Significance, aetiology and prevention of venous thromboembolism in pregnancy and puerperium

Kutlešić, Marija; Kutlešić, Ranko; Koraćević, Goran

doi:10.2298/vsp1406580k

Cited by 5 publications

(3 citation statements)

References 75 publications

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“…The resulting increase in myocardial consumption puts the body at risk of myocardial infarction, arrhythmias, heart failure, and acute lung edema. In the elderly, the hemodynamic impact of tracheal intubation is more pronounced than in the general population; in fact, the main characteristic of the cardiovascular system in the elderly is its difficulty in adapting to stressful situations [ 17 , 18 ]. This is due to a higher prevalence of cardiovascular comorbidities and the atypical aspect of these.…”

Section: Discussionmentioning

confidence: 99%

McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized clinical trial

Ketata¹,

fourati²,

Derbel³

et al. 2023

Pan Afr Med J

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Introduction laryngoscopy and tracheal intubation induce catecholaminergic release. Our study aimed to evaluate the hemodynamic impact of orotracheal intubation by McGrath® compared to the Macintosh laryngoscope in the elderly. Methods we conducted a prospective randomized clinical trial that included elderly patients proposed for a scheduled surgery under general anesthesia with orotracheal intubation and divided into 2 groups: patients who were intubated using the McGrath® (group V) and patients who were intubated using the Macintosh direct laryngoscope (group M). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP), were recorded before induction of anesthesia (baseline), and at 1 min, 3 min, and 5 min after intubation. Our outcomes were the increase of SBP (∆ SBP), MAP (∆ MAP), and HR (∆ HR) between the two groups, during the 5 minutes following the start of the orotracheal intubation, intubation time and the incidence of its related complications. Results sixty patients were included and randomized into 2 groups of 30. The average age of our sample was 70±6 years with a sex ratio of 1.22. Most of the patients were operated on for orthopedic, urologic, or abdominal surgery. There were no statistically significant differences between the two groups in terms of demographic characteristics and the duration of anesthesia (p> 0.05). The intubation time was significantly increased in group M (p≤0.001). There was a significant difference in SBP, MAP, and HR values at 1 min after orotracheal intubation compared with the baseline values in Group V(P<0,05) and Group M (p < 0.05). There was a significant increase in the first minute after tracheal intubation in terms of SBP (151±42 vs 134.5±26 mmHg, p=0.012), MAP (114±4 vs 102±17 mmHg, p=0.015), DBP (89±32 vs 84±16 mmHg, p=0.01), and HR (99.5±10 vs 94.5±2 b/min, p=0.008) when group M was compared to group V. The ∆SBP was significantly different between group M (∆SBP = 36.2±23.5mmHg) and group V (∆SBP= 30.77±21.6mmHg) (p = 0.005). There were 4 ventricular arrhythmias in group M versus zero in group V (p <0.0001). The postoperative sore throat was significantly decreased in group M vs V (p=0.036). Conclusion the McGrath® videolaryngoscope decreased the hemodynamic fluctuations due to endotracheal intubation in elderly patients.

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Section: Discussionmentioning

confidence: 99%

McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized clinical trial

Ketata¹,

fourati²,

Derbel³

et al. 2023

Pan Afr Med J

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“…Системна вазоконстрикція, викликана підвищенням концентрації катехоламінів, призводить до зниження маткового кровотоку (на 20-35 %) та негативного впливу на плід [60]. Нестабільна гемодинаміка разом із гіперкоагуляційними та гормональними змінами організму під час вагітності роблять кесарів розтин незалежним фактором ризику виникнення інсульту [25,27,32,36]. Отримані результати, наведені в табл.…”

Section: результати та обговоренняunclassified

Analysis of clinical series with the use of adjuvants to general anesthesia during elective caesarean section

2023

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Background. Caesarean section remains one of the most common surgical interventions in the world. The main disadvantages of the general anesthesia in caesarean section are a high risk of awareness during the operation and a pronounced hemodynamic reaction to the surgical trauma in a patient. The most dangerous period of intervention in terms of these complications is the period before the birth of a child. This article analyzes our own clinical cases of the general anesthesia during elective caesarean section with the addition of adjuvants and compares anesthetic management with world practices. In all cases from our own clinical practice, total intravenous anesthesia with artificial lung ventilation was performed. Intravenous forms of medical drugs were used as adjuvants: paracetamol (1000 mg) and clonidine (100 μg), 30 minutes before the elective surgical intervention. The newborns were examined with the Apgar scale and umbilical venous blood gas analysis was carried out. Preoperative, intraoperative, and postoperative management of patients was based on recommendations of the Enhanced Recovery After Caesarean Section and guidelines of the PROSPECT working group. Results. The analysis of our own clinical cases revealed the presence of a hemodynamic reaction of the patient’s body to the operative injury (in the period before the birth of a child), which does not exceed safe levels; absence of anesthetic complications and cases of accidental awareness during surgery; absence of a negative influence of adjuvants on newborns; sufficient depth of anesthesia and reduction of the intraoperative doses of opioids and intravenous anesthetics (“on patient’s request”). Conclusions. The analysis of clinical cases argues for the need to use “safe adjuvants” (acetaminophen, clonidine) to general anesthesia during elective caesarean section and the necessity for further research.

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“…Effective anticoagulation can be achieved by subcutaneous application of LMWH once daily, with no need for routine laboratory monitoring of anti-factor Xa activity in plasma. Nevertheless, in certain situations LMWH dose adjustment is necessary and that demands anti-Xa level assessment [8].…”

mentioning

confidence: 99%

Thrombophilia, Pulmonary Embolism (PE) and Deep Venous Thrombosis (DVT) in pregnant women: a brief communication

Fernandes¹,

A²,

Sales³

et al. 2015

Int Arch Med

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Venous thromboembolism (VTE), deep vein thrombosis and pulmonary embolism, are among the main causes of morbidity and mortality in pregnancy with an estimated incidence of 1 per thousand women years. Despite identification of maternal and pregnancy-specific risk factors for development of pregnancy-associated venous thromboembolism, limited data are available to inform on optimal approaches for prevention. The relatively low overall prevalence of pregnancyassociated venous thromboembolism has prompted debate about the validity of recommendations, which are mainly based on expert opinion, and have resulted in an increased use of pharmacological thromboprophylaxis in pregnancy and postpartum.

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Significance, aetiology and prevention of venous thromboembolism in pregnancy and puerperium

Abstract: nema

Cited by 5 publications

References 75 publications

McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized clinical trial

McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized clinical trial

Analysis of clinical series with the use of adjuvants to general anesthesia during elective caesarean section

Thrombophilia, Pulmonary Embolism (PE) and Deep Venous Thrombosis (DVT) in pregnant women: a brief communication

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