Search

Background: Hemovigilance (HV) is usually based on voluntary reports (passive HV). Our aim is to ascertain credible incidence, severity, and mortality of transfusion-associated adverse events (TAAEs) using an active HV program., Study Design and Methods: Prospective cohort study to estimate transfusion risk after 46,488 transfusions in 5830 patients, using an active HV program with follow-up within the first 24 h after transfusion. We compared these results to those with the previously established passive HV program during the same 30 months of the study. We explored factors associated with the occurrence of TAAEs using generalized estimating equations models., Results: With the active HV program TAAEs incidence was 57.3 (95% CI, 50.5-64.2) and mortality 1.1 (95% CI, 0.13-2.01) per 10,000 transfusions. Incidence with the new surveillance model was 14.0 times higher than with the passive. Most events occurred when transfusions had already finished (60.2%); especially pulmonary events (80.4%). Three out of five deaths and 50.3% of severe TAAEs were pulmonary. In the multivariate analysis surgical patients had half TAAEs risk when compared to medical patients (OR, 0.53; 95% CI, 0.34-0.78) and women had nearly twice the risk of a pulmonary event compared to men (OR, 1.84; 95% CI, 1.03-3.32). Patient's age, blood component type, or blood component shelf-life were unrelated to TAAEs risk., Discussion: Active hemovigilance programs provide additional data which may lead to better recognition and understanding of TAAEs and their frequency and severity., (© 2023 The Authors. Transfusion published by Wiley Periodicals LLC on behalf of AABB.)

Patient blood management (PBM) is the timely application of evidence-informed medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis, and minimise blood loss in an effort to improve patient outcomes. The aim of this consensus statement is to provide recommendations on the prevention and treatment of postpartum haemorrhage as part of PBM in obstetrics. A multidisciplinary panel of physicians with expertise in obstetrics, anaesthesia, haematology, and transfusion medicine was convened by the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) in collaboration with the International Federation of Gynaecology and Obstetrics (FIGO), the European Board and College of Obstetrics and Gynaecology (EBCOG), and the European Society of Anaesthesiology (ESA). Members of the task force assessed the quantity, quality and consistency of the published evidence, and formulated recommendations using the system developed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. The recommendations in this consensus statement are intended for use by clinical practitioners managing perinatal care of women in all settings, and by policy-makers in charge of decision making for the update of clinical practice in health care establishments.

We contacted and analyzed the data of 18 lung transplant recipients who had had children. The complications we detected included: hypertension (50%), diabetes mellitus (21%), preeclampsia (13%), infection (21%), rejection (30%), loss of graft function (23%) and a lower percentage of live births than in transplant recipients of other organs. Other aspects to keep in mind are: the potential risk for fetal alterations (caused by drugs used as prophylaxis against rejection crossing the placental barrier); greater risk for infection and alterations in drug levels due to changes in metabolism typical of pregnancy and postpartum period. We describe the two cases in Spain of female lung transplant recipients who have had children after transplantation. Although pregnancy in these cases can have a similar evolution as in non-transplanted women, doctors should recommend their transplanted patients to avoid becoming pregnant, while explaining the high risk of both fetal and maternal morbidity and mortality after transplantation., (Copyright © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved.)

Three percent of rare diseases are pneumopathies. Improvements in survival and quality of life have led to a new situation where patients with rare respiratory diseases want to plan their reproductive lives. The intention of this review is to present the experience accumulated in the field of the reproductive health of these women. In several rare respiratory diseases, a genetic base has been identified. The combination of preimplantation genetic diagnosis, assisted reproduction and molecular biology techniques enable embryos to be studied genetically before being transplanted into the uterus. Therefore, the risk for transmitting a certain disease or chromosome alteration may be avoided in high-risk couples, and prenatal diagnoses may be done by chorionic villus sampling or amniocentesis. As a general rule, contraceptive methods should be personalized by evaluating the general state of female patients as well as their possibilities for pregnancy, complications and the future possibility of lung transplantation. In lymphangioleiomyomatosis and primary pulmonary hypertension, pregnancy is considered a contraindication. In the former, there is a very high risk for pneumothorax and loss of lung function. In the latter, mortality reaches 33%. In cystic fibrosis, it is estimated that each year 4% of patients become pregnant and there is no observed loss in lung function. There are special circumstances in childbirth that should be considered as well as specific anesthesia risks. The present review suggests that the decision about contraceptive methods, pregnancy as a contraindication or conditions for managing a pregnancy should be both individualized and multidisciplinary., (Copyright © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved.)

