 2
Results Per Page
Sort Options
- Laryngeal mask airway in prone position in ambulatory surgery: a prospective observational studyPublication . Araújo, Marta; Saraiva, Alexandra; Nunes, Catarina S.; Couto, Paula Sá; Fonseca, Luís; Machado, Humberto S.Introduction: The laryngeal mask airway (LMA) is a common airway device used for anesthesia in ambulatory surgery, with a recently new described utilization in prone position. The aim of this study was to evaluate the safety and the effectiveness of the LMA, in prone position for anesthesia in ambulatory surgery, based on our new anesthesia department protocol. Methods: Patients from February 2013 to July 2014 were included in this prospective study. After the patient selfpositioning in prone position, general anesthesia was induced and the LMA was placed. Second generation LMA types were used (Supreme™, iGel™ and Proseal™) and all patients were mechanically ventilated. At the end of surgery, LMA was removed in prone or supine position. Number of attempts of LMA insertion, volume leak, airway peak pressure and complications were registered until 2 hours after the procedure. Results: The LMA placement was 85.1% effective in the first attempt and 100% in the second attempt. The need for a second attempt LMA placement was due to non-progression of the aspiration probe, a high leak and impossible ventilation. Mechanical ventilation was considered effective and safe with maximum peak airway pressure of 17.9 ± 5.5 cm H2O and maximum leak of 47.7 ± 31.2 ml. Complications were present in 6 patients (9%) with hypoventilation, bronchospasm and laryngospasm. Other “minor” events registered included the presence of blood in the LMA at the end of procedure and gum lesion with the rigid piece of the Supreme™ LMA. Discussion and conclusion: Complications found in our study are similar to those described in literature in supine position and are related to the anesthetist previous experience. Anesthetic depth adjustment improved all complications found. Effectiveness and overall safety of LMA use in prone position was observed, allowing further utilizations in selected patients according to the anesthesia department protocol.
- Predictive factors for cesarean delivery : a retrospective studyPublication . Duarte, Sónia; Saraiva, Alexandra; Lagarto, Filipa; Susano, Maria João; Oliveira, Ricardo; Nunes, Catarina S.; Pina, Pedro; Lemos, Paulo; Machado, Humberto S.Background: Cesarean section rates have risen markedly worldwide. Considering the potential harm caused by this mode of delivery, and the general concern in reducing its incidence, it would be useful to individualize the risk of non-planned cesareans, and if there is any possibility, reduce that risk, and anesthesiologists should take part of this risk evaluation. In recent studies, many factors have been related with a higher risk of cesarean, and controversy still surrounds labor analgesia impact on cesarean risk. The aim of this study was to search for predictive factors for nonplanned cesarean delivery. Methods: Retrospective analysis of all labors occurred in our Obstetric Department during 2014. Maternal related factors, previous obstetric history, birth weight and factors related to labor analgesia and labor progression were studied. Our primary outcome was cesarean delivery. Results: We identified two independent predictive factors for cesarean delivery: birth weight (p=0,007 OR= 1,001 CI 95% [1,0003; 1,002]) and labor length since beginning of analgesia (p<0,0001 OR= 1,00005 CI 95%[1,00003; 1,00007]). Searching correlation between registered variables, maternal body mass index was positively associated with newborn birth weight (p<0.0001, R=0.157). Conclusion: Our study showed that birth weight and labor length since beginning of epidural analgesia are independent predictor factors of non-planned cesarean delivery. Furthermore, birth weight was associated with maternal body mass index, providing health professionals a modifiable factor in which we can intervene to improve outcome. As labor progression to cesarean is of major obstetric and anesthetic concern, multidisciplinary initiatives are warranted to clearly identify important variables concurring to operative delivery.