English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

espanolIntroduccion: Los intentos repetidos de puncion son factores de riesgo para la aparicion de complicaciones neurologicas secundarias a la practica de la analgesia espinal y aumentan la ansiedad del paciente. El objetivo de este estudio es determinar que factores son mejores predictores de la colocacion dificultosa del cateter epidural en la paciente obstetrica. Material y metodo: Estudio observacional y prospectivo en 120 gestantes a termino que solicitan la analgesia epidural para el trabajo de parto. Se recogen variables demograficas y antecedentes de anestesia espinal previa no exitosa o considerada dificultosa por la paciente. Se identifican variables anatomicas y se clasifica la calidad de los puntos de referencia anatomicos segun los criterios publicados por Chien en cuatro grados. Las condiciones de la tecnica y la experiencia del anestesiologo son similares en todos casos. Consideramos puncion dificultosa si se necesita mas de una puncion en la piel o una puncion pero mas de un cambio de direccion de aguja en el espacio interespinoso. Se recoge el exito obtenido y las complicaciones de la tecnica. Resultados: Fueron calificadas de puncion dificil segun los criterios del estudio en el 36,67 % de los casos. En la mayoria de los casos la tecnica fue efectiva obteniendo una adecuada analgesia. La incidencia de repuncion epidural fue de 5 %. En las pacientes clasificadas en el grado 4, la tasa de puncion epidural considerada dificultosa supuso un 90 %, necesitando en el 80 % de esos casos 3 o mas intentos. En las pacientes con antecedentes personales de tecnica neuroaxial dificultosa se encontro dificultad de puncion epidural en un 28,57 % de los casos. El habito corporal no tuvo efecto significativo sobre la tasa de exito con el primer intento. Discusion: Nuestro estudio representa una buena estimacion de la dificultad tecnica de un bloqueo neuroaxial. Seria dificil saber si los datos reflejados serian extrapolables a la realizacion de la tecnica en decubito lateral, donde los puntos de referencia anatomicos son mas dificiles de identificar. Conclusiones: Nuestra recogida concluye que el metodo mas fiable para determinar de antemano la posibilidad de una dificultad tecnica de colocacion del cateter epidural lumbar es un examen de la espalda de la paciente para identificar la calidad de los puntos de referencia anatomicos e identificar la deformidad obvia de la columna vertebral. EnglishIntroduction: Repeated attempts punctureare risk factors for the appearance of neurologic complications caused by the practice of spinal analgesia and increase patient anxiety. The purpose of this study is to determine which factor sare better predictors of difficult epidural catheter placement in the obstetric patient. Material and methods: Prospective observational study in 120 pregnant women at term who request edepidural analgesia during labor. Demographic variables and history of difficult or unsuccessful spinal anesthesia were collected. Anatomical variables were identified and the quality of anatomical landmarks was classified according to criteria published by Chien in four grades. The conditions of the technique and the experience of anesthesiologists were similar in all cases. It was considered as difficult puncture that in which was made more than one attempt on skin or more than one change of direction with the epidural needle in interspinous space. We collected the successand complications of the technique. Results: 36.67 % of cases were classified as difficult punctures according to the criteria of the study. In most cases the technique was effective obtaining asuccessful analgesia. The incidence of repeat epidural puncture was 5 %. In patients classified in grade 4, the percentage of difficult epidural puncture was 90 %, requiring in 80 % of the cases 3 or more attempts. In patients with a history of difficult neuraxial technique in 28.57 % of the cases was found difficulty in epidural puncture. Body habitus had no significant effect on the rate success in first attempt. Discussion: Our study represents a good estimationof a difficult neuraxial blockade. It would bedifficult to know if there flected datawould be applicable to the lateral decubitus technique where anatomical landmarksare more difficult to identify. Conclusions: Our study concludes thatt he most reliable method to predict the possibility of a technical difficulty in the placement of lumbar epidural catheter, is the examination of the back of the patient to identify the quality of anatomical landmarks and identify obvious deformities of the spine.

Identificación de factores predictores de técnica epidural dificultosa en la paciente obstétrica