Malaria infection during pregnancy is a serious health problem in most of the world's tropical regions. The disease has also been imported into Western countries, however, as an increasing number of infected women, who may become pregnant, emigrate from areas where malaria is endemic. Infection during pregnancy can have serious repercussions for both mother and fetus. Early diagnosis and multidisciplinary management are essential. We report the case of a woman from Guinea who debuted with severe, acute blood-stage malaria in the 32nd week of pregnancy and was admitted to the recovery care unit.

Coffin-Siris syndrome is a rare genetic disease characterized by coarse facial features, sparse scalp hair, hirsutism, hypoplasia of the distal phalanges, hypoplastic nail in the fifth digit, and mental retardation and delayed growth evident in both weight and height. Most cases are sporadic, but the possibility of recessive or dominant autosomal inheritance has been suggested. Facial abnormalities that make intubation difficult and mental retardation that interferes with cooperation are aspects of this disease that can affect the choice of type of anesthesia. We report the case of a parturient with Coffin-Siris syndrome who refused epidural analgesia for labor pain and for whom the obstetrician later decided that an emergency cesarean was necessary due to fetal distress.

Ritodrine, a beta2-adrenergic agonist with a selective effect on the uterine muscle, is prescribed to prevent premature labor and to treat a hypertonic uterus. At therapeutic doses ritodrine has chronotropic and peripheral vasodilator effects. At high doses it has been related to sporadic cases of subendocardial necrosis, pulmonary edema, and death in pregnancy. We report the case of a pregnant woman who had a non-Q wave acute myocardial infarction after administration of ritodrine.

Objectives: To assess whether using a needle-locking device in combined spinal-epidural analgesia leads to better quality of pain relief for advanced stages of obstetric labor than can be achieved with conventional materials., Patients and Methods: A total of 230 women in advanced labor were randomized to 2 groups. In both groups the needle-through-needle technique was used. In group N we used a new technique with a Tuohy needle and a system for locking the spinal needle (27-gauge, pencil-point design). The conventional technique (group C) made use of the same Tuohy needle and spinal needle without the needle-locking device. The variables considered were patient characteristics, anesthesiologist, number of attempts and level of difficulty in carrying out the procedure, pain on a simple verbal visual analog scale before the procedure and 5 minutes later, latency, motor block, duration of spinal analgesia, complications, type of expulsion, and maternal satisfaction., Results: The 2 groups were similar with respect to all studied variables except duration of spinal analgesia (longer in group N, P<0.001); VAS after 5 minutes (lower in group N, P<0.010); latency (shorter in group N, P<0.001); lateralization (less in group N, P=0.034), and maternal satisfaction (greater in group N, P=0.037)., Conclusions: The use of devices specifically designed for administering combined spinal-epidural analgesia in advanced stages of labor provides faster pain relief, longer duration of analgesia, and greater maternal satisfaction without increasing the incidence of complications.

We report the cases of 2 women with epilepsy who suffered generalized postpartum seizures on the first day after giving birth. The first had a history of febrile convulsions in childhood and had a seizure in the 36th week of gestation due to sleep deprivation. She had received epidural analgesia for labor pain. The second patient had had her most recent crisis at the beginning of the third trimester of pregnancy. Both patients had low serum levels of antiepileptic drugs. The pharmacokinetics of antiepileptic drugs can change during pregnancy, making seizures more difficult to control. Serum levels of these drugs should therefore be monitored more often, given that a generalized maternal seizure can have devastating consequences for the fetus. More careful planning and management of pregnancy is necessary for epileptic patients to ensure successful outcomes for both mother and fetus.

The amniotic fluid embolism, is a very uncommon syndrome but because of its severity and high mortality, it is interesting to study and to get a deep knowledge of its etiopathogenia and physiopathology. In this article, we revise the actually purposed pathogenic mechanisms, specially the humoral mechanisms in front of mechanical, as it was defended a few years ago. The diagnostic of this syndrome, is an interesting question, because it is not only pathology, actually it trends to immunologic diagnosis. The amniotic fluid embolism, interests to anesthesiologist and its differences in cardiopulmonary resuscitation in the pregnant woman too. All these data are discussed in our article, as much as treatment, that is based upon haemodinamics and cardiopulmonary resuscitation.

We present a patient suffering severe, mainly cervical, ankylopoietic spondylitis who was scheduled for posterior vertebral osteoclasis under local anesthesia. We describe handling of anesthesia, particularly airway control by flexible bronchoscopy in an awake, locally anesthetized patient sedated with benzodiazepines and inhalational anesthetics as compared with other alternatives: an awake patient who is not intubated, under local anesthesia and sedated with narcotics and gaseous anesthetics, or a patient under general anesthesia with placement of a flexible bronchoscope and neurological monitoring by evoked potentials. The surgical technique was Simmons' posterior vertebral osteoclasis, with the column extended and immobilized with wire.